Diagnostischer Stellenwert der multiparametrischen MRT mit gezielter Fusionsbiopsie der Prostata bei Patienten mit PSA-Anstieg und negativer Stanzbiopsie zur Detektion klinisch signifikanter Prostatakarzinome

Zusammenfassung

Ziel: Die multiparametrische MRT (mpMRT) in Verbindung mit einer perinealen gezielten Ultraschall (US)-Fusionsbiopsie soll die diagnostische Präzision bei der Diagnose des klinisch signifikanten Prostatakarzinoms steigern und die Überdiagnose niedrigmaligner Karzinome reduzieren.Methoden: Bei 99 Männern mit vorherigen negativen Standardbiopsien und erhöhtem PSA wurde eine mpMRT durchgeführt und anschließend ul traschallgestützte gezielte perineale Fusionsbiopsien entnommen. Die mittels mpMRT gewonnenen PI-RADS-Daten (PS) und der histopathologisch erhobene Gleason Score (GS) wurden miteinander verglichen.Ergebnisse: Bei der mpMRT wurden bei 72/99 Patienten (73 %) Läsionen des PS 4 oder 5 gefunden. Histopathologisch zeigte sich bei 33/99 Patienten (33 %) kein Anhaltspunkt für Malignität. Bei 66 Patienten wurde trotz vorheriger negativer konventioneller Stanzbiopsien in 42 Fällen (64 %) ein low-grade- (GS 6, ≤ 7a) und in 24 Fällen (36 %) ein High-grade-Karzinom (GS ≥ 7b) entdeckt. Bei 21/24 high-grade-Karzinomen (88 %) war auch bei der mpMRT ein Karzinom detektiert worden (PS 4-5). Bei einer Sensitivität von 88 % fand sich ein negativer prädiktiver Wert (NPV) von 85 % (p=0,002). Darüber hinaus wurde bei 35 von 42 low-grade-Karzinomen (83 %) in der mpMRT ein Karzinom-Befund (PS 4-5) erhoben (p < 0,001). Die Sensitivität für eine Differenzierung zwischen low- und high- grade-Karzinomen (GS ≤ 7a vs. ≥ 7b) mittels PS betrug 88 % bei einem NPV von 70 % (p=0,74).Schlussfolgerung: Die Ergebnisse der vorliegenden Studie weisen darauf hin, dass die mpMRT-gestützte US-Fusionsbiop- sie erheblich höhere Detektionsraten zum Nachweis klinisch signifikanter Prostatakarzinome aufweist als die bislang gebräuchlichen Diagnoseverfahren. Jedoch konnte keine statistische Signifikanz bezüglich der Differenzierung zwischen high- und low-gra- de-Karzinomen gezeigt werden. Es ist zu hoffen, dass die Hybridverfahren PSMA- PET/CT bzw. PSMA-PET/MRT in der bis jetzt nicht befriedigenden Signifikanz bei der Differenzierung zwischen high- und low-gra- de-Karzinomen den nächsten Optimierungsschritt herbeiführen werden.

Summary

Aims: To increase diagnostic precision and to reduce overtreatment of low-risk malignant disease, multiparametric MRI (mpMRI) combined with ultrasound (US) fusion guided biopsy of the prostate were performed.Methods: In 99 male patients with increased PSA plasma levels and previous negative standard biopsy procedures, mpMRI was carried out followed by US fusion guided perineal biopsy. PI-RADS-Data (PS) of mpMRI and histopathological Gleason score (GS) were categorized and statistically compared.Results: Lesions in 72/99 (73 %) of patients were determined to be suspect of malignan cy, based on a PS 4 or 5. In 33/99 (33 %) of patients, malignancy could not be confirmed by histopathology. With regard to the remaining 66 patients with previous negative biopsy results, 42 (64 %) were diagnosed with a low- grade carcinoma (GS 6, 7a) and 24 (36 %) with a high-grade carcinoma (GS ≥ 7b). The proportion of corresponding results in mpMRI (PS 4-5) when a high-grade carcinoma had been detected, was 21/24 (88 %), which related to a sensitivity of 88 % and a negative predictive value (NPV) of 85 % (p = 0,002). In addition, 35 of 42 patients (83%), graded PS 4-5 in mpMRI, were diagnosed with low- grade carcinoma-positive (p < 0,001). Sensitivity to differentiation between low- and highgrade carcinomas (GS ≤ 7a vs. ≥ 7b) by means of PS was 88 % with a NPV of 70 % (p = 0,74).Conclusion: Our results suggest that mpMRI combined with US-fusion guided biopsy is able to detect considerably higher rates of clinically relevant prostate malignancies compared to conventional diagnostic procedures. However, no statistical significance could be shown regarding the differentiation between high- and low-grade carcinomas. It is hoped that the hybrid methods PSMA-PET/ CT or PSMA-PET/MRI will lead to the next optimization step in the differentiation between high- and low-grade carcinomas which so far has been unsatisfactory.

Keywords

PI-RADS - mpMRI - Gleason score - prostate cancer

Schlüsselwörter

PI-RADS - mpMRT - Gleason Score - Prostatakarzinom

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