Influencia de la curva de aprendizaje en el diagnóstico del cáncer de próstata mediante biopsia ecodirigida / Influence of learning curve in the diagnosis of prostate cancer by ultrasound guided biopsy

OBJETIVO: Analizar si existe una curva de aprendizaje hasta lograr realizar biopsias prostáticas ecodirigidas de alta calidad que permitan efectuar el diagnóstico de cáncer de próstata con eficacia, teniendo en cuenta el resultado anatomopatológico de las muestras. MÉTODOS: Se revisaron retrospectivamente los datos de las 790 biopsias de próstata ecodirigidas realizadas en nuestro servicio entre mayo de 2009 y diciembre 2012 por cuatro cirujanos de modo consecutivo. Se revisaron los siguientes datos: cirujano que la realizaba, fecha de realización, edad del paciente, PSA, tacto rectal, ecografía, volumen prostático, número de cilindros recogidos y resultado anatomopatológico de la biopsia. Los cirujanos eran médicos internos residentes de urología en su primer año en nuestro servicio. Para el análisis estadístico se agruparon las biopsias en bloques de 25 y 75 casos realizados por cirujano, ordenados cronológicamente. Para valorar la influencia de la curva de aprendizaje en el diagnóstico se realizó un análisis univariante y multivariante entre las distintas variables y el resultado anatomopatológico. RESULTADOS: La mediana de edad fue 67 años (42-90). Fueron positivas para cáncer de próstata 300 biopsias (38%). En el análisis univariante respecto a la tasa de detección de cáncer, las variables cirujano, PSA, tacto rectal, resultado ecográfico, volumen prostático, número de cilindros y grupos de 75 mostraron diferencias estadísticamente significativas, esta última mostró un porcentaje de 32% en las primeras 75 biopsias realizadas por los cirujanos y 43,2% en el último grupo. No las mostraron las variables edad (p = 0,11) y grupos de 25 pacientes (p = 0,07). En el análisis multivariante, sin embargo, únicamente fueron estadísticamente significativas las variables PSA, tacto rectal, volumen prostático y grupos de 75 pacientes, esta última con una OR de 1,35 (IC95% 1,09 - 1,66). CONCLUSIONES: Los resultados obtenidos en nuestro estudio muestran que sí influye el número de procedimientos realizados, es decir la experiencia del cirujano, para alcanzar una rentabilidad diagnóstica óptima en las biopsias de próstata ecodirigidas

OBJECTIVE: To analyze if there is a learning curve to get to perform high quality ultrasound guided prostate biopsies that enable to effectively perform the diagnosis of prostate cancer, taking the pathological result of the samples into consideration. METHODS: We retrospectively reviewed data from 790 ultrasound-guided biopsies performed consecutively in our center between May 2009 and December 2012 by four surgeons. We reviewed the following data: Surgeon, date of intervention, patient age, PSA, rectal digital examination (DRE), ultrasound, prostate volume, number of cores obtained, pathology result of the biopsy. The surgeons were residents in Urology in their first year in the department. For statistical analysis the biopsies were grouped in blocks of 25 and 75 cases performed by a surgeon, in a chronological order. To evaluate the influence of the learning curve on diagnosis we performed univariate and multivariate analysis between the different variables and pathological report. RESULTS: Median age was 67 years (42-90). 300 biopsies (38%) were positive for prostate cancer. On univariate analysis, regarding cancer detection rate, the variables surgeon, PSA, DRE, ultrasound result, prostate volume, number of cores and groups of 75 showed statistically significant differences, this latter showing 32% in the first 75 biopsies and 43.2% in the last group. The variables age (p = 0.11) and groups of 25 patients (p = 0.07) did not show differences. Nevertheless, on multivariate analysis only PSA, DRE, prostate volume and groups of 75 patients were statistically significant, this latter with an OR of 1.35 (95%CI 1.09-1.66). CONCLUSIONS: The results obtained in our study show that the number of procedures performed, namely surgeon experience, does have an influence to achieve an optimal diagnostic yield in ultrasound guided prostatic biopsies

[Influence of learning curve in the diagnosis of prostate cancer by ultrasound guided biopsy]. / INFLUENCIA DE LA CURVA DE APRENDIZAJE EN EL DIAGNÓSTICO DEL CÁNCER DE PRÓSTATA MEDIANTE BIOPSIA ECODIRIGIDA.

OBJECTIVE: To analyze if there is a learning curve to get to perform high quality ultrasound guided prostate biopsies that enable to effectively perform the diagnosis of prostate cancer, taking the pathological result of the samples into consideration. METHODS: We retrospectively reviewed data from 790 ultrasound-guided biopsies performed consecutively in our center between May 2009 and December 2012 by four surgeons. We reviewed the following data: Surgeon, date of intervention, patient age, PSA, rectal digital examination (DRE), ultrasound, prostate volume, number of cores obtained, pathology result of the biopsy. The surgeons were residents in Urology in their first year in the department. For statistical analysis the biopsies were grouped in blocks of 25 and 75 cases performed by a surgeon, in a chronological order. To evaluate the influence of the learning curve on diagnosis we performed univariate and multivariate analysis between the different variables and pathological report. RESULTS: Median age was 67 years (42-90). 300 biopsies (38%) were positive for prostate cancer. On univariate analysis, regarding cancer detection rate, the variables surgeon, PSA, DRE, ultrasound result, prostate volume, number of cores and groups of 75 showed statistically significant differences, this latter showing 32% in the first 75 biopsies and 43.2% in the last group. The variables age (p=0.11) and groups of 25 patients (p=0.07) did not show differences. Nevertheless, on multivariate analysis only PSA, DRE, prostate volume and groups of 75 patients were statistically significant, this latter with an OR of 1.35 (95%CI 1.09-1.66). CONCLUSIONS: The results obtained in our study show that the number of procedures performed, namely surgeon experience, does have an influence to achieve an optimal diagnostic yield in ultrasound guided prostatic biopsies.