Zusammenfassung
Hintergrund
Um die Prostatakarzinomdiagnostik zu optimieren wurde ein neues System für perineale Prostatastanzbiopsien entwickelt, welches eine Echtzeitübertragung von MRT-Daten auf den periinterventionellen Ultraschall gestattet. Hierdurch können suspekte Läsionen gezielt biopsiert werden. Darüber hinaus erlaubt das System, den Entnahmeort jeder einzelnen Biopsie in einer virtuell dreidimensional (3D-)konfigurierten Prostata zu dokumentieren.
Material und Methoden
Bei 50 konsekutiven Patienten (Alter 67 Jahre, PSA 8,9 ng/ml, Prostatavolumen 51 ml) wurden ein multiparametrisches 3-T-MRT ohne Endorektalspule und anschließend eine stereotaktische Biopsie durchgeführt. Mit Hilfe eines eigens konstruierten TRUS-Schallkopfes, der auf einem speziellen Führungssystem montiert ist, wurde ein 3D-Datensatz der Prostata generiert und mit dem MRT fusioniert. Anschließend wurden suspekte MRT-Befunde gezielt perineal biopsiert. Darüber hinaus wurden nicht auffällige Prostataareale systematisch gestanzt.
Ergebnisse
Bei 27 von 50 Patienten wurde ein Prostatakarzinom diagnostiziert. Bei zuvor negativ biopsierten Männern erfolgte ein Tumornachweis in 36%. Eine positive Korrelation zwischen MRT-Befund und Histopathologie fand sich bei 36/50 Patienten (72%). Bei hochsuspekten MRT-Läsionen lag die Detektionsrate bei 100% (13/13). Betrachtet man die einzelnen Zylinder aus hochsuspekten Arealen, so waren 40/75 (53%) positiv. Zum Vergleich waren nur 7% der systematischen Stanzen positiv (66/927). Die Abweichung zwischen der geplanten und der tatsächlich biopsierten Position in der Prostata betrug bei 1159 Stanzen im Mittel 1,7 mm. An Nebenwirkungen wurden ein Harnverhalt und ein Hämatom beobachtet. Harnwegsinfekte traten nicht auf.
Schlussfolgerungen
Perineale stereotaktische Prostatabiopsien unter Zuhilfenahme fusionierter MRT und Ultraschall Datensätze ermöglichen eine effektive Untersuchung von MRT-suspekten Läsionen. Zusätzlich ist es möglich, jede einzelne Biopsie exakt zu dokumentieren. Dadurch können MRT-Daten validiert und Therapien differenziert geplant werden. Die Morbidität des Eingriffs ist minimal.
Abstract
Background
A key challenge for prostate cancer (PC) therapy is to exactly diagnose tumor lesions. In this context we describe a new stereotactic prostate biopsy system, which integrates pre-interventional MRI with peri-interventional ultrasound for targeted perineal prostate biopsies. Furthermore, the novel system allows exact documentation of biopsies in three dimensions.
Patients and methods
Stereotactic biopsy was performed in 50 consecutive men with suspicion of PC [median age 67 years (42–77), mean PSA 8.9±6.8 ng/ml, and mean prostate volume 51±23.7 ml]. Twenty-five of these patients (50%) had already had a negative transrectal ultrasound (TRUS)-guided biopsy. All men underwent multiparametric, contrast-enhanced 3T MRI without endorectal coil. Suspicious lesions were marked before the obtained data were transferred to a novel stereotactic biopsy system. Using a custom-made biplane TRUS probe mounted on a stepper, 3-D ultrasound data were generated and fused with the MRI. As a result, suspicious MRI lesions were superimposed onto the TRUS data. Next, 3-D biopsy planning was performed including systematic biopsies from the peripheral zone of the prostate. According to local standards patients were treated with perioperative quinolone antibiotics and applied a rectal enema the evening before the procedure. Perineal biopsies were taken under live US imaging, and the location of each biopsy was documented in an individual 3-D model. Feasibility, safety, target registration error, and cancer detection were evaluated.
Results
The median number of biopsies taken per patient was 24 (12–36). In 27 men of the initial cohort of 50 consecutive patients presented here, biopsy samples showed PC (54%). In patients undergoing their first biopsy, cancerous lesions were diagnosed in 13 of 19 patients (68%). The result was positive in 36% of men undergoing a re-biopsy without previous cancer diagnosis (9/25). A positive correlation between MRI findings and histopathology was found in 72%. In MRI lesions marked as highly suspicious, the tumor detection rate was 100% (13/13). Looking at single cores from highly suspicious lesions, 40 of 75 (53%) biopsies were positive. The target registration error of the first 1,159 biopsy cores was 1.7 mm. Regarding adverse effects, one patient experienced urinary retention and one patient a perineal hematoma. Urinary tract infections did not occur.
Conclusion
Perineal stereotactic prostate biopsies guided by the combination of MRI and ultrasound allow effective examination of suspicious MRI lesions. Each biopsy core taken is documented accurately for its location in 3-D enabling MRI validation and tailored treatment planning. The morbidity of the procedure was minimal.
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B.A. Hadaschik und M. Hohenfellner teilen sich die Seniorautorenschaft.
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Kuru, T., Tulea, C., Simpfendörfer, T. et al. MRT-navigierte stereotaktische Prostatabiopsie. Urologe 51, 50–56 (2012). https://doi.org/10.1007/s00120-011-2707-3
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DOI: https://doi.org/10.1007/s00120-011-2707-3