MRI靶向系統聯合活檢診斷前列腺癌
作者：
小柯機器人發布時間：2020/3/8 12:49:54
使用12核系統前列腺活檢會導致診斷不準確，從而導致前列腺癌的過度診斷和診斷不足。以磁共振成像（MRI）定位的活檢可以減少男性MRI可見病變的前列腺癌分級錯誤。
根據Gleason等級分類，1級指臨床上無足輕重的疾病； 2級或更高等級，具有中等風險或較差的癌症； 3級或更高級別的患者，具有中等或更高風險。
該研究中，共有2103名MRI可見前列腺病變的男性接受了MRI靶向和系統活檢。兩種方法（聯合活檢）相結合，有1312（62.4％）位患者診斷為癌症，404例進行了根治性前列腺切除術（19.2％）。
對於1級癌症，MRI靶向活檢的癌症檢出率顯著低於系統活檢，但對3至5級則顯著高於系統活檢。聯合活檢導致確診癌症的男性比單獨使用任一種方法多208人（9.9％），並使458名男性（21.8％）的癌症級別上升。
但如果僅進行MRI靶向活檢，則將有8.8％的具有臨床意義的癌症（≥3級）被誤分類。在404位接受了前列腺癌根治術的男性中，手術標本的組織病理學分析（3.5％）與聯合MRI活檢（8.7％）和系統活檢相比（16.8％），聯合活檢中升級到3級或更高級別癌症的最少。
總之，在具有MRI可見病變的患者中，聯合活檢可以檢測出更多的前列腺癌。但僅針對MRI的活檢低估了某些腫瘤的組織學等級。
附：英文原文
Title: MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis
Author: Michael Ahdoot, M.D.,, Andrew R. Wilbur, B.S.,, Sarah E. Reese, Ph.D.,, Amir H. Lebastchi, M.D.,, Sherif Mehralivand, M.D.,, Patrick T. Gomella, M.D.,, Jonathan Bloom, M.D.,, Sandeep Gurram, M.D.,, Minhaj Siddiqui, M.D.,, Paul Pinsky, Ph.D.,, Howard Parnes, M.D.,, W. Marston Linehan, M.D.,, Maria Merino, M.D.,, Peter L. Choyke, M.D.,, Joanna H. Shih, Ph.D.,, Baris Turkbey, M.D.,, Bradford J. Wood, M.D.,, and Peter A. Pinto, M.D.
Issue&Volume: 2020-03-04
Abstract: AbstractBackgroundThe use of 12-core systematic prostate biopsy is associated with diagnostic inaccuracy that contributes to both overdiagnosis and underdiagnosis of prostate cancer. Biopsies performed with magnetic resonance imaging (MRI) targeting may reduce the misclassification of prostate cancer in men with MRI-visible lesions.MethodsMen with MRI-visible prostate lesions underwent both MRI-targeted and systematic biopsy. The primary outcome was cancer detection according to grade group (i.e., a clustering of Gleason grades). Grade group 1 refers to clinically insignificant disease; grade group 2 or higher, cancer with favorable intermediate risk or worse; and grade group 3 or higher, cancer with unfavorable intermediate risk or worse. Among the men who underwent subsequent radical prostatectomy, upgrading and downgrading of grade group from biopsy to whole-mount histopathological analysis of surgical specimens were recorded. Secondary outcomes were the detection of cancers of grade group 2 or higher and grade group 3 or higher, cancer detection stratified by previous biopsy status, and grade reclassification between biopsy and radical prostatectomy.ResultsA total of 2103 men underwent both biopsy methods; cancer was diagnosed in 1312 (62.4%) by a combination of the two methods (combined biopsy), and 404 (19.2%) underwent radical prostatectomy. Cancer detection rates on MRI-targeted biopsy were significantly lower than on systematic biopsy for grade group 1 cancers and significantly higher for grade groups 3 through 5 (P<0.01 for all comparisons). Combined biopsy led to cancer diagnoses in 208 more men (9.9%) than with either method alone and to upgrading to a higher grade group in 458 men (21.8%). However, if only MRI-target biopsies had been performed, 8.8% of clinically significant cancers (grade group ≥3) would have been misclassified. Among the 404 men who underwent subsequent radical prostatectomy, combined biopsy was associated with the fewest upgrades to grade group 3 or higher on histopathological analysis of surgical specimens (3.5%), as compared with MRI-targeted biopsy (8.7%) and systematic biopsy (16.8%).ConclusionsAmong patients with MRI-visible lesions, combined biopsy led to more detection of all prostate cancers. However, MRI-targeted biopsy alone underestimated the histologic grade of some tumors. After radical prostatectomy, upgrades to grade group 3 or higher on histopathological analysis were substantially lower after combined biopsy.
DOI: 10.1056/NEJMoa1910038
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1910038