Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study

作者：Olivier Rouvière, Philippe Puech, Raphaële Renard‐Penna, M. Claudon, Catherine Roy, Florence Mège‐Lechevallier, Myriam Decaussin‐Petrucci, Marine Dubreuil-Chambardel, Laurent Magaud, Laurent Remontet, A. Ruffion, Marc C. Colombel, Sébastien Crouzet, Anne‐Marie Schott, LAURENT LEMAITRE, Muriel Rabilloud, N. Grenier, Nicolas Barry Delongchamps, Romain Boutier, Flavie Bratan, Serge Brunelle, Philippe Camparo, Pierre Colin, Jean-Michel Corréas, F. Cornélis, François Cornud, Fanny Cros, Jean-Luc Descotes, Pascal Eschwège, G. Fiard, Jean-Philippe Fendler, Hocine Habchi, Philippe Hallouin, Ahmed Khairoune, Hervé Lang, Yann Lebras, Frédéric Lefèvre, Bernard Malavaud, Paul Cezar Moldovan, Nicolas Mottet, Pierre Mozer, P. Nevoux, Gaële Pagnoux, G. Pasticier, D. Portalez, Eric Potiron, Athivada Soto Thammavong, Marc‐Olivier Timsit, Arnault Viller, Jochen Christoph Walz · 发表于：The Lancet Oncology · 年份：2018 · DOI：10.1016/s1470-2045(18)30569-2 · 被引用次数：1099 · 研究领域：Prostate Cancer Diagnosis and Treatment、Prostate Cancer Treatment and Research、Urologic and reproductive health conditions

BACKGROUND: Whether multiparametric MRI improves the detection of clinically significant prostate cancer and avoids the need for systematic biopsy in biopsy-naive patients remains controversial. We aimed to investigate whether using this approach before biopsy would improve detection of clinically significant prostate cancer in biopsy-naive patients. METHODS: In this prospective, multicentre, paired diagnostic study, done at 16 centres in France, we enrolled patients aged 18-75 years with prostate-specific antigen concentrations of 20 ng/mL or less, and with stage T2c or lower prostate cancer. Eligible patients had been referred for prostate multiparametric MRI before a first set of prostate biopsies, with a planned interval of less than 3 months between MRI and biopsies. An operator masked to multiparametric MRI results did a systematic biopsy by obtaining 12 systematic cores and up to two cores targeting hypoechoic lesions. In the same patient, another operator targeted up to two lesions seen on MRI with a Likert score of 3 or higher (three cores per lesion) using targeted biopsy based on multiparametric MRI findings. Patients with negative multiparametric MRI (Likert score ≤2) had systematic biopsy only. The primary outcome was the detection of clinically significant prostate cancer of International Society of Urological Pathology grade group 2 or higher (csPCa-A), analysed in all patients who received both systematic and targeted biopsies and whose results from both were ...