Institutional Experience of Magnetic Resonance Imaging–directed Targeted Transrectal Ultrasound–guided Prostate Biopsy
YHA Tsang, CHS Lam, PP Iu, HY Cho
Hong Kong J Radiol 2016;19:10-8
DOI: 10.12809/hkjr1615312
Objective: To evaluate the efficacy of magnetic resonance imaging (MRI)–directed targeted transrectal ultrasound (TRUS) prostate biopsy in the detection of clinically significant prostate cancer.
Methods: The records of patients who underwent MRI-directed targeted TRUS prostate biopsy from August 2013 to December 2014 in a regional hospital in Hong Kong were retrospectively reviewed. The procedure was indicated in patients with persistently elevated prostate-specific antigen (PSA) and at least two consecutive negative random systematic TRUS prostate biopsies. Pre-biopsy MRI localisation was arranged. Multiparametric MRI of the prostate (T2-weighted, diffusion-weighted imaging, apparent diffusion coefficient, dynamic contrast–enhanced imaging, and spectroscopy) was performed and each lesion was mapped to one of 16 sectors of the prostate. Prostate Imaging–Reporting and Data System (PI-RADS) classification was used to score each suspicious lesion. TRUS-guided prostate biopsy was then performed at the sector with PI-RADS score of ≥3. Pathological reports were reviewed and cancer detection rate was calculated.
Results: Overall, 27 patients were referred during the study period. Of these patients, seven (25.9%) had positive findings: prostatic acinar adenocarcinoma was identified in six, and high-grade prostatic intra-epithelial neoplasia in one. Among the six patients with adenocarcinoma, three had a Gleason score of ≥7, and three had a score of 6. There was a cancer detection rate of 25.9% in our population with negative random TRUS biopsies and persistently elevated PSA.
Conclusion: MRI-directed targeted TRUS prostate biopsy is able to further detect prostate cancer that requires treatment in patients with persistently elevated PSA and repeated negative random TRUS biopsy. The cancer detection rate from our institution is comparable to other reported studies. MRI-directed targeted TRUS prostate biopsy requires no significant extra resources, and may help selected patients in our locality.
中文摘要
根據磁共振成像經直腸超聲引導下的前列腺穿刺活檢：一所機構的經驗
曾彥豪、林卓恆、姚寶平、曹慶恩
目的：探討根據磁共振成像（MRI）經直腸超聲引導下（TRUS）的前列腺穿刺活檢用作檢測前列腺癌的效果。
方法：研究對象為在2013至8月至2014年12月期間到香港一所分區醫院接受MRI指導TRUS前列腺穿刺活檢的病人，回顧分析其病歷紀錄。病人均有持續高水平的前列腺特異性抗原（PSA），以及至少兩個連續TRUS的前列腺活檢陰性。活檢前先以MRI定位，並進行多參數MRI（T2加權、擴散加權成像、表觀擴散係數、動態對比增強成像和磁共振波普），把每個病變定位到前列腺16個分區中的其中一個。再利用前列腺影像學報告和數據系統指南（PI-RADS）為每個可疑的病變評分。PI-RADS分數≥3時進行TRUS前列腺穿刺活檢。最後審查患者的病理報告，並計算出癌症檢測率。
結果：研究期間27名患者中7例（25.9%）有陽性結果，包括6例前列腺腺泡腺癌及1例高級別前列腺上皮內瘤。6例腺癌中，3例Gleason評分≥7，另3例評分為6。在這研究中，有持續高水平PSA和TRUS引導下前列腺活檢陰性樣本的癌症檢測率為25.9%。
結論：對於有持續高水平PSA和前列腺活檢陰性樣本的患者，以MRI定位的TRUS引導下前列腺穿刺活檢能進一步提高前列腺癌檢出率。我們醫院的癌症檢出率與其他研究報導相近，而且這種檢測方式無需額外設備。以MRI定位的前列腺穿刺活檢可以在本地選擇性地應用於患者身上。