J Urol:前列腺癌中系统活检与MRI靶向活检的检出率比较

2021-09-19 AlexYang MedSci原创

比较了系统、MRI靶向和联合活检的PCa检出率,并对重要的亚组队列进行了评估。

传统上,前列腺癌(PCa)的诊断通过经直肠超声检查(TRUS)引导,并进行系统穿刺活检,且该方法的等级错误分类比例已知。在过去的几年里,一些研究表明,多参数磁共振成像(mpMRI)可用于识别和分级前列腺中的可疑PCa病变。在PRECISION和PRECISE随机试验中,通过mpMRI-TRUS融合引导下的靶向活检结果与系统TRUS活检结果相比,临床显著性PCa(csPCa)的检出率更高,csPCa为存在2级(GG)及以上的疾病。

近期,来自美国的研究人员在《J Urol》上发表文章,在研究中,他们比较了系统、MRI靶向和联合活检的PCa检出率,并对重要的亚组队列进行了评估

研究纳入了来自两个机构的临床疑似PCa的男性,其可见的PI-RADSv2病变通过mpMRI-US融合引导的前列腺活检检测(2015-2020年);检测出的PCa按等级组(GG)分类。患者按活检方法和PI-RADS进行分层。

在纳入的1236名患者中(647名既往没有进行过活检),626名(50.6%)患有PCa,412名(33.3%)在联合活检中诊断为csPCa。靶向活检与系统活检的csPCa检出率分别为27.9%和23.3%(+4.6%),GG1 PCa检出率分别为11.3%和17.8%(-6.5%)。在既往检测阴性的患者中,靶向活检与系统活检相比,csPCa的检出率增加7.8%(p<0.0001),而在既往未接受活检的患者中增加1.7%(p=0.3);GG1 PCa检出率在上述两类患者中类似(-5.6%(p=0.0002)vs. -7.3%(p=0.0001)),均为减少。相对于系统活检,靶向活检中PI-RADS 5的csPCa检出率上升,PI-RADS 3的GG1检出率下降,PI-RADS 4的csPCa检出率上升,GG1检出率下降。与系统活检相比,联合活检能够检测到更多的csPCa(+10.0%),而GG1 PCa(-0.5%)检出略少。在系统活检中,9.8%的无癌患者和23.6%的GG1患者通过靶向活检升级为≥GG2。

整个队列中不同活检方法的前列腺癌等级组检出率

综上所述,相对于靶向活检,联合活检在csPCa方面的检出率增加了一倍,而GG1 PCa的检出率相对于系统活检无变化。在既往活检阴性的队列中,靶向活检的效用更高,但无论活检历史如何,联合活检都存在优势

原始出处:

Hiten D Patel , Elizabeth L Koehne , Steven M Shea et al. Systematic versus Targeted MRI/Ultrasound Fusion Prostate Biopsy Among Men with MRI-Visible Lesions. J Urol. Aug 2021

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    2021-09-21 smlt2008
  3. [GetPortalCommentsPageByObjectIdResponse(id=1904828, encodeId=48bb1904828a8, content=<a href='/topic/show?id=ae97625036d' target=_blank style='color:#2F92EE;'>#检出率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62503, encryptionId=ae97625036d, topicName=检出率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ce68183, createdName=xiongke010, createdTime=Tue Oct 19 10:04:10 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1278249, encodeId=94d312e82492d, content=<a href='/topic/show?id=d34e6523544' target=_blank style='color:#2F92EE;'>#活检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65235, encryptionId=d34e6523544, topicName=活检)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c39f145, createdName=smlt2008, createdTime=Tue Sep 21 13:04:10 CST 2021, time=2021-09-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053213, encodeId=0a99105321329, content=不i回去咯鼻孔?。locust, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Mon Sep 20 10:23:31 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053195, encodeId=be3f105319517, content=相对于靶向活检,联合活检在csPCa方面的检出率增加了一倍,最终增加了获益没有?比较怀疑, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Mon Sep 20 08:49:36 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053161, encodeId=f099105316165, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210511/e9408422a23545ef9738dd674abfc4ff/c719925083844b82986bc39d43051172.jpg, createdBy=8eb14795142, createdName=与狼共舞, createdTime=Mon Sep 20 06:06:52 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053134, encodeId=d21f10531340e, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sun Sep 19 22:11:26 CST 2021, time=2021-09-19, status=1, ipAttribution=)]
    2021-09-20 查查佳佳

