Application Value Of MRI-TRUS Cognitive Fusion Guided Transrectal Prostate Biopsy In The Diagnosis Of Prostate Cancer

Objective : The purpose of this study is to evaluate the application value of MRI-TRUS(magnetic resonance imaging-transrectal ultrasound)cognitive fusion in the diagnosis of prostate cancer during 12 needle systematic prostate puncture by comparing the difference between 12 needle systematic puncture with MRI-TRUS cognitive fusion and traditional 12 needle systematic puncture in terms of the detection rate of prostate cancer,the detection rate of clinically significant prostate cancer,the number of puncture positive needles,and the content of tumor samples.Method: The clinical data of 604 hospitalized patients who underwent ultrasound guided transrectal prostate biopsy in the ultrasound intervention room of the Second Affiliated Hospital of Kunming Medical University from May 2020 to March 2022 were retrospectively collected,including basic information of the patient,sorting out the levels of serum t PSA(total prostate specific antigen)and f PSA(free prostate specific antigen)before puncture,prostate volume,transrectal ultrasound showing echo of prostate parenchyma,MRI,preoperative rectal digital examination and postoperative pathological results,puncture tumor content,and pathological Gleason score.Excluding cases that did not meet the inclusion criteria and incomplete data,a total of 467 patients were eventually enrolled.According to the puncture method,the enrolled patients were randomly divided into a 12 needle puncture group(cognitive fusion group)with a total of 260 patients after the cognitive fusion planning of transrectal MRI-TRUS;There were 207 cases in the systematic 12 needle puncture group(system group)under the guidance of transrectal ultrasound.Using pathological diagnosis as the gold standard,the detection rate of prostate cancer,the detection rate of clinically significant prostate cancer,the positive rate of a single needle,and the highest tumor content of the key needle were compared between two groups.The accuracy of PI-RADS(prostate imaging reporting and data System)score prediction for clinically significant prostate cancer was evaluated using the ROC(receiver operating characteristic curve)curve,and the impact of MRI-TRUS cognitive fusion on the tumor content of the sample during puncture was analyzed using multivariate logistic regression.Results:(1)In this study,there were no statistically significant differences between the two groups in terms of age,prostate volume,t PSA,f PSA,transrectal ultrasound showing echo of prostate parenchyma,rectal digital examination,and PI-RADS scores(P>0.05).(2)Comparison of the detection rate of prostate cancer: In the cognitive fusion group,there were 130 cases(130/260)with positive puncture pathological results,with a puncture positive rate of 50.00%.In the system group,there were 97 cases(97/207)with positive puncture pathological results,with a positive rate of 46.86%.There was no statistically significant difference between the two groups(P>0.05);The positive rate of clinically significant prostate cancer in the two groups: 107 patients(107/130)in the cognitive fusion group had clinically significant prostate cancer,with a positive rate of 82.30%.78 patients(78/97)in the system group had clinically significant prostate cancer,with a positive rate of 80.41%.There was no statistically significant difference between the two groups(P>0.05).(3)Comparative single needle positive rate: Both groups had 12 punctures,while the cognitive fusion group had 1010 positive needles,with a positive rate of 32.37%.The system group had 803 positive needles,with a positive rate of 32.33%.There was no statistically significant difference between the two groups(P>0.05).(4)The relationship between preoperative MRI lesion assessment and postoperative Gleason score in the cognitive fusion group: There were a total of 260 patients in the cognitive fusion group,of which 130 were biopsy positive.Spearman correlation test showed a positive correlation between PI-RADS score and Gleason score.The PI-RADS score predicts a ROC curve AUC(area under curve)of 0.825(95% CI: 0.730-0.920)for cs PCA,with a maximum Jordan index of 0.589,roughly corresponding to 5categories of PI-RADS scores.MRI imaging with a PI-RADS score of 5 predicts a sensitivity of 72.0%(77/107),specificity of 87.0%(20/23),accuracy of 74.6%(97/130),positive predictive value of 96.3%(77/80),and negative predictive value of40.0%(20/50)for cs PCA.(5)To compare the highest tumor content of prostate cancer patients with puncture key needle: cognitive fusion group 130 cases of PCa,system group 97 cases of PCa.There was no significant difference in the distribution of age,prostate volume,PSA,lesion PI-RADS score,and Gleason score between the two groups of PCa patients(P>0.05).The key needle tumor content in the cognitive fusion group was significantly higher than that in the system group,with a statistically significant difference(P<0.05).The multivariate logistic regression results showed that whether the cognitive fusion group had a significant correlation with the tumor content of the key needle punctured by the patient(P<0.001).The probability of obtaining a single needle high tumor content(single needle tumor content>87.5%)in the cognitive fusion group was 10.29 times higher than in the system group;Whether the lesion PI-RADS score is 5 pairs or not is significantly correlated with the tumor content of the key needle punctured by the patient(P<0.001).The probability of obtaining a single needle high tumor content(single needle tumor content>87.5%)when the lesion PI-RADS score is 5 is 8.73 times higher than when the lesion score is3 or 4.Conclusion(s):(1)There is no statistical difference in the detection rate of prostate cancer between the 12 needle puncture method guided by MRI-TRUS cognitive fusion and the traditional 12 needle systematic puncture method.(2)There is a positive correlation between preoperative PI-RADS score and postoperative Gleason score;A PI-RADS score of 5 has certain accuracy in predicting clinically significant prostate cancer.(3)The prostate puncture method guided by MRI-TRUS cognitive fusion and lesions with a PI-RADS score of 5 categories can make it easier to obtain tissue with higher tumor content during puncture sampling,which is helpful for pathological grouping and grading.