Thesis:analysis Of The Diagnostic Efficacy Of Different Biopsy Protocols For Patients With PI-RADS Score Of 4~5

Objective To analyze the diagnostic efficacy of different biopsy protocols for patients with multi-parametric magnetic resonance imaging(mp MRI)prostate imaging–reporting and data system(PI-RADS)score of 4~5.Methods The clinical data of 378 patients with mp MRI PI-RADS score of 4~5 in Nanjing Drum Tower Hospital from January 2018 to February 2020 who received prostate targeted biopsy(TB)and systematic biopsy(SB)were retrospectively analyzed.All patients underwent transperineal prostate biopsy.Under the guidance of mp MRI/transrectal ultrasound fusion image,TB was performed first,and then a12-needle SB was performed.Evaluating Gleason score of positive biopsy pathology and using χ2 test or Fisher exact test to analyze the detection of prostate cancer(PCa)and clinically significant prostate cancer(cs PCa)by different biopsy protocols.Results Of the all 378 cases,88 cases(23.3%)were negative and 290 cases(76.7%)were positive.The average number of needle of TB was 2.4 per person,while SB was12 per person.TB and SB had no statistically significant difference in the detection rate of PCa(73.3% vs.68.3%,P=0.129)and cs PCa(55.8% vs.49.7%,P=0.094)and in the accuracy(79.1% vs.77.8%,P=0.658),but had a statistically significant difference in the positive rate(64.2% vs.23.1%,P < 0.001).The pathological coincidence rate of TB and TB+SB was 92.3%.There was no significant difference in the detection rate of PCa(73.3% vs.76.7%,P=0.275)and cs PCa(55.8% vs.62.2%,P=0.076)between TB and TB+SB.The missed diagnosis rate of TB for PCa was4.5%,for cs PCa was 10.2%.For patients with PI-RADS score of 4 and 5,TB had no significant difference in the detection rate of PCa(65.4% vs.69.2%,P=0.381,87.0% vs.89.9%,P=0.452)and cs PCa(46.7% vs.52.9%,P=0.171,71.7% vs.78.3%,P=0.211)from TB+SB.The accuracy of TB was 82.1% and 73.9%.The missed diagnosis rate of TB for PCa was 5.4% and 3.2%,for cs PCa was 11.8% and8.3%.Comparing patients with PI-RADS scores 4 and 5,TB had a significant difference in the detection rate of PCa(65.4% vs.87.0%,P<0.001)and cs PCa(46.7%vs.71.7%,P<0.001),had no significant difference in the missed diagnosis rate of PCa(5.4% vs.3.2%,P=0.371)and cs PCa(11.8% vs.8.3%,P=0.380).Conclusions For patients with PI-RADS score of 4~5,TB had better diagnostic efficacy than SB,and obtained a diagnostic effect similar to that of TB+SB with few needles,and the diagnostic effect in patients with PI-RADS score of 5 is better than 4.