Tekrarlanan prostat biyopsisinde saturasyon ve MRG-US füzyon prostat biyopsi yöntemlerinin karşılaştırılması
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Dosyalar
Tarih
2021
Yazarlar
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Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada, tekrarlanan prostat biyopsilerinde prostat kanseri tanısında saturasyon biyopsi (SB) ve manyetik rezonans görüntüleme-ultrasonografi (MRG-US) füzyon görüntüleme kılavuzluğunda yapılan hedefli ve sistematik kombine prostat biyopsi (KB) yöntemlerini değerlendirmeyi amaçladık. Bu iki yöntemin tanısal performansları ve etkinlikleri karşılaştırıldı. Gereç ve Yöntem: Çalışmaya negatif prostat biyopsi öyküsü olan 160 hasta dahil edildi. Etik kurul onayı ardından Ocak 2014–Mart 2021 tarihleri arasındaki hasta verileri retrospektif olarak tarandı. Prostat tekrar biyopsi yöntemi olarak 80 hastaya SB, 80 hastaya da multiparametrik manyetik rezonans görüntülemede (mpMRG) prostat görüntüleme, raporlama ve data sistemi (PIRADS) ?3 lezyon saptanarak KB uygulandığı görüldü. SB grubundaki hastalara transrektal ultrasonografi (TRUS) eşliğinde 20 odak biyopsi yapılmıştı. KB grubu hastaların her bir lezyonundan en az 2 adet hedefli biyopsi alınmıştı. Ardından sadece TRUS görüntüleri kılavuzluğunda sistematik 12 odak biyopsi alınmıştı. Yöntemler arası kanser ve klinik anlamlı kanser saptama oranları ile gruplar ve patoloji sonuçları arasında yaş, prostat spesifik antijen (PSA), serbest PSA (sPSA), prostat volümü (PV), PSA dansitesi (PSAD), sPSA/tPSA oranları ve parmakla rektal muayene (PRM) bulguları gibi genel özellikler istatistiksel olarak karşılaştırıldı. Bulgular: Kanser ve klinik anlamlı kanser saptama oranları, SB ve diğer alt gruplara göre istatistiksel olarak anlamlı fark saptanmasa da, en yüksek oran KB grubundaydı (%20'ye karşı %16,3 ve %11,25'e karşı %7,5, p=0,682, p=0,715 ). PIRADS?4 lezyonu olan hasta grubuna yapılan KB ile SB karşılaştırıldığında ise klinik önemli prostat kanseri oranı arasındaki fark istatistiksel anlamlı bulundu (%28,6'ya karşı %7,5, p=0,008). Bir diğer sonuç olarak yöntem bakılmaksızın re-biyopsilerinde kanser saptanan hastaların sPSA ve sPSA/tPSA yüzdeleri ortalamalarının benign sonuçlananlardan istatistiksel olarak anlamlı düzeyde daha düşük olduğu bulundu (1,23±0,76'ya karşı 1,73±1,18, p=0,032 ve %17,10±9,72'ye karşı %21,35±8,13, p=0,015). Sonuçlar: KB sayısal üstünlüğü ile tekrarlanan prostat biyopsisinde en yüksek kanser tespit oranını elde etti. Bu fark PIRADS?4 olan hastalarda çok daha yüksekti. Ayrıca tekrar biyopsi kararı ve kanser şüphesinde serum sPSA değeri ve sPSA/tPSA yüzdesi klinisyenlere diğer testlere göre daha yol gösterici olabilir.
