Objective This study aimed to compare the upgrade rate and cancer detection rate between the 18F-DCFPyL PET/MRI-guided ultrasound fusion targeted biopsy(TB)and systematic biopsy in selected patients with suspected pro...Objective This study aimed to compare the upgrade rate and cancer detection rate between the 18F-DCFPyL PET/MRI-guided ultrasound fusion targeted biopsy(TB)and systematic biopsy in selected patients with suspected prostate cancer(the molecular imaging prostate-specific membrane antigen score of≥2 and multiparametric MRI Prostate Imaging Reporting and Data System score of≥4).Methods Eighty-seven selected biopsy-naive patients were randomized into two groups:TB(n=41)and systematic biopsy(control;n=46).Patients diagnosed with clinically significant prostate cancer proceeded to radical prostatectomy.The primary outcome was the pathological upgrade rate.Secondary outcomes,including the cancer detection rate,incidence of repeat biopsy,positive surgical margin,complications,and prostate-specific antigen level at 6 weeks postoperatively,were compared between the groups using the Pearson or Fisher's exact test,as appropriate.Results In the study,prostate cancer was ultimately detected in all patients.The TB group successfully identified all tumors,whereas five patients in the control group initially missed diagnosis.The pathological upgrade rates for the TB and control groups were 31.7%and 56.5%,respectively.Overall,the detection rate for clinically significant prostate cancer(the International Society of Urological Pathology grade of≥2)was significantly higher in the TB group(92.7%)compared with the control group(76.1%,p=0.035).However,no significant difference was found in the detection rate of all prostate cancer.Complications(Clavien–Dindo grade of≤2)occurred in both the TB group(n=11)and control group(n=13).No statistically significant difference was observed between the groups in terms of the positive surgical margin,complications,or 6-week postoperative prostate-specific antigen level.Conclusion The 18F-DCFPyL PET/MRI-guided ultrasound fusion TB alone was an efficient modality in diagnosing selected patients with prostate cancer.展开更多
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 ...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.展开更多
Prostate cancer is the second most common cancer in men, with 1.1 million new cases worldwide reported by the World Health Organization in one recent year. Transrectal ultrasound （TRUS）-guided biopsy has been used f...Prostate cancer is the second most common cancer in men, with 1.1 million new cases worldwide reported by the World Health Organization in one recent year. Transrectal ultrasound （TRUS）-guided biopsy has been used for the diagnosis of prostate cancer for over 2 decades, but the technique is usually blind to cancer location. Moreover, the false negative rate of TRUS biopsy has been reported to be as high as 47%. Multiparametric magnetic resonance imaging （mp-MRI） includes T1- and T2-weighted imaging as well as dynamic contrast-enhanced （DCE） and diffusion-weighted imaging （DWI）. mp-MRI is a major advance in the imaging of prostate cancer, enabling targeted biopsy of suspicious lesions. Evolving targeted biopsy techniquesmincluding direct in-bore biopsy, cognitive fusion and software-based MRI-ultrasound （MRI-US） fusion--have led to a several-fold improvement in cancer detection compared to the earlier method. Importantly, the detection of clinically significant cancers has been greatly facilitated by targeting, compared to systematic biopsy alone. Targeted biopsy via MRI-US fusion may dramatically alter the way prostate cancer is diagnosed and managed.展开更多
Objective:Active surveillance(AS)offers a strategy to reduce overtreatment and now is a widely accepted treatment option for low-risk prostate cancer.An ideal tool for risk-stratification would detect aggressive cance...Objective:Active surveillance(AS)offers a strategy to reduce overtreatment and now is a widely accepted treatment option for low-risk prostate cancer.An ideal tool for risk-stratification would detect aggressive cancers and exclude such men from taking up AS in the first place.We evaluate if a combination of transperineal template biopsy with magnetic resonance imaging(MRI)-targeted biopsy identifies significant prostate cancer amongst men initially diagnosed with low-risk prostate cancer.Methods:This prospective,single-blinded study included men with low-risk prostate cancer(D’Amico’s Criteria)diagnosed on conventional transrectal ultrasound-guided biopsy.Patients first underwent multiparametric