【探泌】Eur Urol Oncol：在磁共振靶向穿刺活检时代，既往穿刺活检阴性患者是否仍需二次系统穿刺活检？

Intervention: All patients underwent 3 T mpMRI according to Prostate Imaging Reporting and Data System (PI-RADS) v2. Patients with PI-RADS ≥3 were randomized 1:1:1 for three TB techniques: MRI-TRUS fusion TB (FUS-TB), cognitive registration fusion TB (COG-TB), or in-bore MRI TB. FUS-TB and COG-TB were combined with repeated SBs.

Outcome measurements and statistical analysis: Clinically significant prostate cancer (csPCa) was defined as Gleason ≥3 + 4. Differences in detection rates of csPCa, clinically insignificant PCa (cisPCa), and overall PCa between TBs (FUS-TB and COG-TB) and repeated SBs were compared using McNemar's test.

Results and limitations: In the 152 patients who underwent both TB and SB, PCa was detected by TB in 47% and by SB in 32% (p < 0.001, 95% confidence interval [CI]: 6.0–22%). TB detected significantly more csPCa than SB (32% vs 16%; p < 0.001, 95% CI: 11–25%). Clinically significant PCa was missed by TB in 1.3% (2/152). Combining SB and TB resulted in detection rate differences of 6.0% for PCa, 5.0% for cisPCa, and 1.0% for csPCa compared with TB alone.

经直肠超声引导下系统穿刺活检是诊断前列腺癌最常用的手段，但也存在局限性，比如易漏诊临床意义显著前列腺癌(csPCa)、对前列腺尖部或MRI可疑部位难以精准穿刺等，导致漏诊或重复穿刺几率增加，重复穿刺亦增加了疼痛、焦虑和感染等风险。那么，既往系统穿刺活检阴性但仍持续怀疑前列腺癌的患者，在靶向穿刺时是否需附加系统穿刺？

该项研究表明靶向穿刺对临床意义显著前列腺癌的检出率明显高于系统穿刺。仅行靶向穿刺时，临床意义显著前列腺癌的漏诊率仅为1.3%。因此，在二次穿刺时靶向穿刺附加系统穿刺的作用是有限的。

该项研究采用靶向穿刺 vs 靶向穿刺联合系统穿刺，可以做到减少干扰因素及组别差异性，结论更可靠。

【参考文献】

[1] Exterkate L, Wegelin O, Barentsz J O, et al. Is There Still a Need for Repeated Systematic Biopsies in Patients with Previous Negative Biopsies in the Era of Magnetic Resonance Imaging-targeted Biopsies of the Prostate?[J]. European urology oncology, 2019.