    不i回去咯鼻孔?。locust

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1904828, encodeId=48bb1904828a8, content=<a href='/topic/show?id=ae97625036d' target=_blank style='color:#2F92EE;'>#检出率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62503, encryptionId=ae97625036d, topicName=检出率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ce68183, createdName=xiongke010, createdTime=Tue Oct 19 10:04:10 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1278249, encodeId=94d312e82492d, content=<a href='/topic/show?id=d34e6523544' target=_blank style='color:#2F92EE;'>#活检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65235, encryptionId=d34e6523544, topicName=活检)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c39f145, createdName=smlt2008, createdTime=Tue Sep 21 13:04:10 CST 2021, time=2021-09-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053213, encodeId=0a99105321329, content=不i回去咯鼻孔?。locust, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Mon Sep 20 10:23:31 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053195, encodeId=be3f105319517, content=相对于靶向活检,联合活检在csPCa方面的检出率增加了一倍,最终增加了获益没有?比较怀疑, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Mon Sep 20 08:49:36 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053161, encodeId=f099105316165, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210511/e9408422a23545ef9738dd674abfc4ff/c719925083844b82986bc39d43051172.jpg, createdBy=8eb14795142, createdName=与狼共舞, createdTime=Mon Sep 20 06:06:52 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053134, encodeId=d21f10531340e, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sun Sep 19 22:11:26 CST 2021, time=2021-09-19, status=1, ipAttribution=)]
    2021-09-20 病毒猎手

    相对于靶向活检,联合活检在csPCa方面的检出率增加了一倍,最终增加了获益没有?比较怀疑

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1904828, encodeId=48bb1904828a8, content=<a href='/topic/show?id=ae97625036d' target=_blank style='color:#2F92EE;'>#检出率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62503, encryptionId=ae97625036d, topicName=检出率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ce68183, createdName=xiongke010, createdTime=Tue Oct 19 10:04:10 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1278249, encodeId=94d312e82492d, content=<a href='/topic/show?id=d34e6523544' target=_blank style='color:#2F92EE;'>#活检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65235, encryptionId=d34e6523544, topicName=活检)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c39f145, createdName=smlt2008, createdTime=Tue Sep 21 13:04:10 CST 2021, time=2021-09-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053213, encodeId=0a99105321329, content=不i回去咯鼻孔?。locust, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Mon Sep 20 10:23:31 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053195, encodeId=be3f105319517, content=相对于靶向活检,联合活检在csPCa方面的检出率增加了一倍,最终增加了获益没有?比较怀疑, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Mon Sep 20 08:49:36 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053161, encodeId=f099105316165, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210511/e9408422a23545ef9738dd674abfc4ff/c719925083844b82986bc39d43051172.jpg, createdBy=8eb14795142, createdName=与狼共舞, createdTime=Mon Sep 20 06:06:52 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053134, encodeId=d21f10531340e, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sun Sep 19 22:11:26 CST 2021, time=2021-09-19, status=1, ipAttribution=)]
    2021-09-20 与狼共舞

    学习学习

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1904828, encodeId=48bb1904828a8, content=<a href='/topic/show?id=ae97625036d' target=_blank style='color:#2F92EE;'>#检出率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62503, encryptionId=ae97625036d, topicName=检出率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ce68183, createdName=xiongke010, createdTime=Tue Oct 19 10:04:10 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1278249, encodeId=94d312e82492d, content=<a href='/topic/show?id=d34e6523544' target=_blank style='color:#2F92EE;'>#活检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65235, encryptionId=d34e6523544, topicName=活检)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c39f145, createdName=smlt2008, createdTime=Tue Sep 21 13:04:10 CST 2021, time=2021-09-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053213, encodeId=0a99105321329, content=不i回去咯鼻孔?。locust, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Mon Sep 20 10:23:31 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053195, encodeId=be3f105319517, content=相对于靶向活检,联合活检在csPCa方面的检出率增加了一倍,最终增加了获益没有?比较怀疑, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Mon Sep 20 08:49:36 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053161, encodeId=f099105316165, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210511/e9408422a23545ef9738dd674abfc4ff/c719925083844b82986bc39d43051172.jpg, createdBy=8eb14795142, createdName=与狼共舞, createdTime=Mon Sep 20 06:06:52 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053134, encodeId=d21f10531340e, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sun Sep 19 22:11:26 CST 2021, time=2021-09-19, status=1, ipAttribution=)]
    2021-09-19 医鸣惊人

    认真学习了

    0

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