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Objective:This study aimed to compare the detection efficacy of transrectal ultrasound-guided transrectal cognitive fusion targeted+ systematic prostate biopsy and transperineal cognitive fusion targeted + systematic biopsy in patients with suspected prostate cancer (PCa). In addition, the relative clinical characteristics of PCa were evaluated.Methods:A total of 385 patients with suspected prostate cancer in the affiliated hospital of Qingdao University from May 2019 to November 2019 were retrospectively analyzed. All patients met the prostate biopsy criterion, who underwent transrectal(n=275)and transperineal(n=110)prostate biopsy respectively. There were no significant differences of mean age [(70.7±7.3)years vs.(69.2±8.4) years], PSA [(55.12±116.96)ng/ml vs. (63.41±315.34)ng/ml], prostate volume [(55.96±35.26)ml vs. (64.35±55.99)ml] between two groups. According to preoperative prostate magnetic resonance imaging combined with intraoperative ultrasound, 2-4 needles targeted puncture of suspected lesion were performed, followed by 12 needle systematic prostate biopsy. The detection rate of prostate cancer between two biopsy ways were compared. The related factors of PCa including age, prostate volume and PSA level were collected for univariable and multivariable logistic analysis. The cancer detection rate was compared and logistic regression was used to assess the impact of patient characteristics on PCa detection.Results:For all patients, the detection rate with cancer between transrectal group and transperineal group were 121/275(40.0%) and 67/110(60.9%), respectively. The transperineal group detected a higher rate of PCa ( P=0.003)and more clinically significant prostate cancers (csPCa) (54.6% vs.36.7%, P=0.001) than that of the transrectal group, there were significant differences between two groups ( P<0.05). Univariate and multivariate logistic regression analysis revealed that PSA( OR=1.025, P=0.001) and prostate volume( OR=0.984, P=0.001)were two independent factors for the detection rate of prostate cancer between two biopsy ways( P<0.05). The effect of age on the detection rate of PCa in the transperieal group was significantly lower than that of the transrectal group( OR=0.037, P=0.238 vs. OR=0.053, P=0.002). Conclusion:The transperieal biopsy could find more PCa than the transrectal biopsy. PSA level and prostate volume could affect the detection rate of cancer between two prostate biopsy ways.
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Objective:To investigate the safety and efficacy of individualized transperineal prostate biopsy based on the segmentation of PI-RADS v2 for mpMRI.Method:The clinical data of patients undergoing prostate biopsy in Beijing Friendship Hospital from December 2018 to November 2021 were analyzed retrospectively . A total of 228 patients with a median age of 65(49-83)years underwent biopsy. There were 102(44.7%) with tPSA <10 ng / ml, 108(47.4%) with tPSA 10-20 ng /ml, and 18(7.9%) with tPSA >20 ng /ml, with the median tPSA of 9.87(4.1-89.0)ng /ml. There were 42(18.4%) cases without MRI results, and 32(14.0%)cases with PI-RADS score of 1-2, 47(20.6%)cases of PI-RADS 3, 66(28.9%)cases of PI-RADS 4 and 41(18.1%)cases of PI-RADS 5, respectively.Transrectal ultrasound-guided transperineal prostate targeted biopsy (TB) and systematic biopsy (SB) were performed under local anesthesia or intravenous anesthesia. SB was performed for those without MRI and PI-RADS score of 1-2 (SB group), and TB and SB were performed for those with PI-RADS score of 3-5 (TB+ SB group). Prostate image under ultrasound was cognitively fused according to PI-RADS v2. One needle per area was distributed in 10 areas of each layer(the transition zone anterior and posterior sectors, the peripheral zone anterior, lateral, and medial sectors or central zone in left and right lobe). For those whose prostate length was less than 3cm, 10 needles were punctured, and two needles were added to each lateral lobe of the apex with a total of 14 needles. For those whose prostate length was from 3 to 6 cm, selected two layers with a total of 20 needles. For those with a length greater than 6cm, selected three layers with a total of 30 needles. If there was a suspicious lesion with PI-RADS score of 3-5, two needles were targeted for each lesion.The detection rate and complication rate of prostate cancer and clinically significant prostate cancer (csPCa) in the overall samples were observed, and the difference