Kezdeti tapasztalataink az mpMR fúziós ultrahangvezérelt prosztatabiopsziával

Osszefoglalo. Bevezetes: A prosztatarak diagnosztikajaban az utobbi evekben paradigmavaltas tortent. Az MR-vizsgalat fejlődese lehetőve tette a prosztatatumor gyanus elvaltozasainak celzott mintavetelet. Az mpMR fuzios biopszia pontos es koltseghatekony modszer. Celkitűzes: Celkitűzesunk az volt, hogy osszegezzuk az mpMR fuzios biopsziak teren szerzett tapasztalatainkat. Modszer: A Semmelweis Egyetem Urologiai Klinikajan 2017 es 2019 kozott 40, mpMR fuzios biopsziat vegeztunk a BioJet-program segitsegevel, transperinealis behatolasbol. Az MR-vizsgalatok kiertekelese a PI-RADS v2 ajanlasa szerint tortent. Megvizsgaltuk, hogy a laesiok PI-RADS-besorolasa, elhelyezkedese, merete, az extraprosztatikus terjedes jeleinek meglete, a paciensek PSA-, illetve PSAD-ertekei, valamint a prosztata volumene befolyasolja-e a mintavetelek kimenetelet. Eredmenyek: A celzott mintavetelek soran pacienseink 80%-anal igazolodott malignitas. PI-RADS 5. es 4. besorolasu laesiok eseten a detektacios rata 91%, illetve 85%, mig PI-RADS 3. laesioknal 20% volt. A periferias zona elvaltozasainal szignifikansan magasabb volt a pozitiv eredmeny valoszinűsege, mint a tranzicionalis zona laesioinal (khi2(1) = 6,555, p = 0,010, Fisher-fele egzakt p = 0,017, V = 0,355). Az extraprosztatikus terjedes jelei es a magasabb PSAD-ertekek noveltek a pozitiv mintak valoszinűseget (khi2(1) = 7,704, p = 0,006, Fisher-fele egzakt p = 0,004, V = 0,355; illetve 0,47 ± 0,50 ng/ml2 vs. 0,18 ± 0,17 ng/ml2; Z = 3,447, p<0,001), mig az elvaltozasok merete nem befolyasolta a kimenetelt. A prosztatavolumen szignifikansan magasabb volt azoknal, akiknel nem igazolodott malignitas (50,9 ± 18,8 ml vs. 119,6 ± 91,6 ml; Z = -3,505, p<0,001). Kovetkeztetesek: Az elvegzett fuzios biopsziak detektacios rataja magasabb volt az irodalmi atlagnal. Eredmenyeink alapjan a mintavetelek kimenetelet befolyasolhatja az elvaltozasok PI-RADS-besorolasa, elhelyezkedese, az extraprosztatikus terjedes, a PSAD-ertekek, valamint a prosztataterfogat. A fenti szempontok figyelembevetelevel kivalaszthatok azok a paciensek, akik a legtobbet profitalhatnak a beavatkozasbol. Orv Hetil. 2020; 161(52): 2188-2194. SUMMARY INTRODUCTION The past decade has seen some major changes in the diagnostics of prostate cancer. Progress in MR imaging has allowed us to better visualise prostate cancer and thus perform targeted biopsies of tumour suspect lesions. mpMRI-ultrasound fusion-guided prostate biopsy is a precise and cost-effective method to diagnose prostate cancer. OBJECTIVE The purpose of this study was to summarise our results in mpMRI-ultrasound fusion biopsy between 2017 and 2019 and compare them with the findings in the current literature. METHOD Between 2017 and 2019, fully 40, mpMRI-ultrasound fusion biopsies were performed transperineally using the BioJet fusion system at Semmelweis University Urology Clinic. The MRI evaluations were done in line with the PI-RADS v2 guidelines. It was analysed whether the PI-RADS score, the location of the tumour, lesion size, the signs of extraprostatic extension, PSA/PSAD density and prostate volume have an influence on the outcome of mpMRI-ultrasound fusion biopsy. RESULTS Prostate cancer was diagnosed in 80% of the cases during targeted biopsies. The detection rate was 91%, 85%, and 20% for PI-RADS 5, 4 and 3 lesions, respectively. The detection rate was significantly higher for lesions located at the peripheral zone compared to the ones in the transitional zone (khi2(1) = 6.555, p = 0.010, Fisher-exact p = 0.017, V = 0.355). Signs of extraprostatic extension and higher PSAD correlated with better detection rate (khi2(1) = 7.704, p = 0.006, Fisher-exact p = 0.004, V = 0.355; and 0.47 ± 0.50 ng/ml2 vs. 0.18 ± 0.17 ng/ml2; Z = 3.447, p<0.001, respectively). The size of the lesions did not influence the outcome. The analysis showed a significant correlation between large prostate volumes and negative biopsies (50.9 ± 18.8 ml vs. 119.6 ± 91.6 ml; Z= -3.505, p<0.001). CONCLUSIONS The detection rate of prostate cancer with targeted biopsies was higher than the data found in the international literature. The PI-RADS score, the location of the tumour, MRI signs of extraprostatic extension, PSAD and prostate volume had an influence on the detection rate. Our findings may promote a better selection of the best candidates for targeted biopsies in the future. Orv Hetil. 2020; 161(52): 2188-2194.