Regional Versus Systematic Biopsy in Addition to Targeted Biopsy: Results from a Systematic Review and Meta-analysis.

IF 8.3 1区 医学 Q1 ONCOLOGY European urology oncology Pub Date : 2024-10-24 DOI:10.1016/j.euo.2024.10.006
Francesco Sanguedolce, Carol Nancy Gianna Lauwers, Alessandro Tedde, Giuseppe Basile, Daria Chernysheva, Alessandro Uleri, Michael Baboudjian, Gianluca Giannarini, Valeria Panebianco, Massimo Madonia, Lars Budeaus, Morgan Roupret, Joan Palou, Alberto Breda, Ivo Schoots, Anwar R Padhani
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Abstract

Background and objective: Intensification of targeted biopsy (TBx) around a magnetic resonance imaging (MRI)-visible lesion with regional biopsy (RBx) could obviate the need for systematic biopsy (SBx). We aimed to compare the detection yields of clinically significant prostate cancer (csPCa)-defined as International Society of Urological Pathology (ISUP) grade group ≥2-between TBx + RBx and the reference standard (TBx + SBx).

Methods: RBx was defined as perilesional or ipsilateral biopsy. A literature search was conducted up to September 2023 using PubMed, Embase, and Web of Science databases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Included studies were eligible when presenting data from SBx, TBx, and TBx + RBx cores and their detection yields. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria were used to assess the risk of bias of the included studies.

Key findings and limitations: Twenty-one studies were included for a meta-analysis. The overall detection yield of csPCa was not statistically different between TBx + SBX and TBx + RBx (46.1% vs 44.2%; odds ratio [OR] 1.07, 95% confidence interval [CI] 0.99-1.16, p = 0.07); similar findings were found also for ISUP grade group ≥3 prostate cancer (PCa; OR 1.06, 95% CI 0.92-1.22, p = 0.43) and in different subgroup analyses. TBx + SBx was associated with higher cancer detection of ISUP grade group 1 PCa (OR 1.16, 95% CI 1.04-1.30, p = 0.008). The main limitations include the retrospective nature of most of the selected studies, heterogeneity of RBx definition, and template.

Conclusions and clinical implications: Our study supports the use of the TBx + RBx template in the early detection pathway for the detection of csPCa. SBx can be omitted when targeting lesions visible on MRI.

Patient summary: A prostate biopsy strategy consisting of taking biopsy in and around an magnetic resonance imaging-visible lesion reduces the risk of detecting indolent prostate cancers without affecting the detection of aggressive tumours.

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在靶向活检基础上进行区域活检与系统活检:系统综述和 Meta 分析的结果。
背景和目的:在磁共振成像(MRI)可见病灶周围加强靶向活检(TBx)并进行区域活检(RBx)可避免系统性活检(SBx)的需要。我们的目的是比较 TBx + RBx 和参考标准(TBx + SBx)对有临床意义的前列腺癌(csPCa)(定义为国际泌尿病理学会(ISUP)分级组≥2)的检出率:RBx定义为周围或同侧活检。使用PubMed、Embase和Web of Science数据库对截至2023年9月的文献进行了检索。研究遵循了系统综述和荟萃分析首选报告项目(PRISMA)指南。如果纳入的研究提供的数据来自 SBx、TBx 和 TBx + RBx 核心及其检测率,则符合条件。诊断准确性研究质量评估(QUADAS-2)标准用于评估纳入研究的偏倚风险:荟萃分析共纳入了 21 项研究。TBx+SBX和TBx+RBx对csPCa的总体检出率没有统计学差异(46.1% vs 44.2%;几率比[OR]1.07,95%置信区间[CI]0.99-1.16,p = 0.07);对于ISUP分级≥3级的前列腺癌(PCa;OR 1.06,95% CI 0.92-1.22,p = 0.43),在不同的亚组分析中也发现了类似的结果。TBx+SBx与更高的ISUP分级1组PCa癌症检出率相关(OR 1.16,95% CI 1.04-1.30,p = 0.008)。主要的局限性包括大多数所选研究的回顾性、RBx定义和模板的异质性:我们的研究支持在检测 csPCa 的早期检测路径中使用 TBx + RBx 模板。患者小结:前列腺活检策略包括在磁共振成像可见病灶及其周围进行活检,这种策略可降低检测出懒惰性前列腺癌的风险,同时不会影响侵袭性肿瘤的检测。
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来源期刊
CiteScore
15.50
自引率
2.40%
发文量
128
审稿时长
20 days
期刊介绍: Journal Name: European Urology Oncology Affiliation: Official Journal of the European Association of Urology Focus: First official publication of the EAU fully devoted to the study of genitourinary malignancies Aims to deliver high-quality research Content: Includes original articles, opinion piece editorials, and invited reviews Covers clinical, basic, and translational research Publication Frequency: Six times a year in electronic format
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