MRI of the prostate6 weeks after initial biopsy.Each suspicious lesion is mapped and assigned a Prostate Imaging Reporting and Data System(PIRADS)score.Template biopsy is first performed with the surgeon blinded to MRI findings followed by MRI-targeted biopsy using a robotic transperineal biopsy platform.Results:The age of the 19 men included is 65.4±4.9 years(mean±SD).Prostate specific antigen(PSA)at diagnosis and at the time of transperineal biopsy were comparable(7.3±1.7 ng/mL and 7.0±1.8 ng/mL,p Z 0.67),so were prostate volumes(34.2±8.9 mL and 32.1±13.4 mL,p Z 0.28).MRI-targeted biopsy had a higher percentage of cancer detection per core compared to template biopsy(11.7%vs.6.5%,p Z 0.02),this was more than 3 times superior for Gleason 7 disease(5.9%vs.1.6%,p<0.01).Four of 18(22.2%)patients with MRI lesions had significant disease with MRI-targeted biopsy alone.Three of 19 patients(15.8%)had significant disease with template biopsy alone.In combination,both techniques upclassified five patients(26.3%),all of whom underwent radical prostatectomy.Whole mount histology confirmed tumour location and grade.All six patients with PIRADS 5 lesions had cancer detected(66.6%significant disease).Conclusion:A combination of MRI-targeted and template biopsy may optimally risk-classify“low-risk”patients diagnosed on initial conventional transrectal ultrasonography(TRUS)prostate biopsy.展开更多
Prostate-targeted biopsy is usually the preferred method over systematic biopsy because it can effectively detect prostate cancer using only a few puncture cores with fewer complications.With the development of ultras...Prostate-targeted biopsy is usually the preferred method over systematic biopsy because it can effectively detect prostate cancer using only a few puncture cores with fewer complications.With the development of ultrasound,it has gained multimodal technological upgrades,such as the emergence of contrast-enhanced ultrasound,ultrasound elastography,and three-dimensional ultrasonography.Moreover,multimodal ultrasound has played an increasingly significant role in prostate-targeted biopsies.展开更多
The aim of this study was to compare the accuracies of cognitive fusion-guided targeted biopsy(TB),systematic biopsy(SB),and combined TB+SB for the detection of prostate cancer(PCa)and clinically significant PCa(csPCa...The aim of this study was to compare the accuracies of cognitive fusion-guided targeted biopsy(TB),systematic biopsy(SB),and combined TB+SB for the detection of prostate cancer(PCa)and clinically significant PCa(csPCa)in males with lesions detected by magnetic resonance imaging(MRI).We conducted a retrospective analysis of individuals who underwent prostate biopsy at Peking University People's Hospital(Beijing,China),with an emphasis on patients with both transrectal TB and SB.The main objective was to determine the precisions of SB,TB,and TB+SB for diagnosing PCa and csPCa.We also evaluated the detection rates of TB,SB,TB+ipsilateral-SB(ipsi-SB),TB+contralateral-SB(contra-SB),and TB+SB for PCa and csPCa in patients with unilateral MRI lesions.We compared the diagnostic yields of the various biopsy schemes using the McNemar’s test.A total of 180 patients were enrolled.The rates of PCa detection using TB,SB,and TB+SB were 52.8%,62.2%,and 66.7%,respectively,and the corresponding rates for csPCa were 46.1%,56.7%,and 58.3%,respectively.Among patients with unilateral MRI lesions,the PCa detection rates for TB,SB,TB+ipsi-SB,TB+contra-SB,and TB+SB were 53.3%,64.8%,65.6%,61.5%,and 68.0%,respectively.TB+ipsi-SB detected 96.4%of PCa and 95.9%of csPCa cases.These findings suggest that the combination of TB+SB has better diagnostic accuracy compared with SB or TB alone.For patients with unilateral MRI lesions,the combination of TB+ipsi-SB may be suitable in clinical settings.展开更多
Introduction: Prostate cancer (PCa) is the third most prevalent cancer among Malaysian males, often diagnosed at advanced stages, leading to suboptimal outcomes. While transrectal ultrasound-guided systematic biopsy (...Introduction: Prostate cancer (PCa) is the third most prevalent cancer among Malaysian males, often diagnosed at advanced stages, leading to suboptimal outcomes. While transrectal ultrasound-guided systematic biopsy (TRUS-SB) is the primary diagnostic method, prebiopsy multiparametric magnetic resonance imaging (mpMRI) is gaining popularity in identifying suspicious lesions. This study addresses the lack of comprehensive investigations into the efficacy of cognitive registration TRUS targeted biopsy (COG-TB) compared to conventional TRUS-SB, considering the resource limitations of the Malaysian healthcare system. Materials and Methods: A retrospective cohort study was conducted in two Malaysian healthcare facilities. 