Objective: This study aimed to evaluate the prostate cancer detection rates of saturation biopsy (SB) and manyetic resonance imaging-ultrasonography (MRI-US) fusion guided targeted and systematic combined prostate biopsy (CB) in patients with previous negative biopsy. We compared the diagnostic performances and efficacy of these two methods. Materials and Methods: 160 patients with previously negative prostate biopsies were included. After ethics committee approval, patient data between January 2014 and March 2021 were reviewed retrospectively. Eighty patients performed the SB method, and the other 80 patients with Prostat Imaging Reporting and Data System (PIRADS)?3 lesions in multiparametric magnetic resonance imaging (mpMRI) were performed CB. All patients in the SB group performed 20-core transrectal ultrasound (TRUS) guided biopsies. In the CB group, at least two targeted biopsies per lesion were performed from each lesion detected on MRI under real-time MRI-US fusion imaging guidance. After the targeted biopsy procedure is completed, the fusion imaging system is turned off. Biopsies were systematically taken from 12-core guided only by TRUS images. Cancer and clinically significant cancer detection rates between methods and general characteristics such as age, prostate specific antigen (PSA), free PSA (fPSA), prostate volume (PV), PSA density (PSAD), fPSA/tPSA ratios and digital rectal examination (DRE) findings between groups and pathology results were statistically compared. Results: Cancer and clinically significant cancer detection rates were highest in the CB group (20% vs 16.3% and 11.25% vs 7.5%, p =0.682, p=0.715 ); however, there was no statistically significant difference according to SB and other subgroups. When CB and SB were compared in patients with PIRADS?4 lesions, the difference between clinically significant prostate cancer rates was statistically significant in favour of CB (28.6% vs 7.5%, p=0.008). As another result, regardless of the method, the mean fPSA and fPSA/tPSA percentages of patients with cancer in their rebiopsy were found to be statistically significantly lower than patients with benign results (1.23±0.76 vs 1.73±1.18, p=0.032 and 17.10±9.72% vs 21.35±8.13%, p=0.015). Conclusions: CB achieved the best cancer detection rate. This difference was much higher in patients with PIRADS?4. In addition, fPSA and fPSA/tPSA percentage values may be more guiding for clinicians than other tests in repeat biopsy decisions and cancer suspicion.
Objective: This study aimed to evaluate the prostate cancer detection rates of saturation biopsy (SB) and manyetic resonance imaging-ultrasonography (MRI-US) fusion guided targeted and systematic combined prostate biopsy (CB) in patients with previous negative biopsy. We compared the diagnostic performances and efficacy of these two methods. Materials and Methods: 160 patients with previously negative prostate biopsies were included. After ethics committee approval, patient data between January 2014 and March 2021 were reviewed retrospectively. Eighty patients performed the SB method, and the other 80 patients with Prostat Imaging Reporting and Data System (PIRADS)?3 lesions in multiparametric magnetic resonance imaging (mpMRI) were performed CB. All patients in the SB group performed 20-core transrectal ultrasound (TRUS) guided biopsies. In the CB group, at least two targeted biopsies per lesion were performed from each lesion detected on MRI under real-time MRI-US fusion imaging guidance. After the targeted biopsy procedure is completed, the fusion imaging system is turned off. Biopsies were systematically taken from 12-core guided only by TRUS images. Cancer and clinically significant cancer detection rates between methods and general characteristics such as age, prostate specific antigen (PSA), free PSA (fPSA), prostate volume (PV), PSA density (PSAD), fPSA/tPSA ratios and digital rectal examination (DRE) findings between groups and pathology results were statistically compared. Results: Cancer and clinically significant cancer detection rates were highest in the CB group (20% vs 16.3% and 11.25% vs 7.5%, p =0.682, p=0.715 ); however, there was no statistically significant difference according to SB and other subgroups. When CB and SB were compared in patients with PIRADS?4 lesions, the difference between clinically significant prostate cancer rates was statistically significant in favour of CB (28.6% vs 7.5%, p=0.008). As another result, regardless of the method, the mean fPSA and fPSA/tPSA percentages of patients with cancer in their rebiopsy were found to be statistically significantly lower than patients with benign results (1.23±0.76 vs 1.73±1.18, p=0.032 and 17.10±9.72% vs 21.35±8.13%, p=0.015). Conclusions: CB achieved the best cancer detection rate. This difference was much higher in patients with PIRADS?4. In addition, fPSA and fPSA/tPSA percentage values may be more guiding for clinicians than other tests in repeat biopsy decisions and cancer suspicion.
Açıklama
Anahtar Kelimeler
Üroloji, Urology, Biyopsi, Biopsy, Manyetik rezonans görüntüleme, Magnetic resonance imaging, Prostat, Prostate, Prostat hastalıkları, Prostatic diseases, Ultrasonografi, Ultrasonography