of the detection rate of prostate cancer and csPCa between the two groups was compared.Results:Of the 228 cases, there were 46 cases undergoing biopsy of one layer, 148 cases of two layers, and 34 cases of three layers, detecting 131 prostate cancer (PCa) diagnosed by pathology, with a detection rate of 57.5%, including 40 cases (17.5%)of clinically insignificant PCa and 91 cases(39.9%)of csPCa. The detection rate of PCa in TB+ SB group was 61.0%(94/154), which was higher than that in SB group, but there was no significant difference ( P=0.114). However, the detection rate of csPCa in TB + SB group was higher than that in SB group, which was 46.8%(72/154)vs. 25.6%(19/74), respectively ( P=0.002). In the combined TB and SB group (TB + SB group), the detection rate of csPCa by TB was 44.8% (69/154), which was higher than that of 33.8%(52/154)by SB( P=0.047). In the TB+ SB group, 7(4.5%) PCa were missed by SB, which was less than 18 cases (11.7%) missed by TB( P=0.022), but csPCa were missed by SB more than that missed by TB( P<0.001). There were 37 cases suffered from complications, with Clavien Dindo classification grade 1 of 29 cases (12.7%), grade 2 of 7 cases (3.1%), and grade 3 of 1 case(0.4%). Conclusions:Individualized transperineal prostate biopsy based on the segmentation of PI-RADS v2 for mpMRI is safe and reliable. Target biopsy by cognitive fusion can improve the detection rate of significant PCa. Systematic biopsy is also an important and essential supplement, which can detect prostate cancer missed by TB. Combined TB and SB are the best choice.
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Objective:To investigate the efficacy of the biopsy strategy combining 6-core systematic and 3-core MRI-targeted biopsy on prostate cancer (PCa) detection in biopsy-na?ve patients.Methods:The clinical data of 121 biopsy-na?ve patients who underwent transperineal prostate biopsy in West China Hospital of Sichuan University from July 2018 to January 2020 were retrospectively analyzed. The average age was (64.7±9.1) years old. Pre-biopsy prostate-specific antigen (PSA) was (12.4±7.5)ng/ml, f/t PSA was 0.13±0.05. Prostate volume was (43.1±26.1) ml and PASD was (0.35±0.27) ng/ml 2. The prostate-imaging and data system (PI-RADS) score of MRI before biopsy was reported to be 3 for 29 patients (24.0%), 4 for 54 patients (44.6%) and 5 for 38 patients (31.8%). All 121 patients underwent 12-core systematic biopsy combined with a 3-core or 5-core MRI-targeted biopsy, of which 61 patients underwent 3-core targeted biopsy and 60 underwent 5-core targeted biopsy. There was no significant difference in the pre-biopsy clinical data between the two groups ( P>0.05). A 6-core systematic biopsy was redefined as the results of 6 cores among the 12-core systematic biopsy. We compared the detection rates among the single 12-core systematic biopsy, 6-core systematic biopsy, MRI-targeted biopsy (3-core or 5-core), and different systematic biopsy combing with targeted biopsy for any PCa and clinically significant PCa, and we also analyzed the cumulative cancer detection rates for MRI-targeted biopsy of different cores. Results:Of the 121 patients in this study, the biopsy results were negative for 43 patients (35.5%) and positive for 78 (64.5%). The detection rate of clinically significant PCa was 55.4% (67/121). The detection rate of the 6-core systematic biopsy combined with MRI-targeted biopsy was 62.0% (75/121) for PCa and 55.4% (67/121) for clinically significant PCa, which was of no difference compared with that for the 12-core systematic biopsy combined with MRI-targeted biopsy ( P>0.05), but the 6-core systematic biopsy combined with MRI-targeted biopsy avoided the overdiagnosis of 3 patients with Gleason score 3+ 3. The detection rate of PCa for MRI-targeted biopsy was 57.9% (70/121), including 42.1% (51/121) for the first core, 55.4% (67/121) for the first two cores, and 57.9% (70/121) for the first three cores. Compared with the single-core targeted biopsy for suspicious lesions, the first 2-core targeted biopsy ( OR=1.7, 95% CI 1.0-2.8) and 3-core targeted biopsy ( OR=1.9, 95% CI 1.1-3.1) can significantly increase the detection rate of PCa, while the fourth or fifth core of targeted biopsy can not increase the detection rate additionally (60%, 36/60). Conclusion:For patients with suspected PCa, the prostate biopsy strategy combing 6-core systematic and 3-core MRI-targeted biopsy performs no inferior than the current 12-core systematic biopsy combined with MRI-targeted biopsy.
