提示: 手机请竖屏浏览!

MRI靶向、系统性和联合活检诊断前列腺癌的比较
MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis


Michael Ahdoot ... 肿瘤 • 2020.03.05
NEJM 动画解读

前列腺癌的诊断和分级
相关阅读
• 通过前列腺特异性膜抗原PET-CT检测转移性前列腺癌 • MRI靶向和系统性活检诊断前列腺癌的比较 • MRI靶向活检或标准活检用于前列腺癌诊断的比较

摘要


背景

前列腺12针系统性活检的诊断准确性低,因而导致了前列腺癌的过度诊断和诊断不足。在有磁共振成像(MRI)可见病变的男性中,MRI靶向活检有可能减少对前列腺癌的错误分类。

 

方法

前列腺有MRI可见病变的男性接受了MRI靶向和系统性活检。主要结局是各级别组(即根据格里森分级分组)的癌症检出率。级别组1指无临床意义的疾病;级别组2或更高级别组指预后良好型中危(favorable intermediate risk)或更严重的癌症;级别组3或更高级别组指预后不良型中危(unfavorable intermediate risk)或更严重的癌症。在之后接受了根治性前列腺切除术的男性中,我们记录了全器官病理切片组织病理学分析结果与活检结果相比,级别组的升级和降级情况。次要结局包括级别组2或更高级别组以及级别组3或更高级别组的癌症检出率、根据之前活检状况分层的癌症检出率,以及活检和根治性前列腺切除术之间发生的癌症重新分级。

 

结果

共计2,103名男性接受了两种活检方法检查;联合应用这两种方法(联合活检)时,有1,312人(62.4%)被诊断为前列腺癌,有404人(19.2%)接受了根治性前列腺切除术。对于级别组1的癌症,MRI靶向活检的癌症检出率显著低于系统性活检,对于级别组3~5的癌症,MRI靶向活检的癌症检出率显著高于系统性活检(对于所有比较,P<0.01)。联合活检检出的前列腺癌患者人数比单独应用任一活检方法多出208例(9.9%),并使458名男性(21.8%)的级别组升级。然而,如果仅进行MRI靶向活检,则有8.8%的有临床意义癌症(级别组≥3)将被错误分类。在之后接受了根治性前列腺切除术的404名男性中,与MRI靶向活检(8.7%)和系统性活检(16.8%)相比,采用联合活检时,根据手术标本的组织病理学分析结果升级至级别组3或更高级别组的病例数最少(3.5%)。

 

结论

在有MRI可见病变的患者中,联合活检提高了所有前列腺癌的检出率。而单独MRI靶向活检低估了一些肿瘤的组织学分级。采用联合活检时,在根治性前列腺切除术后根据组织病理学分析结果升级至级别组3或更高级别组的病例数显著较少(由美国国立卫生研究院等资助,Trio Study在ClinicalTrials.gov注册号为NCT00102544)。





作者信息

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.
From the Urologic Oncology Branch (M.A., A.R.W., A.H.L., S.M., P.T.G., J.B., S.G., W.M.L., P.A.P.), the Biometric Research Program, Division of Cancer Treatment and Diagnosis (S.E.R., J.H.S.), the Molecular Imaging Program (S.M., P.L.C., B.T.) and the Translational Surgical Pathology Section (M.M.), Center for Cancer Research, the Division of Cancer Prevention (P.P., H.P.), the Center for Interventional Oncology (B.J.W.), and Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center (B.J.W.), National Cancer Institute, National Institutes of Health, Bethesda, and the Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore (M.S.) — all in Maryland. Address reprint requests to Dr. Pinto at the National Cancer Institute, 10 Center Dr., Bldg. 10, Rm. 2W-5940, Bethesda, MD 20892, or at pintop@mail.nih.gov. A complete list of members of the Trio Study Group is provided in the Supplementary Appendix, available at NEJM.org.

 

参考文献

1. Hamdy FC, Donovan JL, Lane JA, et al. 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 2016;375:1415-1424.

2. Bill-Axelson A, Holmberg L, Garmo H, et al. Radical prostatectomy or watchful waiting in prostate cancer — 29-year follow-up. N Engl J Med 2018;379:2319-2329.

3. Tosoian JJ, Mamawala M, Epstein JI, et al. Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer. J Clin Oncol 2015;33:3379-3385.

4. Godtman RA, Holmberg E, Khatami A, Stranne J, Hugosson J. Outcome following active surveillance of men with screen-detected prostate cancer: results from the Göteborg randomised population-based prostate cancer screening trial. Eur Urol 2013;63:101-107.

5. Klotz L, Vesprini D, Sethukavalan P, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 2015;33:272-277.

6. American Cancer Society. Cancer facts & figures 2019 (http://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2019.html. opens in new tab).

7. Albertsen PC, Hanley JA, Fine J. 20-Year outcomes following conservative management of clinically localized prostate cancer. JAMA 2005;293:2095-2101.

8. Carter HB, Albertsen PC, Barry MJ, et al. Early detection of prostate cancer: AUA guideline. J Urol 2013;190:419-426.

9. Epstein JI, Feng Z, Trock BJ, Pierorazio PM. Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades. Eur Urol 2012;61:1019-1024.

10. Bittner N, Merrick G, Taira A, et al. Location and grade of prostate cancer diagnosed by transperineal template-guided mapping biopsy after negative transrectal ultrasound-guided biopsy. Am J Clin Oncol 2018;41:723-729.

11. Bittner N, Merrick GS, Butler WM, Bennett A, Galbreath RW. Incidence and pathological features of prostate cancer detected on transperineal template guided mapping biopsy after negative transrectal ultrasound guided biopsy. J Urol 2013;190:509-514.

