Clinical Research Of Transperineal Prostate Targeted Biopsy Guided By MpMRI-TRUS Image Fusion

Objective:To evaluate the difference between transperineal prostate targeted biopsy and systemic biopsy guided by mp MRI-TRUS image fusion in the diagnosis of prostate cancer.Methods:Retrospective analysis of 3.0T Multiparameter Magnetic Resonance Imaging(mp MRI)at the First Affiliated Hospital of Nanchang University from July 2020 to January 2021 for suspected prostate cancer(PCa)and received mp MRI-TRUS image fusion The clinical data of 112 patients who guided transperineal prostate targeted biopsy and systemic biopsy.All patients underwent mp MRI-TRUS image fusion transperineal prostate targeted biopsy(TB)2-3 needles and transperineal systemic biopsy(SB)12 needles,all specimens were sent to pathology,including biopsies specimens and confirmed diagnosis After PCa,the specimens after radical prostatectomy(RP)were received.The primary study endpoint was to compare the detection rate of PCa with different biopsy methods,and the secondary study endpoint was the detection rate of Clinically significant prostate cancer(Cs PCa),And analysis of the correlation between biopsy pathology and RP postoperative specimen pathology.Cs PCa definition: Gleason score ≥ 3 + 4 = 7 points(International Society of Urological Pathology,ISUP ≥ 2);pathological upgrade is defined as the pathological biopsy ISUP grading is less than the ISUP grading after RP or the targeted or systemic biopsy is not detected into a combined biopsy Prostate cancer.Pathological degradation is defined as the ISUP grade of biopsy pathology greater than the ISUP grade after RP.Results:A total of 112 patients received two puncture methods,52 cases(46.4%)were diagnosed as PCa by TB+SB,60 cases were diagnosed as benign prostate disease,The two groups of patients had statistically significant differences in age,t PSA,prostate volume,PSAD,and PI-RADS score indicators(P<0.05),and the difference in f/t PSA indicators was not statistically significant(P>0.05).Among 52 cases(46.4%),44 cases(39.4%)were detected by TB;and 50cases(44.6%)were detected by SB.There was no significant difference in the detection rate of PCa among the three biopsy methods(P> 0.05);A total of 47 cases(42.0%)of Cs PCa were detected,of which only 39 cases(34.8%)of Cs PCa were detected in TB,and only 45 cases(40.1%)of Cs PCa were detected in SB.The three biopsy methods showed no significant difference in the detection rate of Cs PCa(P>0.05).If only TB is performed,8 cases of PCa will be missed,of which 5 cases(4.4%)are Cs PCa,and only SB will be missed in 2 cases(1.8%)of PCa,and 2 cases are Cs PCa.Comparing the positive rate of single needles for TB and SB,TB has 234 needles,90 needles(38.5%)are positive,SB has 1,344 needles,and 282 needles(21.0%)are positive.There is a statistically significant difference between the two in the positive rate of puncture needles.(P<0.001).Comparing the correlation analysis between TB and SB and pathological specimens after RP,it was found that 6 cases(14.3%)of TB had pathological upgrade,6 cases(14.3%)had pathological degradation,30 cases(71.4%)had the same pathology,and 14 of SB cases Cases(33.3%)had pathological upgrade,8 cases(19.0%)had pathological degradation,20cases(47.6%)had the same pathology;the difference in pathological upgrade rate between TB and SB was statistically significant(P<0.05),and TB and SB had the same pathology The rate difference is statistically significant(P<0.05),and the pathological degradation rate between TB and SB is not statistically significant(P>0.05).Complications related to biopsies were relatively low,37.5%(42/112)had slight gross hematuria,all of which healed spontaneously within 5 days after biopsy,and none of them had fever,bleeding,acute urinary retention and vagus nerve reflex.Conclusions:1.Targeted biopsy can achieve the equivalent biopsy positive rate of systematic biopsy with fewer biopsy needles,and the pathology of targeted biopsy is closer to the pathology of specimens after radical prostatectomy.2.Targeted biopsy combined systematic biopsy can increase the detection rate of Cs PCa,and the complications of the transperineal route are low,and it is a safe and feasible biopsy method.