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Objective:To explore the detection rate of prostate cancer and clinically significant prostate cancer (CsPCa) in three puncture methods: targeted biopsy fusion with MRI and ultrasound imaging, system puncture, and combined puncture.Methods:The clinical data of 164 patients who underwent both targeted biopsy and systematic biopsy in Zhejiang Provincial People's Hospital from April 2019 to April 2020 were retrospectively analyzed. The median age was 67(33-90)years. Preoperative serum tPSA was 8.97(0.64-95.63)ng/ml and fPSA was 1.31(0.29-9.25)ng/ml. There were 96 patients result in tPSA<10 ng/ml, 65 and 3 patients result in 10≤tPSA<50 ng/ml and tPSA≥50 ng/ml. The prostate volume was 34.9(11.6-152.0) cm 3. According to result of PI-RADS score, there were 42 patients got 3 points and 66, 56 patients got 4 and 5 points respectively in PI-RADS score of suspicious nodules. First, a targeted puncture (targeted biopsy) was performed on the suspected lesions by fusion imaging of magnetic resonance and ultrasound. Then 12-needle systematic prostate biopsy was performed under the guidance of ultrasound. Those two methods performed together was called combined biopsy. This study compared the detection rates of prostate cancer and CsPCa among the three popular methods in all cases, different PI-RADS cases, and different tPSA cases. Results:In this study, patients was detected as positive result in 126 of 164 patients. The detection rates of prostate cancer in targeted biopsy and systematic biopsy were 66.46%(109/164) and 64.02%(105/164), respectively, the result reveals no statistical significance ( P=0.64). In contrast, the positive rate of combined biopsy [76.83%(126/164)] was higher than targeted biopsy ( P=0.04) and systematic biopsy ( P=0.01), and the difference was statistically significant. In the detection rate of CsPCa, the positive detection rates of targeted biopsy group, systematic biopsy group and combined biopsy group were 50.61%(83/164), 45.12%(90/164) and 54.88% (126/164), respectively. Moreover, there was no significant statistical significance among the three groups ( P>0.05). Group comparison was analyzed according to PI-RADS score. In PI-RADS 4 group and PI-RADS 5 group, combined biopsy was[90.91%(60/66), 100.00%(56/56)] and systematic biopsy was [71.21%(47/66), 87.50%(49/56)] which reveals significant difference in prostate cancer detection rates ( P=0.00, P=0.01). In PI-RADS 4-5 groups, the detection rate of prostate cancer by targeted biopsy [86.89%(106/122)] was significantly higher than systematic biopsy [78.69%(96/122), P=0.01], but still lower than that by combined biopsy [95.08%(116/122), P=0.03]. The CsPCa detection rates of PI-RADS 3 group targeted biopsy, systematic biopsy and combined biopsy were 2.38%(1/42), 7.14%(3/42) and 7.14%(3/42), respectively. There were 59.09%(39/66), 46.97%(31/66) and 62.12%(41/66) in PI-RADS 4 groups, respectively; There were 78.57%(44/56), 71.43%(40/56) and 82.14%(46/66) in PI-RADS 5 groups, respectively, with no statistical significance ( P>0.05). However, in PI-RADS 4-5 groups, the CsPCa detection rate of combined biopsy [71.31%(87/122)] was higher than that of systematic biopsy [58.20%(71/122)], with statistical significance ( P=0.03). In the tPSA<10 ng/ml group, the prostate cancer detection rate of combined biopsy[72.92%(70/96)] was higher than that of systematic biopsy[59.38%(57/96)], and the difference was statistically significant ( P<0.05). There was no significant difference between the detection rate of targeted biopsy[61.43%(59/96)]and combined biopsy ( P=0.09). In the group of 10ng/ml≤tPSA<50ng/ml, the