Comparison Of The Efficacy Of Different Diameter Biopsy Needles In Targeted Puncture Of The Prostate

Objectives:1.To compare the efficacy of different diameter biopsy needles in targeted puncture of isolated prostate.2.To compare the efficacy of 16G biopsy needle with 18G biopsy needle in actual clinical targeted prostate biopsy.Methods:1.Isolated prostate specimens from patients who underwent radical prostatectomy(RP)at Subei People’s Hospital from January 2019 to January 2021 were collected.Inclusion criteria:1),patients with a confirmed diagnosis of prostate cancer(Prostate Cancer,PCa)and complete retention of clinical data;2),patients with a preoperative multiparametric MRI examination no more than 1 month from radical prostatectomy;3),Prostate imaging reporting and data system(PI-RADS)score.PI-RADS)score of 3-5 and clear multiparametric MRI images;4),the isolated prostate was intact and unbroken.Exclusion criteria:1)incomplete clinical data;2)preoperative multiparametric MRI examination more than 1 month after radical prostatectomy;3)PI-RADS score<3;4)isolated prostate with broken gland and involved lesions.Immediately after radical prostatectomy,14G,16G,18G and 20G biopsy needles(2.1 mm,1.7 mm,1.2 mm and 0.9 mm in diameter,respectively)were used to puncture each target site of the isolated prostate twice,and large tissue sections were performed on the isolated prostate.The biopsies were grouped into 14G,16G,18G and 20G groups according to the type of biopsy needle,and the detection rates of PCa and Clinically significant Prostate cancer(CsPCa)in each group were compared.The differences in the percentage of empty needles(the number of biopsy needles without tissue specimens)and the percentage of positive puncture needles were analyzed,and the size and quality of the tissue specimens were compared between the groups(size and quality were evaluated by tissue specimen area and total tissue specimen quality score,respectively).The pathological accuracy of the biopsy specimens in each group was analyzed based on the results of large tissue sections of isolated prostate whole organs.2.Patients who underwent prostate puncture at Subei People’s Hospital from February 2021 to September 2022 were prospectively included.Inclusion criteria:1),prostate-specific antigen(PSA)values greater than 10 ng/ml or rectal finger examination revealed prostate nodules or PSA 4-10 ng/ml,ratio of serum free prostate-specific antigen to total prostatespecific antigen(f/tPSA)Abnormal prostate specific antigen density(PSAD);2)no previous prostate biopsy;3)PI-RADS score of 3-5.Exclusion criteria vertebrae:1),abnormal coagulation or abnormal liver or kidney function or abnormal cardiac function or major systemic disease or severe urinary tract infection;2),PI-RADS score<3;3),Patients who did not sign the informed consent form.The included patients were randomly grouped into 18G and 16G groups,and the puncture method was targeted biopsy combined with systematic puncture.In the 16G group,the 16G biopsy needle was used for targeted biopsy,and in the 18G group,the 18G biopsy needle was used for targeted biopsy,and in both groups,the 18G biopsy needle was used for systematic puncture of the prostate.The PCa detection rate,CsPCa detection rate,the percentage of positive puncture needles and the percentage of empty needles were compared between the two groups and the differences in the size and quality of the targeted biopsy tissue specimens were analyzed.After the puncture,the complications and pain scores of the two groups were compared.Some patients with positive biopsies underwent radical prostatectomy in our hospital,and the Gleason score(GS)escalation of the pathology was analyzed using pathology of large histological sections after radical prostatectomy in the two groups.Results:1.In this study,the prostates of 48 patients were collected,and 50 lesions were punctured,with a total of 100 stitches for each biopsy needle.(1),Comparison of pathology of isolated prostate targeted puncture with four types of biopsy needles:the number of empty needles was 3(3%),3(3%),5(5%)and 16(16%)in the 14G,16G,18G and 20G groups,respectively;positive biopsies in the four groups were 45(93.75%),44(91.66%),40(83.33%)and 32(66.67%);43(89.58%),42(87.50%),34(70.83%)and 23(47.91%)CsPca detected in the four groups;86(88.65%),83(88.29%),73(76.84%)and 48(57.14%)positive stitches in the four groups,respectively.Fisher’s test or chi-square test was used for multiple group comparisons,and chi-square test was applied for two-way comparisons between groups.The percentage of empty stitches,percentage of positive stitches,Pca detection rate and CsPca detection rate in the four groups were statistically significant in the multiple group comparison(P<0.05).A two-way comparison between groups showed that the percentage of empty stitches was higher in the 20G group than in the 14G,16G and 18G groups and statistically different(P<0.05),while there was no significant difference in the 14G,16G and 18G groups(P>0.05);in the comparison of Pca detection rate,the 20G group was lower than the 14G,16G and 18G groups and statistically different(P<0.05),while the 14G,16G and 18G groups were statistically different(P<0.05).There was no significant difference between the 14G group,16G group and 18G group(P>0.05);in terms of the detection rate of CsPca and the percentage of positive stitches,there was no significant difference between the 14G group and 16G group(P>0.05),and there was a statistical difference between the 16G group,18G group and 20G group(P<0.05).