116 adult patients with a prostate-specific antigen (PSA) level of more than 4 ng/mL who underwent both COG-TB and TRUS-SB between October 2020 and March 2022 were included. Primary outcomes were cancer detection rate and histopathological outcomes, including Gleason score. Results: COG-TB showed a higher overall cancer detection rate (50%) compared to TRUS-SB (44%). Clinically significant cancer detection rates were similar between COG-TB and TRUS-SB (37.1%). Further analysis revealed that both COG-TB and TRUS-SB detected clinically significant cancer in 30.2% of patients, did not detect it in 56.0%, and had conflicting findings in 16 patients (p Conclusion: COG-TB and TRUS-SB have comparable detection rates for clinically significant prostate cancer, with COG-TB showing a higher tendency to detect insignificant prostate cancer. Further studies comparing these methods are warranted.展开更多
Objective:Multiparametric magnetic resonance imaging(MP-MRI)helps to identify lesion of prostate with reasonable accuracy.We aim to describe the various uses of MP-MRI for prostate biopsy comparing different technique...Objective:Multiparametric magnetic resonance imaging(MP-MRI)helps to identify lesion of prostate with reasonable accuracy.We aim to describe the various uses of MP-MRI for prostate biopsy comparing different techniques of MP-MRI guided biopsy.Materials and methods:A literature search was performed for“multiparametric MRI”,“MRI fusion biopsy”,“MRI guided biopsy”,“prostate biopsy”,“MRI cognitive biopsy”,“MRI fusion biopsy systems”,“prostate biopsy”and“cost analysis”.The search operation was performed using the operator“OR”and“AND”with the above key words.All relevant systematic reviews,original articles,case series,and case reports were selected for this review.Results:The sensitivity of MRI targeted biopsy(MRI-TB)is between 91%e93%,and the specificity is between 36%e41%in various studies.It also has a high negative predictive value(NPV)of 89%e92%and a positive predictive value(PPV)of 51%e52%.The yield of MRI fusion biopsy(MRI-FB)is similar,if not superior to MR cognitive biopsy.In-bore MRI-TB had better detection rates compared to MR cognitive biopsy,but were similar to MR fusion biopsy.Conclusions:The use of MRI guidance in prostate biopsy is inevitable,subject to availability,cost,and experience.Any one of the three modalities(i.e.MRI cognitive,MRI fusion and MRI in-bore approach)can be used.MRI-FB has a fine balance with regards to accuracy,practicality and affordability.展开更多
Lack of investment for magnetic resonance(MR)fusion systems is an obstacle to deliver targeted prostate biopsies within the prostate cancer diagnostic pathway.We developed a coordinate-based method to support cognitiv...Lack of investment for magnetic resonance(MR)fusion systems is an obstacle to deliver targeted prostate biopsies within the prostate cancer diagnostic pathway.We developed a coordinate-based method to support cognitive targeted prostate biopsies and then performed an audit on cancer detection and the location of lesions.In each patient,the prostate is considered as two separate hemiprostates,and each hemiprostate is divided into 4×4×4 units.Each unit is therefore defined by a three-dimensional coordinate.We prospectively applied our coordinates approach to target 106 prostatic lesions in 93 men.Among 45(of 106;42.5%)lesions positive for cancer,27 lesions(60.0%)harbored clinically significant disease.PSA density was significantly higher in patients with proven cancer(median:0.264 ng ml^(-2))when compared to the noncancer group(median:0.145 ng ml-2;P=0.003,Wilcoxon ranksum test).Lesions with Prostate Imaging-Reporting and Data System(PIRADS)score of 5 were found to have a cancer incidence of 65.2%,while PI RADS 4 and 3 lesions have a lower risk of cancer detection,as expected,at 37.3%and 31.3%,respectively.The probability of a lesion being cancerous in our series significantly decreases as we go from the“apex-to-base”dimension(odds ratio[OR]:2.62,95%confidence interval[Cl]:1.55-4.44,P=0.00034).Our analysis also indicates that the probability of cancer decreases as the prostate volume increases(OR:1.03,95%Cl:1.01-1.05,P=0.00327).Based on this feasibility study,the use of coordinates to guide cognitive targeted prostate biopsies warrants future validation study in additional centers.展开更多
基金supported by the Youth support Program of Chinese General Hospital (Grand Number: 22QNFC044 to Niu S).