prostate cancer detection rates of targeted biopsy, systematic biopsy and combined biopsy were 72.31%(47/65), 69.23%(45/65) and 81.54%(53/65), respectively, and there was no statistical significance ( P>0.05). In tPSA≥50 ng/ml group, the prostate cancer detection rate of the three biopsy methods was 100.00% (3/3), and there was no statistical significance ( P>0.05). Conclusion:For patients with highly suspected prostate cancer on multiparameter MRI(PI-RADS 4-5) or tPSA<10 ng/ml, combined biopsy was an appropriate method to diagnose the prostate cancer.
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A cognitive magnetic resonance imaging (MRI)-targeted prostate biopsy conducted by an experienced clinician enhances the detection rate of (high-grade) prostate cancer; however, this method is less successful in the hands of inexperienced surgeons. Therefore, an alternative method of conducting a cognitive MRI-targeted biopsy that can be successfully performed by the inexperienced clinicians should be developed. Ninety-six males suspected of prostate cancer were analyzed using systematic biopsy and cognitive MRI-targeted biopsy based on our novel three-dimensional matrix positioning method. Typically, the core principle of the latter procedure was to put the MRI and ultrasound images into the same virtual coordinate system. Afterward, the targeted biopsy was transformed to target a coordinate for the suspected lesion in the MRI. Subsequently, patients were assessed for the presence/absence of prostate cancer or high-grade prostate cancer. According to our results, the overall detection rate of prostate cancer was 70.8% (68/96), and the detection rate of high-grade prostate cancer was 56.3% (54/96). Specifically, the detection rate of prostate cancer by systematic biopsy was 54.2% (52/96) and that by targeted biopsy was 59.4% (57/96; P = 0.560). Clearly, the combined application of targeted biopsy could remarkably increase the detection rates of prostate cancer (P = 0.025) and high-grade prostate cancer (P = 0.009). Taken together, the findings of this study suggest that the combination of systematic biopsy with our three-dimensional matrix positioning-driven cognitive-targeted biopsy is superior to systematic biopsy in detecting prostate cancer and high-grade prostate cancer.
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This study aims to compare the prostate cancer detection rate between magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) cognitive fusion targeted biopsy and systematic biopsy. A total of 614 patients who underwent transrectal prostate biopsy during 2016-2018 with multiparametric magnetic resonance imaging (mpMRI) were included. All patients with a PI-RADS V2 score ≥ 3 accepted both targeted biopsy and systematic biopsy, and those with a PI-RADS V2 score ≤ 2 only accepted systematic biopsy. Overall prostate cancer detection rate between the two biopsies was compared. MRI-TRUS cognitive fusion targeted biopsy identified 342 cases (75.7%) of prostate cancer while systematic biopsy identified 358 cases (79.2%). There was no significant difference in the detection rate between the two groups ( = 1.621, = 0.203). Targeted biopsy had significant fewer biopsy cores compared with systematic biopsy, reducing (9.3 ± 0.11) cores ( < 0.001) in average. Targeted biopsy had about 10.8% ( < 0.001) more tumor tissues in positive cores compared with systematic biopsy. The results show that both MRI-TRUS cognitive fusion targeted biopsy and systematic biopsy have good detection rate on prostate cancer. Cognitive targeted biopsy may reduce biopsy cores and provide more tumor tissues in positive cores.
