MRI-TRUS Cognitive Fusion-guided Biopsy For The Diagnosis Of Prostate Cancer

Context:Prostate cancer(PCa)is a common malignant tumor in urology.It is current-1y the focus of research in urology.Worldwide,the incidence of prostate cancer is the second highest among all male malignant tumors,which seriously endangers men's health.Because of the characteristics of long course and slow progress of prostate cancer,if early detection and timely treatment can achieve,most patients will get good therapeutic effects,so early diagnosis and treatment is especially important.Prostate biopsy is considered to be the gold standard for clinical diagnosis of prostate cancer at present,transrectal ultrasound systematic prostate biopsy is currently the standard surgery for prostate biopsy,but there are problems such as high false negative rate,missed diagnosis of high-risk prostate cancer or excessive puncture.With the development of imaging technology,the research focus of prostate biopsy in recent years is targeted prostate biopsy,which can improve the accuracy of single-needle puncture.As the highest resolution of the prostate imaging examination,multiparametric magnetic resonance imaging(MRI)is used to guide the targeted prostate biopsy.Currently,MRI based prostate targeted biopsy techniques include MRI direct guided biopsy,MRI-TRUS imaging fusion guided targeted biopsy,MRI-TRUS cognitive fusion guided targeted biopsy and so on.Objective:By comparing and analyzing the positive rate and complication of the two puncture methods,which are MRI-TRUS cognitive fusion guided targeted prostate biopsy combined with system biopsy(TB + SB)and transrectal ultrasound guided systematic prostate biopsy(SB),to study and compare the accuracy and safety of the two methods of prostate biopsy for the diagnosis of prostate cancer,then provides a reference for the specific method of prostate biopsy in clinical work,so as to improve the accuracy of line of prostate biopsy in the diagnosis of prostate cancer.Methods:A retrospective analysis of clinical data of patients who underwent the transrectal ultrasound guided prostate biopsy in Shandong provincial hospital urinary surgery department from January 2015 to October 2018.there are a total of 360 patients,91 patients without complete clinical data or did not meet the inclusion criteria were excluded,a total of 269 patients were included in the study,the collection of data include age,tPSA,digital rectal exam,prostate volume,MRI report,puncture method,number of puncture needle,biopsy pathological results and complications after puncture,etc.According to the puncture method the patients had received,they were divided into two groups,146 patients received MRI-TRUS cognitive fusion guided targeted prostate biopsy combined with system biopsy,123 patients received\ultrasound guided systematic prostate biopsy.The pathological results of puncture specimens in the two groups were statistically analyzed,and the differences of the positive rate of puncture and the incidence of complications between the two groups were compared.Dates were analyzed by SPSS 19.0.Results:(1)there were no statistically significant differences in general information,DRE,tPSA,prostate volume,and PSAD between the two groups included in this study(P>0.05).The average number of puncture needles in the two groups had statistical significance(P<0.05)(2)85 patients in the two groups had positive rectal digital diagnosis results,and the positive rate of puncture results was 70.59%;184 patients in the two groups had negative rectal digital diagnosis results,and the positive rate of puncture results was 41.30%.The differences were statistically significant(P<0.05).(3)There were 146 patients in group"TB+SB",The positive rate of biopsy was 56.16%.There were 123 patients in group "SB",The positive rate of biopsy was 44.72%.,The differences were statistically significant(P<0.05).In the"TB+SB" group,there were 74 cases of clinically significant prostate cancer,with a positive rate of 50.68%;in the,"SB,group,there were 47 cases of clinically significant prostate cancer,with a positive rate of 38.21%,The differences were statistically significant(P<0.05).(4)MRI-TRUS cognitive fusion guided guided targeted prostate biopsy were 484 cores,with a positive rate of 47.72%.Systematic prostate biopsy were 484 cores,the positive rate was 32.47%.The differences were statistically significant(P<0.05).(6)The positive rate of several targeted in the"TB+SB"group was 90.24%,reaching 90.24%of the total positive rate of puncture in the "TB+SB" group.The Kappa value of the consistency test for the diagnosis of prostate cancer was 0.89,and the P value was less then 0.001.(6)there were 2 cases(1.37%)in the"TB+SB"group and 4 cases(3.25%)in the"SB"group who got the serious complications of hyperthermia after prostate biopsy,with no statistically significant difference(P>0.05).Conclusion:No matter the total positive rate of biopsy and the clinically significant positive rate of prostate cancer and the positive rate of single needle puncture were counted,the results showed that the"TB+SB"group had a higher positive rate than the "SB" group.By comparing the consistency analysis of "TB"puncture only in the "TB+SB" group and the simultaneous "TB+SB" puncture in the diagnosis of prostate cancer,the results showed a high consistency.There was no statistically significant difference in the incidence of complications after prostate biopsy between the two groups.Therefore,MRI-TRUS cognitive fusion guided targeted prostate biopsy combined with system biopsy improves the detection rate of prostate cancer without increasing the incidence of complications,it is a safe and relatively more effective puncture method.