文摘Objective This study aimed to compare the upgrade rate and cancer detection rate between the 18F-DCFPyL PET/MRI-guided ultrasound fusion targeted biopsy(TB)and systematic biopsy in selected patients with suspected prostate cancer(the molecular imaging prostate-specific membrane antigen score of≥2 and multiparametric MRI Prostate Imaging Reporting and Data System score of≥4).Methods Eighty-seven selected biopsy-naive patients were randomized into two groups:TB(n=41)and systematic biopsy(control;n=46).Patients diagnosed with clinically significant prostate cancer proceeded to radical prostatectomy.The primary outcome was the pathological upgrade rate.Secondary outcomes,including the cancer detection rate,incidence of repeat biopsy,positive surgical margin,complications,and prostate-specific antigen level at 6 weeks postoperatively,were compared between the groups using the Pearson or Fisher's exact test,as appropriate.Results In the study,prostate cancer was ultimately detected in all patients.The TB group successfully identified all tumors,whereas five patients in the control group initially missed diagnosis.The pathological upgrade rates for the TB and control groups were 31.7%and 56.5%,respectively.Overall,the detection rate for clinically significant prostate cancer(the International Society of Urological Pathology grade of≥2)was significantly higher in the TB group(92.7%)compared with the control group(76.1%,p=0.035).However,no significant difference was found in the detection rate of all prostate cancer.Complications(Clavien–Dindo grade of≤2)occurred in both the TB group(n=11)and control group(n=13).No statistically significant difference was observed between the groups in terms of the positive surgical margin,complications,or 6-week postoperative prostate-specific antigen level.Conclusion The 18F-DCFPyL PET/MRI-guided ultrasound fusion TB alone was an efficient modality in diagnosing selected patients with prostate cancer.
基金the Fund for National Natural Science Foundation Youth Project(No.81702514,to RC).
文摘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.
文摘Prostate cancer is the second most common cancer in men, with 1.1 million new cases worldwide reported by the World Health Organization in one recent year. Transrectal ultrasound （TRUS）-guided biopsy has been used for the diagnosis of prostate cancer for over 2 decades, but the technique is usually blind to cancer location. Moreover, the false negative rate of TRUS biopsy has been reported to be as high as 47%. Multiparametric magnetic resonance imaging （mp-MRI） includes T1- and T2-weighted imaging as well as dynamic contrast-enhanced （DCE） and diffusion-weighted imaging （DWI）. mp-MRI is a major advance in the imaging of prostate cancer, enabling targeted biopsy of suspicious lesions. Evolving targeted biopsy techniquesmincluding direct in-bore biopsy, cognitive fusion and software-based MRI-ultrasound （MRI-US） fusion--have led to a several-fold improvement in cancer detection compared to the earlier method. Importantly, the detection of clinically significant cancers has been greatly facilitated by targeting, compared to systematic biopsy alone. Targeted biopsy via MRI-US fusion may dramatically alter the way prostate cancer is diagnosed and managed.