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Humans , Male , Biopsy , Methods , Image-Guided Biopsy , Magnetic Resonance Imaging, Interventional , Prospective Studies , Prostatic Neoplasms , Diagnostic Imaging , Ultrasonography, InterventionalABSTRACT
Objective To evaluate whether prostate specific antigen density(PSAD) could improve the multi-parametric MRI detection of prostate cancer.Methods A total of 110 men from Beijing United Family Hospital and clinics undergoing systematic biopsy + MRI-targeted biopsy from April 2013 to March 2019 were included in the study.The median age was 63.5 years (43.0-84.0 years),median prostate specific antigen (PSA)was 7.0 ng/ml (0.7-43.4 ng/ml),median PSAD was 0.16ng/ml2 (0.03-1.15 ng/ml2),median PI-RADS was 3.5 (2.0-5.0).Results A total of 45 cases of prostate cancer were detected,including 32 cases of clinically significant prostate cancer.Systematic biopsy detected 36 cases of prostate cancer,including 23 cases of clinically significant prostate cancer;MRI-targeted biopsy detected 38 cases of prostate cancer,including 27 cases of clinically significant prostate cancer.For MRI-targeted biopsy,the area under curve (AUC) of PSAD,PI-RADS and PSAD + PI-RADS were 0.807,0.757,0.841 for prostate cancer and were 0.806,0.78,0.862 for clinically significant prostate cancer.PSAD + PI-RADS achieved significantly superior AUC compared with PI-RADS alone for both prostate cancer detection (P =0.0034) and clinically significant prostate cancer detection (P =0.0128).For systematic biopsy + MRI-targeted biopsy,the AUC of PSAD,PI-RADS and PSAD + PI-RADS were 0.765,0.791,0.857 for prostate cancer and were 0.790,0.785,0.853 for clinically significant prostate cancer.PSAD + PI-RADS showed significantly higher AUC compared with P[-RADS for prostate cancer detection (P =0.0042) and clinically significant prostate cancer detection(P =0.0170).Conclusions For prostate biopsy na(i)ve men,PSAD + PI-RADS showed significantly higher predictive value than PI-RADS alone for prostate cancer and clinically significant prostate cancer detection either by MRI-targeted biopsy or by systematic biopsy + MRI-targeted biopsy.
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Objective To investigate the influence of preoperative biopsy protocols difference on the material amount and operation time of patients with gastric cancer for early stage underwent ESD. Methods 60 patients with gastric cancer for early stage underwent ESD were chosen from June 2013 to June 2016 and randomly divided into A group (30 patients) with multiple times and points biopsies and B group (30 patients) with targeted biopsy before surgery; the biopsy number, the total number of specimens, the postoperative pathological coincidence rate and the ESD operation time of the two groups were compared. Results The biopsy number and the total number of specimens of B group were significant shorter than that in A group (P < 0.05). The postoperative pathological coincidence rate of B group were significant higher than that in A group (P < 0.05). There was no significant difference in the time of resection range determined, labeling, submucosal injection and specimen resection handling between the two groups (P > 0.05). The time of mucous membrane dissection, hemostasis and wound handling of B group were significant shorter than that in A group (P < 0.05). Conclusion Compared with multiple times and points biopsies, targeted biopsy before surgery on patients with gastric cancer for early stage underwent ESD can efficiently reduce the trauma degree, improve the biopsy accuracy and be helpful to shorten the operation time.
