Transperineal targeted biopsy with real-time fusion image of multiparametric magnetic resonance image and transrectal ultrasound image for the diagnosis of prostate cancer

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  • MRI-TRUS融合画像リアルタイムガイド下経会陰式前立腺標的狙撃生検による前立腺癌診断の有用性に関する検討
  • MRI-TRUS ユウゴウ ガゾウ リアルタイムガイド カケイ エインシキ ゼンリツセン ヒョウテキ ソゲキセイケン ニ ヨル ゼンリツセン ガン シンダン ノ ユウヨウセイ ニ カンスル ケントウ

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Objective：To evaluate the transperineal targeted biopsy with real-time fusion image of multiparametric magnetic resonance image（mpMRI）and transrectal ultrasound（TRUS）image for the diagnosis of prostate cancer. <br>  Methods：The patients with PSA level less than 20 ng/ml were performed mpMRI prospectively. All mpMRI images including T2WI, dynamic, DWI, and ADC map. We performed targeted biopsies for each cancersuspicious lesion and 12 systematic biopsies using the BioJet® system（D&K Technologies GmbH, Barum, Germany）. MRI, TRUS image, and pathological findings of targeted and systematic biopsies were analyzed. <br>  Results：90 patients were included in the study. Median age was 68 years（50-89 years）. Median preoperative PSA value was 6.8 ng/ml（3.54-20 ng/ml）. Median preoperative prostate volume was 37 ml（22-68 ml）. The number of the cancer-detected cases was 51（57%）. Rate of positive core（38% vs. 6.0%, p<0.0001）, positive core length（8mm vs. 2mm, p<0.0001）, positive core percent（58% vs. 16%, p < 0.0001）, and Gleason score（6.5 vs. 6, p=0.001）were also significantly different between targeted and systematic biopsies. Cancer detection rate of the patients with PI-RAD classification of 4 or 5 were 52% and 82%, respectively. In 16 patients who underwent radical prostatectomy, the geographic locations and pathological grades of clinically significant cancers and index lesions corresponded to the pathological results of the biopsies. <br>  Conclusions：The cancers detected by targeted biopsies with the present biopsy method had significantly higher grades and larger volumes length compared with those detected by the systematic biopsies. The present biopsy method has a possibility to diagnose the localization of prostate cancer.

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