(2),the tissue specimen areas in the 14G,16G,18G and 20G groups were 11.20(3.45,16.5)mm2,8.60(2.66,10.35)mm2,7.03(2.24,9.780)mm2 and 2.82(1.20,6.80)mm2,respectively;the total tissue specimen quality scores in the four groups were 9(3.9),9(3,9),9(3,9),and 7(3,9)points,respectively,for the four groups.Non-parametric tests were used for multiple and inter-group comparisons,and the area of tissue specimens and the total score of tissue specimens in the 14G,16G,18G and 20G groups were statistically different in multiple comparisons(P<0.05);a two-way comparison between groups showed that:the area of tissue specimens in each group was statistically different between groups(P<0.05);in terms of the total score of tissue specimen quality,the 14G,16G and 20G groups There was no statistical difference in the total score of tissue specimen quality between the 14G,16G and 18G groups(P>0.05),while the 20G group was significantly lower than the 14G,16G and 18G groups and statistically different(P<0.05).(3),the median ISUP grading of large tissue sections was 4(1,5),and the median ISUP grading of 14G,16G,18G and 20G groups were 3.5(1,5),3.5(1,5),3(1,5)and 1(1,5),respectively.By t-test,there was no statistical difference between the ISUP grading of the 14G and 16G groups and the large group sections(P>0.05),and the ISUP grading of the 18G and 20G groups was significantly lower than that of the large group sections and statistically different(P<0.05).2.A total of 229 patients were included in the study,112 in the 16G group and 117 in the 18G group,with no statistical difference in baseline information between the two groups(P>0.05).In the targeted combined systemic puncture,there were 76(67.85%)positive cases in the 16G group and 77(65.81%)positive cases in the 18G group,with no statistical difference in the positive detection rate between the two groups(P>0.05).In the targeted biopsy,there were 72(64.28%)positive cases in the 16G group,including 66(58.92%)cases of CsPCa,and 74(63.24%)positive cases in the 18G group,including 53(45.29%)cases of CsPCa.There was no statistical difference in the PCa detection rate between the 18G and 16G groups of targeted prostate biopsy(P>0.05),while the 16G group had a higher The detection rate of CsPCa in the 16G group was higher than that in the 18G group and statistically different(58.92%vs.45.29%,P<0.05).471 target punctures were performed in the 16G group,41(8.70%)were tissue-free and 256(59.53%)were positive;525 target punctures were performed in the 18G group,70(13.33%)were tissue-free and 227(49.89%)were positive,and the percentage of empty stitches and the percentage of positive stitches were statistically different between the 16G group and the 18G group(8.70%vs.13.33%,59.53%vs.49.89%,P<0.05).There was no statistical difference in postoperative VAS score,VNS score and postoperative complications.the area of tissue specimens was higher and statistically different in the 16G group than in the 18G group(P<0.05),while there was no statistical difference in the total tissue specimen quality score(P>0.05).Using the postoperative pathological results of RP as a reference standard,the percentage of GS upgrade of targeted biopsies was 26.92%(14/52)in patients who underwent radical prostatectomy in the 16G group and 47.91%(23/48)in patients who underwent radical prostatectomy in the 18G group,with a statistical difference between the two groups(P<0.05).Conclusions:1.By applying four types of biopsy needles for ex vivo targeted prostate puncture,it was found that increasing the diameter of the biopsy needle could improve the detection rate of CsPca,the percentage of positive stitches and the accuracy of pathological assessment of biopsy tissue specimens to some extent.the size of the tissue specimens obtained with the 14G biopsy needle was significantly larger than that with the 16G biopsy needle,but the pathological results and the quality of the tissue specimens were not significantly different from those with the 16G biopsy needle,while the 20G biopsy needle The biopsy results and tissue specimen quality of the 20G biopsy needle were significantly lower than those of the 18G biopsy needle,so the 14G and 20G biopsy need to be used with caution in the application of actual clinical targeted biopsies.16G penetration biopsy needle has a better penetration effect than the 18G biopsy needle in isolated targeted puncture,but further validation in actual clinical targeted prostate puncture is needed.2.In the application of actual clinical targeted prostate puncture,the 16G biopsy needle significantly improved the occurrence of empty stitches during puncture and increased the detection rate of CsPCa,the percentage of positive biopsy stitches and the accuracy of pathological evaluation,without increasing the risk of pain and complications during biopsy compared with the 18G biopsy needle.