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Objective To investigate the diagnostic accuracy of magnetic resonance imaging and ultrasound (MRI/US) fusion targeted biopsy (TB) and systematic biopsy (SB) in the patients with prostate specific antigen (PSA) in grey area.Methods The patients who received MRI/US fusion TB and SB in the First Affiliated Hospital of Soochow University between October 2015 and March 2018 were retrospectively reviewed.Eligibility criteria included:tPSA ranged 4 to 10 ng/ml;prebiopsy MRI found at least 1 suspected lesion;no prostate-related treatment history;no prostate biopsy history.A total of 93 patients were invloved.The median age,tPSA and prostate volume were 66 (30-85) years,7.18 (4.11-9.95) ng/ml and 42.01 (14.93-119.15) ml,respectively.Prebiopsy MRI found 136 suspected lesions,with the median PI-RADS of 3 (3-5) and lesion size of 7 (3-20) mm.All patients underwent MRI/US fusion TB followed by SB.The comparison of two protocols in detecting any prostate cancer (PCa) as well as clinically significant prostate cancer (CsPCa) were analyzed.Results Cancer detection rates for PCa in TB [34.40％ (32/93)] was not different with SB [36.55％ (34/93),P =0.759].There was no significant difference in the detection rate of CsPCa between TB and SB [20.43％ (19/93) vs.24.73％ (23/93),P=0.483].A total of 1 374 biopsy cores were sampled,among which 266 were TB cores and additional 1108 were SB cores.The positive rate of TB cores [24.81％ (66/266)] was significantly higher than SB cores [9.84％ (109/1 108),P ＜0.001].Conclusions In the patients with PSA in grey area,MRI/US fusion TB achieved similar cancer detection rate compared with SB using only few biopsy cores.Therefore,TB was appropriate for patients with MRI suspicions.Moreover,combination of TB with SB can achieve the highest cancer detection rate.
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Objective To compare the diagnostic accuracy of clinically significant prostate cancer by general radiologist and uroradiology specialist based on the Prostate Imaging Reporting and Data System (PI-RADS).Methods A total of 45 men from Beijing United Family Hospital and Clinics undergoing prostate mpMRI examination and subsequent MRI-targeted biopsy were included in the study.The age of patients was (60.0 ± 8.0) years,the median PSA level was 7.2 ng/ml (1.2-95.8 ng/ml) and the median prostate volume was 45.0 ml (18.3-127.0 ml).The general radiologists from Beijing United Family Hospital and Clinics made the diagnosis according to PI-RADS 2.0.One uroradiology specialist from Beijing Anzhen hospital reviewed all the mpMRIs retrospectively and marked new PI-RADS score based on PI-RADS 2.0.The PI-RADS ≥ 3 lesion was recognized as suspicious of clinically significant prostate cancer.The distribution of PI-RADS score from different doctors and the diagnostic accuracy of clinically significant prostate cancer was compared.Results All the 45 patients underwent MRI-targeted cognitive biopsy and 14 cases of prostate cancer were detected,including 9 cases of clinically significant prostate cancer.There was no significant difference in the distribution of PI-RADS by general radiologist and uroradiology specialist (P =0.064).82.8％ (37/45) and 37.8％ (17/45) patients were diagnosed with PI-RADS ≥ 3 by general radiologist and uroradiology specialist respectively.The interobserver agreement was only 17.8％ (8/45).The positive predictive value of PI-RADS≥3 was 35.1％ (13/37) and 76.5％ (13/17) for prostate cancer by general radiologist and uroradiology specialist respectively,and for clinically significant prostate cancer,the positive predictive value of PI-RADS ≥ 3 was 21.6％ (8/37) and 52.9％ (9/17) respectively.Conclusions Uroradiology specialist achieved significantly superior in predictive value of PI-RADS for clinically significant prostate cancer compared with general radiologist.In the experienced centers,MRI-targeted biopsy could be performed only on high PI-RADS score lesions,thus to reduce unnecessary biopsies and to avoid over diagnosis and over treatment of prostate cancer.