文摘Objective:Active surveillance(AS)offers a strategy to reduce overtreatment and now is a widely accepted treatment option for low-risk prostate cancer.An ideal tool for risk-stratification would detect aggressive cancers and exclude such men from taking up AS in the first place.We evaluate if a combination of transperineal template biopsy with magnetic resonance imaging(MRI)-targeted biopsy identifies significant prostate cancer amongst men initially diagnosed with low-risk prostate cancer.Methods:This prospective,single-blinded study included men with low-risk prostate cancer(D’Amico’s Criteria)diagnosed on conventional transrectal ultrasound-guided biopsy.Patients first underwent multiparametric MRI of the prostate6 weeks after initial biopsy.Each suspicious lesion is mapped and assigned a Prostate Imaging Reporting and Data System(PIRADS)score.Template biopsy is first performed with the surgeon blinded to MRI findings followed by MRI-targeted biopsy using a robotic transperineal biopsy platform.Results:The age of the 19 men included is 65.4±4.9 years(mean±SD).Prostate specific antigen(PSA)at diagnosis and at the time of transperineal biopsy were comparable(7.3±1.7 ng/mL and 7.0±1.8 ng/mL,p Z 0.67),so were prostate volumes(34.2±8.9 mL and 32.1±13.4 mL,p Z 0.28).MRI-targeted biopsy had a higher percentage of cancer detection per core compared to template biopsy(11.7%vs.6.5%,p Z 0.02),this was more than 3 times superior for Gleason 7 disease(5.9%vs.1.6%,p<0.01).Four of 18(22.2%)patients with MRI lesions had significant disease with MRI-targeted biopsy alone.Three of 19 patients(15.8%)had significant disease with template biopsy alone.In combination,both techniques upclassified five patients(26.3%),all of whom underwent radical prostatectomy.Whole mount histology confirmed tumour location and grade.All six patients with PIRADS 5 lesions had cancer detected(66.6%significant disease).Conclusion:A combination of MRI-targeted and template biopsy may optimally risk-classify“low-risk”patients diagnosed on initial conventional transrectal ultrasonography(TRUS)prostate biopsy.
文摘Prostate-targeted biopsy is usually the preferred method over systematic biopsy because it can effectively detect prostate cancer using only a few puncture cores with fewer complications.With the development of ultrasound,it has gained multimodal technological upgrades,such as the emergence of contrast-enhanced ultrasound,ultrasound elastography,and three-dimensional ultrasonography.Moreover,multimodal ultrasound has played an increasingly significant role in prostate-targeted biopsies.
基金supported by the National Natural Science Foundation of China(No.82071777)Peking University People's Hospital Scientific Research Development Funds(No.RDJP2022-10).
文摘The aim of this study was to compare the accuracies of cognitive fusion-guided targeted biopsy(TB),systematic biopsy(SB),and combined TB+SB for the detection of prostate cancer(PCa)and clinically significant PCa(csPCa)in males with lesions detected by magnetic resonance imaging(MRI).We conducted a retrospective analysis of individuals who underwent prostate biopsy at Peking University People's Hospital(Beijing,China),with an emphasis on patients with both transrectal TB and SB.The main objective was to determine the precisions of SB,TB,and TB+SB for diagnosing PCa and csPCa.We also evaluated the detection rates of TB,SB,TB+ipsilateral-SB(ipsi-SB),TB+contralateral-SB(contra-SB),and TB+SB for PCa and csPCa in patients with unilateral MRI lesions.We compared the diagnostic yields of the various biopsy schemes using the McNemar’s test.A total of 180 patients were enrolled.The rates of PCa detection using TB,SB,and TB+SB were 52.8%,62.2%,and 66.7%,respectively,and the corresponding rates for csPCa were 46.1%,56.7%,and 58.3%,respectively.Among patients with unilateral MRI lesions,the PCa detection rates for TB,SB,TB+ipsi-SB,TB+contra-SB,and TB+SB were 53.3%,64.8%,65.6%,61.5%,and 68.0%,respectively.TB+ipsi-SB detected 96.4%of PCa and 95.9%of csPCa cases.These findings suggest that the combination of TB+SB has better diagnostic accuracy compared with SB or TB alone.For patients with unilateral MRI lesions,the combination of TB+ipsi-SB may be suitable in clinical settings.
