Are Magnetic Resonance Imaging-Transrectal Ultrasound Guided Targeted Biopsies Noninferior to Transrectal Ultrasound Guided Systematic Biopsies for the Detection of Prostate Cancer?

详细信息    查看全文

• 作者：Nicolas Barry Delongchamps^a ; ^b ; ^&dagger ; ; ^{nicolasbdl@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Daniel Portalez^c ; Eric Brugui&egrave ; re^d ; Olivier Rouvi&egrave ; re^e ; Bernard Malavaud^c ; Pierre Mozer^e ; Gaelle Fiard^f ; Franç ; ois Cornud^a ; ^&dagger ; ; for the MURIELLE Study GroupCaroline Escourrou ; St&eacute ; phanie Renault ; Naï ; m Bouazza ; Jean-Michel Casanova ; Arachk de Gorski ; Raphaelle Renard-Penna ; Mathieu Roumigui&eacute ; Matthieu Thoulouzan ; Vincent Misrai ; Julien Guillotreau ; Richard Aziza ; Jean-Luc Descotes ; No&eacute ; lie Hohn ; Flavie Bratan ; Fanny Cros ; Thomas Sanzalone
• 关键词：prostatic neoplasms ; biopsy ; magnetic resonance imaging ; ultrasonography ; diagnosis
• 刊名：The Journal of Urology
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：196
• 期：4
• 页码：1069-1075
• 全文大小：321 K

文摘

In men with suspicion of prostate cancer the standard of cancer detection is transrectal ultrasound guided 10 to 12-core systematic biopsy. The targeted biopsy only strategy using magnetic resonance imaging-transrectal ultrasound image registration is gaining in popularity. We assessed the noninferiority of targeted vs systematic biopsy.

absSec_2">Materials and Methods

abspara0015">Between June and October 2014 a total of 108 biopsy naïve patients with prostate specific antigen between 4 and 20 ng/ml, normal rectal examination and a single suspicious image on magnetic resonance imaging were included in study at 7 centers. Patients underwent systematic biopsy by a first operator blinded to magnetic resonance imaging, immediately followed by 3 targeted biopsies within the suspicious image by a second operator. The primary end point was the cancer detection rate. The noninferiority margin was set at −5%. The secondary end points were the detection rate of clinically significant prostate cancer (maximum cancer core length 5 mm or greater for Gleason 6 or any Gleason 7 or greater disease) and procedure duration.

absSec_3">Results

abspara0020">Systematic and targeted biopsies detected cancer in 66 (61.1%) and 61 patients (56.5%), respectively. The mean difference was −4.5% with a 95% CI lower bound of −11.8%. A total of 13 patients with protocol violations were excluded from the per protocol analysis, which showed a mean difference of −5.2% with a 95% CI lower bound of −13.1%. Clinically significant prostate cancer was detected in 50 (46.2%) and 52 patients (48.1%) with systematic and targeted biopsies, respectively (p = 0.69). The mean ± SD duration of image fusion plus targeted biopsy was 16.7 ± 7 minutes vs 7.4 ± 3 for systematic biopsy (p <0.001).

absSec_4">Conclusions

abspara0025">Targeted biopsy seemed to be inferior to systematic biopsy for overall cancer detection. Detection of clinically significant prostate cancer did not differ between targeted and systematic biopsies.