12. Walz J, Graefen M, Chun FK, et al. High incidence of prostate cancer detected by saturation biopsy after previous negative biopsy series. Eur Urol 2006;50:498-505.

13. He J, Albertsen PC, Moore D, Rotter D, Demissie K, Lu-Yao G. Validation of a contemporary five-tiered Gleason grade grouping using population-based data. Eur Urol 2017;71:760-763.

14. Siddiqui MM, Rais-Bahrami S, Turkbey B, et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA 2015;313:390-397.

15. Weinreb JC, Barentsz JO, Choyke PL, et al. PI-RADS Prostate Imaging — Reporting and Data System: 2015, version 2. Eur Urol 2016;69:16-40.

16. Johnson DC, Raman SS, Mirak SA, et al. Detection of individual prostate cancer foci via multiparametric magnetic resonance imaging. Eur Urol 2019;75:712-720.

17. Ahmed HU, El-Shater Bosaily A, Brown LC, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017;389:815-822.

18. Rouvière O, Puech P, Renard-Penna R, et al. Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol 2019;20:100-109.

19. Kasivisvanathan V, Emberton M, Moore CM. MRI-targeted biopsy for prostate-cancer diagnosis. N Engl J Med 2018;379:589-590.

20. Kasivisvanathan V, Rannikko AS, Borghi M, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 2018;378:1767-1777.

21. Panebianco V, Barchetti F, Sciarra A, et al. Multiparametric magnetic resonance imaging vs. standard care in men being evaluated for prostate cancer: a randomized study. Urol Oncol 2015;33(1):17.e1-17.e7.

22. Fulgham PF, Rukstalis DB, Turkbey IB, et al. AUA policy statement on the use of multiparametric magnetic resonance imaging in the diagnosis, staging and management of prostate cancer. J Urol 2017;198:832-838.

23. Drost FH, Osses DF, Nieboer D, et al. Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer. Cochrane Database Syst Rev 2019;4:CD012663-CD012663.

24. Exterkate L, Wegelin O, Barentsz JO, et al. Is there still a need for repeated systematic biopsies in patients with previous negative biopsies in the era of magnetic resonance imaging-targeted biopsies of the prostate? Eur Urol Oncol 2019 June 22 (Epub ahead of print).

25. Turkbey B, Mani H, Aras O, et al. Prostate cancer: can multiparametric MR imaging help identify patients who are candidates for active surveillance? Radiology 2013;268:144-152.

26. Yerram NK, Volkin D, Turkbey B, et al. Low suspicion lesions on multiparametric magnetic resonance imaging predict for the absence of high-risk prostate cancer. BJU Int 2012;110(11 Pt B):E783-E788.

27. Rais-Bahrami S, Siddiqui MM, Turkbey B, et al. Utility of multiparametric magnetic resonance imaging suspicion levels for detecting prostate cancer. J Urol 2013;190:1721-1727.

28. Gaur S, Harmon S, Mehralivand S, et al. Prospective comparison of PI-RADS version 2 and qualitative in-house categorization system in detection of prostate cancer. J Magn Reson Imaging 2018;48:1326-1335.

29. Calio BP, Sidana A, Sugano D, et al. Risk of upgrading from prostate biopsy to radical prostatectomy pathology — does saturation biopsy of index lesion during multiparametric magnetic resonance imaging–transrectal ultrasound fusion biopsy help? J Urol 2018;199:976-982.

30. Bjurlin MA, Carter HB, Schellhammer P, et al. Optimization of initial prostate biopsy in clinical practice: sampling, labeling and specimen processing. J Urol 2013;189:2039-2046.

31. Egevad L, Delahunt B, Srigley JR, Samaratunga H. International Society of Urological Pathology (ISUP) grading of prostate cancer — an ISUP consensus on contemporary grading. APMIS 2016;124:433-435.

32. Moore CM, Kasivisvanathan V, Eggener S, et al. Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group. Eur Urol 2013;64:544-552.

33. Pierorazio PM, Walsh PC, Partin AW, Epstein JI. Prognostic Gleason grade grouping: data based on the modified Gleason scoring system. BJU Int 2013;111:753-760.

34. Epstein JI, Zelefsky MJ, Sjoberg DD, et al. A contemporary prostate cancer grading system: a validated alternative to the Gleason score. Eur Urol 2016;69:428-435.

35. Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA. The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol 2016;40:244-252.

36. Agresti A, Caffo B. Simple and effective confidence intervals for proportions and differences of proportions result from adding two successes and two failures. Am Stat 2000;54:280-288.

37. Agresti A, Min Y. Simple improved confidence intervals for comparing matched proportions. Stat Med 2005;24:729-740.

38. Filson CP, Natarajan S, Margolis DJ, et al. Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: the role of systematic and targeted biopsies. Cancer 2016;122:884-892.

39. Klotz L, Loblaw A, Sugar L, et al. Active Surveillance Magnetic Resonance Imaging Study (ASIST): results of a randomized multicenter prospective trial. Eur Urol 2019;75:300-309.

40. Elkhoury FF, Felker ER, Kwan L, et al. Comparison of targeted vs systematic prostate biopsy in men who are biopsy naïve: the Prospective Assessment of Image Registration in the Diagnosis of Prostate Cancer (PAIREDCAP) Study. JAMA Surg 2019 June 12 (Epub ahead of print).

41. Osses DF, van Asten JJ, Tijsterman JD. Cognitive-targeted versus magnetic resonance imaging-guided prostate biopsy in prostate cancer detection. Curr Urol 2018;11:182-188.

42. Meng X, Rosenkrantz AB, Huang R, et al. The institutional learning curve of magnetic resonance imaging-ultrasound fusion targeted prostate biopsy: temporal improvements in cancer detection in 4 years. J Urol 2018;200:1022-1029.

服务条款 | 隐私政策 | 联系我们