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Wertigkeit der multiparametrischen MRT und der MRT-TRUS-Fusionsbiopsie bei primär negativ biopsierten Patienten

Multiparametric MRI and MRI-TRUS fusion biopsy in patients with prior negative prostate biopsy

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Zusammenfassung

Hintergrund

Die multiparametrische MRT (mpMRT) gewinnt in der Prostatakarzinomdiagnostik an Bedeutung und wird u. a. bei primär negativ TRUS-biopsierten Männern mit persistierendem Tumorverdacht empfohlen. Die optimale Biopsiemethode nach erfolgter mpMRT wird aktuell diskutiert.

Ziel der Arbeit

Die vorliegende, prospektive Arbeit analysiert PIRADS- und START-konform den Stellenwert von mpMRT- und MRT-TRUS-Fusionsbiospie im Rahmen der Rebiopsie und vergleicht die Detektionsraten von gezielten Biopsien (gB) und systematischen transperinealen Sättigungsbiopsien (sB).

Material und Methoden

Bei 287 zuvor negativ TRUS-biopsierten Männern wurden von 10/2012–09/2015 Software-assistierte, rigide MRT-TRUS-Fusionsbiopsien durchgeführt. Neben sB (Median n = 24) wurden bei Patienten mit MRT-suspekten Arealen (PIRADS ≥ 2) gB (Median n = 4 pro Patient, n = 3 pro Läsion) entnommen. Die Biopsiemethoden wurden mittels McNemar-Test miteinander verglichen.

Ergebnisse

Von 287 Patienten hatten 148 (52 %) ein Prostatakarzinom (PCa), 108/287 (38 %) ein signifikantes PCa (Gleason-Score [GS] = 3 + 3 und PSA ≥ 10 ng/ml oder GS ≥ 3 + 4)] und davon wiederum 43/287 (15 %) GS ≥ 4 + 3 Tumoren. Transperineale sB übersahen 8/148 (5,4 %) PCa und 6/108 signifikante PCa (5,5 %), während alleinige gB 48 (32,4 %) PCa (p < 0,0001) und 22 (20,4 %) signifikante PCa (p =  0,0046) übersahen. Insgesamt 11 der durch gB verfehlten signifikanten PCa hatten einen GS ≥ 3 + 4 (10,3 %), 5 PCa davon einen GS = 4 + 3. Durch die MRT wurden 5 der signifikanten PCa auf Patientenebene nicht detektiert. 17 der signifikanten Tumoren wurden durch die Fusionsbiopsiezylinder verfehlt.

Schlussfolgerungen

Bei unauffälliger MRT (PIRADS < 3) besteht ein Risiko von 11 %, signifikante PCa zu übersehen. Bei tumorsuspekter MRT bietet die Kombination beider Biopsiemethoden die höchste Detektionsrate und das genaueste lokale Staging.

Abstract

Background

Multiparametric MRI (mpMRI) plays an increasingly important role in prostate cancer (PCa) diagnostics and is recommended in men with previously negative TRUS biopsy. The optimal biopsy method after mpMRI is under discussion.

Objective

Prospective, PIRADS- and START-conform analysis of the relevance of mpMRI and MRI-TRUS fusion biopsy in patients with prior negative TRUS biopsy and comparison of the detection rates of fusion-targeted biopsies (tB) and systematic transperineal saturation biopsies (sB).

Materials and methods

Between 10/2012 and 09/2015, 287 patients with prior negative TRUS biopsy underwent mpMRI and software-assisted, rigid MRI-TRUS fusion biopsy. In addition to and strictly separated from sB (median cores n = 24), tB (median cores per patient n = 4, per lesion n = 3) were performed in case of suspicious MRI lesions (PIRADS ≥ 2). Both biopsy methods were compared by using McNemar’s test.

Results

Of the 287 patients, 148 (52 %) had positive biopsies. Of these, 108/287 (38 %) had significant PCa (Gleason Score [GS] = 3 + 3 and PSA ≥ 10 ng/ml or GS ≥ 3 + 4) and again 43/287 (15 %) had a GS ≥ 4 + 3 PCa. sB failed to diagnose 8/148 PCa (5.4 %) and 6/108 significant PCa (5.5 %), whereas tB failed to diagnose 48 (32.4 %) PCa (p < 0.0001) and 22 (20.4 %) significant PCa (p = 0.0046). Of the PCa missed by tB, 11  had a GS ≥ 3 + 4 and 5 of these a GS = 4 + 3. On a per patient basis, MRI failed to detect 5 significant PCa, whereby 17 of the significant PCa were missed by fusion-targeted cores alone.

Conclusions

In men with unsuspicious MRI (PIRADS < 3), there is a 11 % risk of significant PCa. In case of suspicious MRI lesions, the combination of both biopsy approaches offers maximum tumor detection.

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Danksagung

B.A. Hadaschik erhielt Fördermittel für dieses Projekt von der Deutschen Forschungsgemeinschaft.

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Authors and Affiliations

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

    C. Kesch, J. P. Radtke, F. Distler, T. Klein, C. Hüttenbrink, M. Hohenfellner & B. A. Hadaschik

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

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

  3. Universitätsklinik für Urologie, Universität Bern, Bern, Schweiz

    S. Boxler

  4. Institut für Medizinische Biometrie und Informatik, Heidelberg, Deutschland

    K. Hees

  5. Pathologisches Institut der Universität Heidelberg, Universität Heidelberg, Heidelberg, Deutschland

    W. Roth

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  1. C. Kesch
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Correspondence to C. Kesch.

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Interessenkonflikt

C. Kesch, J. Radtke, F. Distler, S. Boxler, T. Klein, C. Hüttenbrink, K. Hees, W. Roth, M. Roethke, H.P. Schlemmer, M. Hohenfellner und B.A. Hadaschik geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Kesch, C., Radtke, J.P., Distler, F. et al. Wertigkeit der multiparametrischen MRT und der MRT-TRUS-Fusionsbiopsie bei primär negativ biopsierten Patienten. Urologe 55, 1071–1077 (2016). https://doi.org/10.1007/s00120-016-0093-6

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