mpMRI 时代的活检策略:全面回顾。

IF 5.1 2区 医学 Q1 ONCOLOGY
Olivier Windisch, Massimo Valerio, Chi-Hang Yee, Paolo Gontero, Baris Bakir, Christof Kastner, Hashim U Ahmed, Cosimo De Nunzio, Jean de la Rosette
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引用次数: 0

摘要

背景:用于检测前列腺癌(PCA)的前列腺活组织检查技术自最初提出以来一直在不断发展。多参数磁共振成像(mpMRI)已被证实在检测指标病变方面具有超过90%的灵敏度。这篇叙述性综述讨论了围绕几种活检策略的证据,尤其是在患者可能符合病灶治疗条件的情况下:2024年2月15日,我们使用医学文献分析与检索系统在线版(Medline)、科学网(Web of Science)和谷歌学术(Google Scholar)进行了一项非系统性文献研究:结果:经直肠(TR)途径与术后脓毒症发生率增加有关,即使在充分使用抗生素预防的情况下也是如此。目前国际指南推荐经会阴(TP)途径,首先是因为它能降低尿道败血症的发生率。最近的证据显示,经会阴途径的效果并不优于经直肠途径,甚至前部和顶端区域有临床意义的 PCA(csPCA)的检出率更高,而这些区域通常是经直肠途径难以定位的。多种靶向技术(认知、软件融合或孔内)提高了我们对前列腺癌侵袭性和负担进行准确风险评估的能力,同时减少了核芯数量,降低了临床意义不明显的前列腺癌(ciPCA)的数量。虽然 MRI-TB 的作用已得到证实,但系统性活检(SB)的作用仍然很重要,因为它能发现 5-16% 的 csPCA,而这些 csPCA 可能会被 MRI-TB 遗漏。系统活检的策略主要取决于所采用的途径(TR 与 TP)和所需采集的核心数量(10-12 个核心与饱和活检、经会阴模板映射活检或 Ginsburg 协议与区域活检):结论:已有多种活检策略可供参考,在对患者进行病灶治疗评估时应了解这些策略。由于磁共振成像系统对病灶大小的评估不足,因此系统活检,尤其是髂周活检,有助于提高灵敏度,但代价是要增加取芯次数。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Biopsy strategies in the era of mpMRI: a comprehensive review.

Biopsy strategies in the era of mpMRI: a comprehensive review.

Background: Since its initial description the prostate biopsy technique for detection of prostate cancer (PCA) has constantly evolved. Multiparametric magnetic resonance imaging (mpMRI) has been proven to have a sensitivity exceeding 90% to detect the index lesion. This narrative review discusses the evidence around several biopsy strategies, especially in the context of patients that might be eligible for focal therapy.

Method: A non-systematic literature research was performed on February 15th 2024 using the Medical Literature Analysis and Retrieval System Online (Medline), Web of Science and Google Scholar.

Results: The transrectal (TR) route is associated with an increased postoperative sepsis rate, even with adequate antibiotic prophylaxis. The transperineal (TP) route is now recommended by international guidelines, firstly for its decreased rate of urosepsis. Recent evidence shows a non-inferiority of TP compared to TR route, and even a higher detection rate of clinically significant PCA (csPCA) in the anterior and apical region, that are usually difficult to target using the TR route. Several targeting techniques (cognitive, software-fusion or in-bore) enhance our ability to provide an accurate risk assessment of prostate cancer aggressiveness and burden, while reducing the number of cores and reducing the number of clinically insignificant prostate cancer (ciPCA). While MRI-TB have proven their role, the role of systematic biopsies (SB) is still important because it detects 5-16% of csPCA that would have been missed by MRI-TB alone. The strategies of SB depend mainly on the route used (TR vs. TP) and the number of cores to be collected (10-12 cores vs. saturation biopsies vs. trans-perineal template mapping-biopsies or Ginsburg Protocol vs. regional biopsies).

Conclusion: Several biopsy strategies have been described and should be known when assessing patients for focal therapy. Because MRI systematically under evaluates the lesion size, systematic biopsies, and especially perilesional biopsies, can help to increase sensitivity at the cost of an increased number of cores.

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来源期刊
Prostate Cancer and Prostatic Diseases
Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学
CiteScore
10.00
自引率
6.20%
发文量
142
审稿时长
6-12 weeks
期刊介绍: Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.
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