Using Prostate Imaging-Reporting and Data System (PI-RADS) Scores to Select an Optimal Prostate Biopsy Method: A Secondary Analysis of the Trio Study

被引：36

作者：

Ahdoot, Michael ^{[1
]}

Lebastchi, Amir H. ^{[1
]}

Long, Lori ^{[2
]}

Wilbur, Andrew R. ^{[1
]}

Gomella, Patrick T. ^{[1
]}

Mehralivand, Sherif ^{[1
,3
]}

Daneshvar, Michael A. ^{[1
]}

Yerram, Nitin K. ^{[1
]}

O'Connor, Luke P. ^{[1
]}

Wang, Alex Z. ^{[1
]}

Gurram, Sandeep ^{[1
]}

Bloom, Jonathan ^{[1
]}

Siddiqui, M. Minhaj ^{[4
]}

Linehan, W. Marston ^{[1
]}

Merino, Maria ^{[5
]}

Choyke, Peter L. ^{[3
]}

Pinsky, Paul ^{[6
]}

Parnes, Howard ^{[6
]}

Shih, Joanna H. ^{[2
]}

Turkbey, Baris ^{[3
]}

Wood, Bradford J. ^{[7
,8
]}

Pinto, Peter A. ^{[1
]}

机构：

[1] NCI, Urol Oncol Branch, NIH, Bethesda, MD USA

[2] NCI, Biometr Res Program, Div Canc Treatment & Diag, NIH, Bethesda, MD USA

[3] Ctr Canc Res, Mol Imaging Program, NIH, Bethesda, MD USA

[4] Univ Maryland, Sch Med, Div Urol, Dept Surg, Baltimore, MD USA

[5] NCI, Translat Surg Pathol Sect, Ctr Canc Res, NIH, Bethesda, MD USA

[6] NCI, Canc Prevent Div, NIH, Bethesda, MD USA

[7] NCI, Ctr Intervent Oncol, NIH, Bethesda, MD USA

[8] NCI, Intervent Radiol Radiol & Imaging Sci, Natl Inst Hlth Clin Ctr, NIH, Bethesda, MD USA

来源：

EUROPEAN UROLOGY ONCOLOGY | 2022年 / 5卷 / 02期

关键词：

Prostate cancer; Prostate magnetic resonance imaging; Combined biopsy; Fusion biopsy; Prostate cancer diagnosis; Prostate Imaging-Reporting and; Data System; CONFIDENCE-INTERVALS; CANCER DETECTION; TARGETED BIOPSY; COMPLICATIONS; DIAGNOSIS; NUMBER; LESION; CORES; MRI;

D O I：

10.1016/j.euo.2021.03.004

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: While magnetic resonance imaging (MRI)-targeted biopsy (TBx) results in better prostate cancer (PCa) detection relative to systematic biopsy (SBx), the combination of both methods increases clinically significant PCa detection relative to either Bx method alone. However, combined Bx subjects patients to higher number of Bx cores and greater detection of clinically insignificant PCa. Objective: To determine if prebiopsy prostate MRI can identify men who could forgo combined Bx without a substantial risk of missing clinically significant PCa (csPC). Design, setting, and participants: Men with MRI-visible prostate lesions underwent combined TBx plus SBx. Outcome measurements and statistical analysis: The primary outcomes were detection rates for grade group (GG) >= 2 and GG >= 3 PCa by TBx and SBx, stratified by Prostate Imaging-Reporting and Data System (PI-RADS) score. Results and limitations: Among PI-RADS 5 cases, nearly all csPCs were detected by TBx, as adding SBx resulted in detection of only 2.5% more GG >= 2 cancers. Among PI-RADS 3-4 cases, however, SBx addition resulted in detection of substantially more csPCs than TBx alone (8% vs 7.5%). Conversely, TBx added little to detection of csPC among men with PI-RADS 2 lesions (2%) relative to SBx (7.8%). Conclusions: While combined Bx increases the detection of csPC among men with MRI-visible prostate lesions, this benefit was largely restricted to PI-RADS 3-4 lesions. Using a strategy of TBx only for PI-RADS 5 and combined Bx only for PI-RADS 3-4 would avoid excess biopsies for men with PI-RADS 5 lesions while resulting in a low risk of missing csPC (1%). Patient summary: Our study investigated an optimized strategy to diagnose aggressive prostate cancer in men with an abnormal prostate MRI (magnetic resonance imaging) scan while minimizing the risk of excess biopsies. We used a scoring system for MRI scan images called PI-RADS. The results show that MRI-targeted biopsies alone could be used for men with a PI-RADS score of 5, while men with a PI-RADS score of 3 or 4 would benefit from a combination of MRI-targeted biopsy and systematic biopsy. Published by Elsevier B.V. on behalf of European Association of Urology.

引用

页码：176 / 186

页数：11

共 38 条

[1] Simple and effective confidence intervals for proportions and differences of proportions result from adding two successes and two failures [J].