靶向穿刺联合主病灶侧半腺系统穿刺对前列腺癌的诊断效能探索

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ABSTRACT：ObjectiveTo investigate the diagnostic eficacy of targeted biopsy（TB）combined with ipsilateral hemiglandularsystematicbiopsy（SB）of thedominantlesion，soastoexploreanovelreduced-corebiopsystrategy.MethodsA retrospectiveanalysis wasconductedontheclinicaldataof299 patients treatedinour hospitalduringSep.1，2O22，andFeb.28， 2023，who had a Prostate Imaging Reporting and Data System （PI-RADS） score ⩾3 and underwent combined TB and SB.The dominant lesion was defined as the lesion with the highest PI-RADS score on multi-parametric magnetic resonance imaging （204 （mpMRI） ；in cases of identical scores，the largest was designated as the dominant.SB was categorized as ipsilateral （ipsi-SB）or contralateral（contra-SB）tothedominantlesion.Theconsistencyindetecting clinicallysignificantprostatecancer（csPCa）was compared between TB with ipsi-SB（TB+ipsi-SB），TB with contra-SB （ TB+ contra-SB），and TB with SB （ TB+SB） .Subgroup analyses were performed based on PI-RADS score，prostate-specific antigen （PSA）level，prostate volume（PV），and mpMRI lesion distribution to evaluate csPCa detectionrates across diferent variables.ResultsTB+ipsi-SB demonstratedcomparable detection rate to TB+SB （ 46.2% vs. 46.8% ）.The K values for TB+ipsi-SB and TB + contra-SB relative to TB+SB were 0. 987（95%CI：0.969-1.000，P<0.01） and 0.933 （95%CI：0.892-0.974，P<0.01） ，respectively. Across all subgroups， TB+ ipsi-SB showed the highest agreement with TB+SB . Notably，in subgroups with PI-RADS 3 and 5，PSA>0-20ng/mL，PV PV< 25mL ，bilateral or multiple mpMRI lesions， TB+ ipsi-SB achieved complete concordance with TB+SB in csPCa detection [K= 1.000 （95%CI：1.000-1.000） ， P<0.01] .ConclusionFor patients with PI-RADS score ⩾3 ，TB+ ipsi-SB exhibits nearperfect consistency with TB+SB in csPCa detection while requiring fewer biopsy cores.TB + ipsi-SB represents a promising refinement of the TB+SB approach.

KEYWORDS： prostate cancer；magnetic resonance imaging；targeted biopsy；systematic biopsy；clinically significant prostate cancer

摘要：目的分析前列腺靶向穿刺活检（TB）联合主病灶同侧半腺系统穿刺活检（ipsi-SB）对前列腺癌的诊断效能，以期寻找一种新的减针穿刺方式。（剩余11556字）