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Background:Esophageal cancer is a commonly seen gastrointestinal malignancy. Early detection of superficial neoplastic lesions is critical for improving the prognosis. Therefore,it is of great importance to explore new endoscopic techniques for increasing the detection rate of early esophageal cancer. Aims:To assess the diagnostic accuracy of targeted biopsy guided by magnifying endoscopy combined with narrow-band imaging(ME-NBI)for suspected superficial lesions in esophagus. Methods:In a prospective cross-over designed trial,65 patients with suspected superficial lesions in esophagus detected by conventional gastroscopy were randomly assigned to group A and group B. Patients in group A received primary white light imaging(WLI)with Lugol’s staining followed by ME-NBI 4-6 weeks later,and patients in group B received primary ME-NBI followed by WLI with Lugol’s staining 4-6 weeks later. Random biopsy was performed in WLI with Lugol’s staining,while targeted biopsy was performed in ME-NBI based on Inoue’s intraepithelial papillary capillary loop (IPCL)classification. Results:A total of 58 patients completed the study and 68 lesions were eligible for statistical analysis. More biopsies were taken in WLI with Lugol’s staining than in ME-NBI(3. 7 vs. 2. 2 per lesion,P 0. 05). Conclusions:ME-NBI-guided targeted biopsy is superior to random biopsy by WLI with Lugol’s staining for detection of superficial neoplastic lesions in esophagus with higher sensitivity and less number of biopsy. It might benefit the follow-up endoscopic treatment.
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Objective To validate the value of MRI and ultrasound three-dimensional matrix positioning technique in transperineal targeted prostate biopsy so as to improve the positive rate of prostate biopsy. Methods A total of 15 patients received transperineal targeted prostate biopsy using MRI and ultrasound three-dimensional matrix positioning technique + traditional systemic prostate biopsy from Feb. 2015 to Jun. 2015 in Changhai Hospital, Second Military Medical University. The 15 patients met the following criteria:(1) at least one negative prostate biopsy; (2) had the indications for performing re-biopsy; and (3) MRI showed suspected sites of prostate cancer (the PI-RADS scores were 4-5). Before biopsy, all the MRI images were reconstructed and the three-dimensional coordinates(X, Y, Z axis) were confirmed. After general anesthesia, systemic prostate biopsy was performed under the guidance of transrectal ultrasound. Then the transrectal ultrasound-guided biopsy was carried out according to the location in previous MRI images, which were located by the three-dimensional coordinates (X, Y, Z axis). Results Fourteen (93. 3%) of the 15 patients were finally confirmed with prostate cancer, with 13 (86. 7%) being positive only in targeted biopsy, and 6 (40. 0%) being positive only in systemic biopsy. There was only 1 (6. 7%) whose targeted biopsy result was negative and systemic biopsy result was positive, and there were 8 cases (53. 3%) with positive targeted biopsy but negative systemic biopsy. Only 1 case (6. 7%) was negative in both targeted biopsy and systemic prostate biopsy. There was significant difference in positive rates between the targeted biopsy and systemic biopsy (P=0. 002). Conclusion Transperineal targeted prostate biopsy with MRI and ultrasound three-dimensional matrix positioning technique can accurately locate and target puncture the suspected site of prostate cancer in MRI images, and it has a higher diagnostic efficiency especially for the sites which are relatively easy to be missed by systemic prostate biopsy, but its performance still needs further large sample studies.
