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Stellenwert der MRT/TRUS-Fusionsbiopsie im Rahmen der Primärbiopsie beim Prostatakarzinom

Value of MRI/ultrasound fusion in primary biopsy for the diagnosis of prostate cancer

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Zusammenfassung

Hintergrund

Die multiparametrische Magnetresonanztomographie (mpMRT) hat eine zunehmende Bedeutung in der Prostatakarzinomdiagnostik. Die vorliegende Arbeit analysiert die Tumordetektionsrate gezielter Biopsien (gB) von suspekten Läsionen in der mpMRT im Vergleich zu transperinealen systematischen Biopsien (sB) bei Männern mit primärem Verdacht auf ein Prostatakarzinom (PCa).

Methoden

Bei 437 Erstbiopsie-Patienten, die 2012–2014 bei Tumorverdacht eine stereotaktische Prostatabiopsie erhielten, wurden neben sB MRT-suspekte Areale zusätzlich mittels Ultraschallfusion gezielt biopsiert. Die mpMRT-Befundung erfolgte PI-RADS-konform („prostate imaging-reporting and data system“) und die Analyse der Biopsien gemäß den START-Kriterien („standards of reporting for MRI-targeted biopsy studies“).

Ergebnisse

Von 437 Männern hatten 334 insgesamt 426 suspekte MRT-Läsionen. In der Gesamtkohorte wurden 274 PCa und davon 203 signifikante PCa [Gleason-Score (GS) ≥ 3 + 4, GS = 3 + 3 und PSA-Wert (prostataspezifisches Antigen) ≥ 10 ng/ml] diagnostiziert. 52(26 %) signifikante PCa wurden allein durch sB, 18(9 %) nur durch gB entdeckt (p < 0,001). Insgesamt diagnostizierten sB 70 und gB 60 von 80 aggressiven High-grade-Karzinomen (GS ≥ 4 + 3; p = 0,007). 54 % aller insignifikanten PCa (GS < 7, PSA < 10 ng/ml) wurden nur durch sB nachgewiesen (p < 0,001). Die AUC („area under the curve“) der mpMRT-Bildgebung lag bei 0,76–0,78.

Schlussfolgerung

Die perineale Kombinationsbiopsie (sB + gB) steht aktuell für die höchste diagnostische Sicherheit des PCa. Die kritische Evaluation der leitliniengerechten 12fach-TRUS-Biopsie (transrektaler Ultraschall) erfolgt aktuell in prospektiven (Multicenter)studien.

Abstract

Background

Multiparametric magnetic resonance imaging (mpMRI) plays an emerging role in prostate cancer diagnosis. We compared the cancer detection rates of targeted biopsy (tB) of suspicious lesions in mpMRI versus systematic transperineal saturation biopsy (sB) in men with primary suspicion of prostate cancer (PCa).

Methods

A total of 437 consecutive primary biopsy patients, who underwent transperineal systematic and fusion-guided biopsy between 2012 and 2014, were enrolled. mpMRI was evaluated based on PI-RADS. Analysis of biopsy specimen was performed following START criteria.

Results

Of the 437 men, 334 harbored 426 MR lesions. Overall, 274 PCa and 203 significant PCa (Gleason score (GS) ≥ 3 + 4, GS = 3 + 3 and PSA values ≥ 10 ng/ml) were detected. There were 52 (26 %) significant PCa exclusively found by sB, whereas only 18 (9 %) were identified by tB (p < 0.001). Of 80 high-grade PCa with GS ≥ 4 + 3, 70 were diagnosed by sB, and 60 by tB (p = 0.007). In addition, 54 % of all insignificant PCa (GS < 7, PSA < 10 ng/ml) were detected by sB alone (p < 0.001). AUC of mpMRI was 0.76–0.78.

Conclusion

The combination of tB + sB detects PCa most accurately. Ongoing prospective (multicenter) studies are evaluating the status of the 12 core TRUS-guided random biopsy.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. F. Distler, J.P. Radtke, C. Kesch, M. Roethke, H.-P. Schlemmer, W. Roth, M. Hohenfellner und B. Hadaschik geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    F. Distler, J.P. Radtke, C. Kesch, M. Hohenfellner & B. Hadaschik

  2. Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland

    J.P. Radtke, M. Roethke & H.-P. Schlemmer

  3. Pathologisches Institut, Universität Heidelberg, Heidelberg, Deutschland

    W. Roth

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  1. F. Distler
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  2. J.P. Radtke
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  3. C. Kesch
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Correspondence to F. Distler.

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Distler, F., Radtke, J., Kesch, C. et al. Stellenwert der MRT/TRUS-Fusionsbiopsie im Rahmen der Primärbiopsie beim Prostatakarzinom. Urologe 55, 146–155 (2016). https://doi.org/10.1007/s00120-015-3980-3

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