Evaluation of the diagnostic value of targeted biopsy of secondary lesion in the systematic biopsy combined with targeted biopsy for clinically significant prostate cancer
Objective To evaluate the diagnostic value of targeted biopsy of secondary lesion(SL)in systematic biopsy(SB)combined targeted biopsy for clinically significant prostate cancer(CsPCa).Methods A retrospective analysis was conducted on the data of patients who underwent systematic biopsy combined target biopsy at Nanjing Drum Tower Hospital from January 2021 to February 2023,and they had at least two Prostate Imaging-Reporting and Data System(PI-RADS)score ≥3 lesions on prostate magnetic resonance imaging.The study included patients with a median age of 70(65,76)years old,median prostate specific antigen(PSA)was 9.1(5.96,13.62)ng/ml,median prostate volume was 39.1(29.27,53.25)ml,and median PSAD was 0.2(0.15,0.38)ng/ml2.The index lesion(IL)was defined as the one with the highest PI-RADS score and SL was defined as the one with the second-highest PI-RADS score.If the two lesions had the same PI-RADS score,the one with larger maximum diameter was IL and the other one was SL.The median maximum diameter of IL and SL were 1.3(1.06,1.66)cm and 0.9(0.69,1.20)cm,respectively.The median maximum diameter ratio of IL and SL was 1.48(1.10,1.91),and the median maximum diameter difference of IL and SL was 0.9(0.20,1.89)cm.The IL in peripheral zone was found in 238 patients(62.63％)and SL in peripheral zone was found in 255 patients(67.10％).There were 204 patients(53.68％)having both IL and SL on the same side of prostate.According to the combination of PI-RADS scores of IL and SL,patients were categorized into various groups:96 patients(25.26％)with IL3 andSL3,79(20.78％)with IL4 and SL3,98(25.78％)with IL4 andSL4,21(5.52％)with IL5 and SL3,76(20.0％)with IL5 and SL4,and 10(2.63％)with IL5 and SL5.Targeted biopsy was performed on at least two of the most significant lesions.Comparison was performed in the detection rate of CsPCa between SB+IL+SL and SB+IL(SL was omitted).To explore the factors influencing the detection rate of CsPCa,a multivariate logistic regression analysis was used.Results The detection rate of CsPCa in this study was 78.95％(300/380)based on SB+IL+SL.After omitting SL target biopsy,the detection rate of CsPCa was 78.16％(297/380,P＞0.05)under the condition of SB+IL.No significant differences were noted between the two groups.The multivariate logistic regression analysis showed that PSA(OR=1.11,95％CI 1.05-1.20,P＜0.01),prostate volume(OR=0.98,95％CI 0.96-0.99,P＜0.01),SL maximum diameter(OR=0.19,95％CI 0.08-0.50,P＜0.01),ratio of IL and SL maximum diameter(OR=0.34,95％CI 0.16-0.68,P＜0.01),difference of IL and SL maximum diameter(OR=1.50,95％CI 1.10-2.29,P＜0.05),and PI-RADS score group of IL and SL(IL3 vs.SL3 as the reference,IL4 vs.SL3 OR=4.79,95％CI 2.21-10.91,P＜0.01,IL4 vs.SL4 OR=23.11 95％CI 8.09-85.28,P＜0.01,IL5 vs.SL3/4/5 OR=15.28 95％CI 5.21-48.55,P＜0.01)were the influencing factors for detection rate of CsPCa.Conclusions For patients with at least two PI-RADS score ≥3 lesions on prostate magnetic resonance imaging,omitting SL can almost maintain the same detection efficacy.
万方数据
维普