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<p><b>Objective</b>To improve the accuracy of prostate cancer (PCa) detection by focusing biopsy on the suspected lesion manifested by MRI with the total number of biopsy cores relatively unchanged.</p><p><b>METHODS</b>A prospective randomized analysis was performed on 262 cases of suspected PCa detected by multi-parametric MRI (mp-MRI), each with a single suspected lesion with 10 μg/L≤ PSA <20 μg/L. All the patients underwent targeted transrectal prostate biopsy guided by fusion imaging of MRI with transrectal ultrasonography (TRUS), using the 6X+6 strategy (6 cores in the suspected region and another 6 in the systematic prostate) for 134 cases and the traditional 12+2X method (12 cores in the systematic prostate and 2 in the suspected region) for the other 128. Comparisons were made between the two methods in the PCa detection rate in the cases of suspected lesion, total PCa detection rate, incidence of post-biopsy complications, and Gleason scores. Analyses were performed on the prostate imaging reporting and data system (PI-RADS) score, location, transverse section, and diameter of the suspected lesion.</p><p><b>RESULTS</b>Both the total PCa detection rate and that in the cases of suspected lesion were significantly higher in the 6X+6 (44.8% and 37.3%) than in the 12+2X group (37.5% and 27.3%) (P<0.05). MRI showed that the suspected lesions were mostly (45%) located in the middle part of the prostate, the mean area of the transverse section was (0.48±0.11) cm2, and the mean diameter of the tumor was (8.51±2.21) mm. The results of biopsy showed that low-grade tumors (Gleason 3+3=6) accounted for 68% in the 6X+6 group and 71% in the 12+2X group. No statistically significant differences were found between the two groups in the incidence rate of post-biopsy complications.</p><p><b>CONCLUSIONS</b>Compared with the traditional 12+2X method, for the suspected lesion manifested by mp-MRI, focusing biopsy on the suspected region with the 6X+6 strategy can achieve a higher PCa detection rate without increasing the incidence of complications.</p>
Subject(s)
Humans , Male , Image-Guided Biopsy , Methods , Magnetic Resonance Imaging , Methods , Magnetic Resonance Imaging, Interventional , Neoplasm Grading , Prospective Studies , Prostate , Diagnostic Imaging , Pathology , Prostate-Specific Antigen , Blood , Prostatic Neoplasms , Blood , Diagnostic Imaging , PathologyABSTRACT
Systemic transrectal ultrasound-guided biopsy (TRUSBx) is the standard procedure for diagnosing prostate cancer (PCa), but reveals a limited accuracy for the detection of cancer. Currently, multiparametric MR imaging (mp-MRI) is increasingly regarded as a promising method to detect PCa with an excellent positive predictive value. The use of mp-MRI during a MRI-guided biopsy (MRGB) procedure improves the quality of a targeted biopsy. The aim of this article is to provide an overview about the MRGB technique for PCa detection, to review the accuracy and clinical indications of MRGB and discuss its current issues and further directions. A MRGB seems accurate and efficient for the detection of clinically significant PCa in men with previous negative TRUSBx. Moreover, it may decrease the detection of clinically insignificant cancers with fewer biopsy cores.
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Humans , Male , Image-Guided Biopsy , Magnetic Resonance Imaging , Neoplasm Staging , Prostate/pathology , Prostatic Neoplasms/pathologyABSTRACT
Objective To discuss the differential diagnostic value of confocal laser endomicroscopy (CLE)for benign and malignant non-protruding gastric lesions.Methods A total of 37 patients with nonprotruding gastric lesions diagnosed by conventional gastroscopy underwent CLE.Fluorescein sodium was intravenously injected,and target biopsy was obtained.Malignant lesionss diagnosed with CLE or biopsy were treated by endoscopy or surgery.Patients with benign lesions were give routine medication and followed up every 3 months until the lesions were cured.Results CLE diagnosed 11 malignant and 26 benign lesions.However,1 of 11 cancers was confirmed as benign by histopathology,while 1 of 26 benign lesions was confirmed cancer.Lesions in 12 patients were resected,with 3 by endoscopy,and 9 by surgery,and findings of post-operative pathology were consistent with those of target biopsy.No malignancy was found during the follow-up of benign lesions,and all lesions were healed after 3.16(3.58 ± 1.20)months.The sensitivity,specificity,and accuracy of CLE in diagnosis of malignant non-protruding gastric lesion were 90.9％,96.2％,and 90.9％,respectively.The positive and negative predictive values were 90.9％ and 96.2％,respectively.The Kappa value of CLE and histopathology was 0.871.Conclusion CLE is of significant value for the diagnosis of non-protruding gastric lesions,and may replace biopsy in real-time histological diagnosis.