文摘Introduction: Prostate cancer (PCa) is the third most prevalent cancer among Malaysian males, often diagnosed at advanced stages, leading to suboptimal outcomes. While transrectal ultrasound-guided systematic biopsy (TRUS-SB) is the primary diagnostic method, prebiopsy multiparametric magnetic resonance imaging (mpMRI) is gaining popularity in identifying suspicious lesions. This study addresses the lack of comprehensive investigations into the efficacy of cognitive registration TRUS targeted biopsy (COG-TB) compared to conventional TRUS-SB, considering the resource limitations of the Malaysian healthcare system. Materials and Methods: A retrospective cohort study was conducted in two Malaysian healthcare facilities. 116 adult patients with a prostate-specific antigen (PSA) level of more than 4 ng/mL who underwent both COG-TB and TRUS-SB between October 2020 and March 2022 were included. Primary outcomes were cancer detection rate and histopathological outcomes, including Gleason score. Results: COG-TB showed a higher overall cancer detection rate (50%) compared to TRUS-SB (44%). Clinically significant cancer detection rates were similar between COG-TB and TRUS-SB (37.1%). Further analysis revealed that both COG-TB and TRUS-SB detected clinically significant cancer in 30.2% of patients, did not detect it in 56.0%, and had conflicting findings in 16 patients (p Conclusion: COG-TB and TRUS-SB have comparable detection rates for clinically significant prostate cancer, with COG-TB showing a higher tendency to detect insignificant prostate cancer. Further studies comparing these methods are warranted.
文摘Objective:Multiparametric magnetic resonance imaging(MP-MRI)helps to identify lesion of prostate with reasonable accuracy.We aim to describe the various uses of MP-MRI for prostate biopsy comparing different techniques of MP-MRI guided biopsy.Materials and methods:A literature search was performed for“multiparametric MRI”,“MRI fusion biopsy”,“MRI guided biopsy”,“prostate biopsy”,“MRI cognitive biopsy”,“MRI fusion biopsy systems”,“prostate biopsy”and“cost analysis”.The search operation was performed using the operator“OR”and“AND”with the above key words.All relevant systematic reviews,original articles,case series,and case reports were selected for this review.Results:The sensitivity of MRI targeted biopsy(MRI-TB)is between 91%e93%,and the specificity is between 36%e41%in various studies.It also has a high negative predictive value(NPV)of 89%e92%and a positive predictive value(PPV)of 51%e52%.The yield of MRI fusion biopsy(MRI-FB)is similar,if not superior to MR cognitive biopsy.In-bore MRI-TB had better detection rates compared to MR cognitive biopsy,but were similar to MR fusion biopsy.Conclusions:The use of MRI guidance in prostate biopsy is inevitable,subject to availability,cost,and experience.Any one of the three modalities(i.e.MRI cognitive,MRI fusion and MRI in-bore approach)can be used.MRI-FB has a fine balance with regards to accuracy,practicality and affordability.
文摘Lack of investment for magnetic resonance(MR)fusion systems is an obstacle to deliver targeted prostate biopsies within the prostate cancer diagnostic pathway.We developed a coordinate-based method to support cognitive targeted prostate biopsies and then performed an audit on cancer detection and the location of lesions.In each patient,the prostate is considered as two separate hemiprostates,and each hemiprostate is divided into 4×4×4 units.Each unit is therefore defined by a three-dimensional coordinate.We prospectively applied our coordinates approach to target 106 prostatic lesions in 93 men.Among 45(of 106;42.5%)lesions positive for cancer,27 lesions(60.0%)harbored clinically significant disease.PSA density was significantly higher in patients with proven cancer(median:0.264 ng ml^(-2))when compared to the noncancer group(median:0.145 ng ml-2;P=0.003,Wilcoxon ranksum test).Lesions with Prostate Imaging-Reporting and Data System(PIRADS)score of 5 were found to have a cancer incidence of 65.2%,while PI RADS 4 and 3 lesions have a lower risk of cancer detection,as expected,at 37.3%and 31.3%,respectively.The probability of a lesion being cancerous in our series significantly decreases as we go from the“apex-to-base”dimension(odds ratio[OR]:2.62,95%confidence interval[Cl]:1.55-4.44,P=0.00034).Our analysis also indicates that the probability of cancer decreases as the prostate volume increases(OR:1.03,95%Cl:1.01-1.05,P=0.00327).Based on this feasibility study,the use of coordinates to guide cognitive targeted prostate biopsies warrants future validation study in additional centers.
