The Impact of MRI-TRUS Cognitively Targeted Biopsy on the Incidence of Pathologic Upgrading After Radical Prostatectomy

World journal of nephrology and urology Pub Date : 2018-04-04 DOI:10.14740/WJNU285W

R. Saoud, Albert El-Haj, R. Khauli, M. Bulbul

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Abstract

Background: The aim of the study was to evaluate the utility of multiparametric magnetic resonance imaging (mp-MRI)-transrectal ultrasound (TRUS) cognitively targeted biopsy in identifying the most significant cancerous lesion in the prostate to decrease the incidence of pathologic upgrading after radical prostatectomy. Methods: We conducted a retrospective review of all radical prostatectomies at the American University of Beirut Medical Center between January 2016 and 2017. Pathology reports for both, TRUS biopsy and surgically resected specimens were analyzed and compared using SPSS. Results: Among 66 patients who underwent radical prostatectomy, 44 patients underwent a standard random 12-core biopsy of the prostate, while 22 patients underwent 4 - 5 cognitively targeted biopsies. Biopsy Gleason scores were compared to surgically resected specimens. Of mp-MRI targeted biopsies, 86% were identical to the surgical specimen, while 14% were upgraded. Of the random biopsy, 55% patients upgraded after surgery, while 38% were concordant with the random biopsy result. Moreover, 13/24 patients who upgraded after random biopsy, did so from Gleason 6 (3+3) to Gleason 7 (3+4). The difference in pathological upgrading among both groups is statistically significant, and confirms the importance of MRI-TRUS cognitively targeted biopsy in identifying the highest risk lesion. This may have significant implications on the choice of treatment prior to embarking on surgical resection of prostate cancer. Conclusion: MRI-TRUS targeted biopsy is more accurate than random biopsy in identifying the most significant cancerous lesion, resulting in a decreased incidence of pathologic upgrading after prostatectomy. This may have significant implications on the choice of treatment especially in low risk prostate cancer. Larger scale multicenter studies are required. World J Nephrol Urol. 2018;7(1):12-16 doi: https://doi.org/10.14740/wjnu285w

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MRI-TRUS认知靶向活检对前列腺癌根治术后病理升级发生率的影响

背景：本研究的目的是评估多参数磁共振成像（mp-MRI）-经直肠超声（TRUS）认知靶向活检在识别前列腺中最显著的癌性病变以降低根治性前列腺切除术后病理升级的发生率方面的效用。方法：我们对2016年1月至2017年期间在贝鲁特美国大学医学中心进行的所有根治性前列腺切除术进行了回顾性审查。使用SPSS对TRUS活检和手术切除标本的病理学报告进行分析和比较。结果：在66名接受根治性前列腺切除术的患者中，44名患者接受了标准的随机12核心前列腺活检，而22名患者则接受了4-5个认知靶向活检。将活检Gleason评分与手术切除的标本进行比较。在mp MRI靶向活检中，86%与手术标本相同，14%升级。在随机活检中，55%的患者在手术后病情好转，而38%的患者与随机活检结果一致。此外，13/24名患者在随机活检后升级，从Gleason 6（3+3）升级为Gleason 7（3+4）。两组之间病理升级的差异具有统计学意义，并证实了MRI-TRUS认知靶向活检在识别最高风险病变方面的重要性。这可能对癌症手术切除前的治疗选择有重要影响。结论：MRI-TRUS靶向活检在识别最显著的癌性病变方面比随机活检更准确，从而降低前列腺切除术后病理升级的发生率。这可能对治疗的选择有重要影响，尤其是在低风险前列腺癌症中。需要进行更大规模的多中心研究。世界肾脏泌尿学杂志。2018年；7（1）：12-16 doi:https://doi.org/10.14740/wjnu285w

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World journal of nephrology and urology

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