Prostat Biyopsisinde İğne Kalınlığını Küçültmek, Örnek Kalitesini ve Kanser Tespit Oranlarını Etkilemeden, Komplikasyonları Azaltabilir Mi?

Amaç: Çalışmanın amacı; prostat kanseri tanısı için yapılan transrektal ultrason eşliğinde prostat biyopsisinde (TRUSPBx) standart olarak kullanılan 18G (gauge) biyopsi iğnesi ile 20G biyopsi iğnesini alınan örnek kalitesi, kanser tespit oranları, ağrı ve diğer komplikasyonlar açısından karşılaştırmaktır. Materyal-Metot: PSA (Prostat Spesifik Antijen) değerleri 2,5-10 ng/ml, prostat hacimleri 30-80 cc, yaşları 50-70 arasında olan 120 hasta, sayıları eşit olacak şekilde rastgele iki gruba ayrıldı. Grup 1’i 18G, grup 2’yi 20G iğne ile prostat biyopsisi yapılanlar oluşturmaktaydı. Fakat 20G iğne biyopsisi ile yapılan çalışmanın kolu, hasta sayısı 32’ye ulaştığında çok düşük kanser tespit oranı nedeniyle durduruldu. Grup 2'deki tüm hastalara 3 ay sonra 18G iğnesi ile yeniden biyopsi yapıldı. Tüm hastalarda, işlemi sırasında ve sonrasında ki komplikasyonlar ile kanser tespit oranları değerlendirildi. Bulgular: Grup 2’dekilerde kanser tespit oranları grup 1’e kıyasla anlamlı derecede düşüktü. VAS (Visual Analog Scale: Görsel Analog Skalası) 2 ağrı skoru Grup 2’de daha düşüktü (p=0,008) fakat diğer VAS skorlarında istatistiksel olarak anlamlı fark yoktu. Her iki grupta biyopsiye bağlı yan etki ve komplikasyon görülme oranı benzerdi. Grup 2’deki tüm hastalara 18G iğne ile tekrar biyopsi yapıldı. Kanser tespit oranı 18G iğne ile TRUS-PBx yapılanlarda istatistiksel olarak anlamlı derecede yüksekti (p=0,0055). Sonuç: TRUS-PBx için yeterli numune elde etme ve kanser saptama oranını, 18G iğneye kıyasla 20G iğnede çok düşük olduğu bulundu. Ağrı dahil tüm komplikasyonlarda ise her iki iğnenin klinik olarak birbirlerine karşı hiçbir üstünlüğü bulunamadı. Çalışmamıza göre 20G iğne ile prostat biyopsisi almanın doğru bir yaklaşım olmadığı sonucuna varıldı.

Can Smaller Needle Size In Prostate Biopsy Reduce Complications Without Affecting Sample Quality and Cancer Detection Rates?

Objective: The aim of this study is to compare the 18G and20G biopsy needle in transrectal ultrasound guided prostatebiopsy (TRUS-PBx) for diagnosis of prostate cancer in termsof sample quality, cancer detection rates, pain and othercomplications.Material-Method: 120 patients with PSA (prostate specificantigen) levels of 2.5-10 ng/ml, prostate volumes of 30-80 ccand 50-70 years of age were randomly divided into two groupsas those who underwent biopsy with 18G (Group 1) and 20G(Group 2) needles. However, the arm of the study performedwith 20G needle biopsy was stopped due to the very lowcancer detection rate when the number of patients reached32. All patients in Group 2 were performed re-biopsy with an18G needle 3 months later. In all patients, complications andcancer detection rates were evaluated in during and after theprocedure.Results: The cancer detection rates in Group 2 weresignificantly lower compared to Group 1. The VAS (VisualAnalog Scale) 2 score was lower in Group 2 (p=0.008),but there was no statistically significant difference in otherVAS scores. In both groups, the rate of side effects andcomplications related to biopsy were similar. All patientsin Group 2 were re-biopsied with an 18G needle. The rateof cancer detection was significantly higher in patients whounderwent TRUS-PBx with 18G needle (p=0.0055).Conclusions: We found that the rate of obtaining sufficientsample for TRUS-PBx and detection of cancer was verylow in 20G compared to 18G needle. 20G needle had nosuperiority to 18G needle in all complications, including pain.We concluded that 20-gauge needle prostate biopsy was notan accurate approach in our study.

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1. Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, et al. Systematic review of complications of prostate biopsy. European urology. 2013;64(6):876-92.
2. Wang J, Wang L, Du Y, He D, Chen X, Li L, et al. Addition of intrarectal local analgesia to periprostatic nerve block improves pain control for transrectal ultrasonography‐guided prostate biopsy: A systematic review and meta‐analysis. International Journal of Urology. 2015;22(1):62-8.
3. Bjurlin MA, Carter HB, Schellhammer P, Cookson MS, Gomella LG, Troyer D, et al. Optimization of initial prostate biopsy in clinical practice: sampling, labeling and specimen processing. The Journal of urology. 2013;189(6):2039-46.
4. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. European urology. 2014;65(2):467-79.
5. Dasgupta P, Davis J, Hughes S. NICE guidelines on prostate cancer 2019. BJU international. 2019;124(1):1-.
6. Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. European urology. 2017;71(4):618-29.
7. Ochiai A, Babaian RJ. Update on prostate biopsy technique. Current opinion in urology. 2004;14(3):157-62.
8. Cicione A, Cantiello F, De Nunzio C, Tubaro A, Damiano R. Prostate biopsy quality is independent of needle size: a randomized single-center prospective study. Urologia internationalis. 2012;89(1):57-60.
9. Wan B, Li C, Wang J, Zhao W, Fu Q, Zhang K. Diagnostic yield and complications using a 20 gauge prostate biopsy needle versus a standard 18 gauge needle: a randomized controlled study. Urology journal. 2015;12(5):2329-33.
10. Kilciler M, Demir E, Bedir S, Erten K, Kilic C, Peker AF. Pain scores and early complications of transrectal ultrasonography-guided prostate biopsy: effect of patient position. Urologia internationalis. 2007;79(4):361-3.
11. Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery. 2004;240(2):205.
12. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent—update 2013. European urology. 2014;65(1):124-37.
13. Ahdoot M, Wilbur AR, Reese SE, Lebastchi AH, Mehralivand S, Gomella PT, et al. MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis. New England Journal of Medicine. 2020;382(10):917-28.
14. Baco E, Rud E, Eri LM, Moen G, Vlatkovic L, Svindland A, et al. A randomized controlled trial to assess and compare the outcomes of two-core prostate biopsy guided by fused magnetic resonance and transrectal ultrasound images and traditional 12-core systematic biopsy. European urology. 2016;69(1):149-56.
15. Cicione A, Cantiello F, De Nunzio C, Tubaro A, Damiano R. Needle biopsy size and pathological Gleason Score diagnosis: No evidence for a link. Canadian Urological Association Journal. 2013;7(9-10):E567.
16. Inal G, Öztekin V, Uğurlu Ö, Kosan M, Akdemir Ö, Cetinkaya M. Sixteen gauge needles improve specimen quality but not cancer detection rate in transrectal ultrasoundguided 10-core prostate biopsies. Prostate cancer and prostatic diseases. 2008;11(3):270.
17. McCormack M, Duclos A, Latour M, McCormack MH, Liberman D, Djahangirian O, et al. Effect of needle size on cancer detection, pain, bleeding and infection in TRUS-guided prostate biopsies: a prospective trial. Canadian Urological Association Journal. 2012;6(2):97.
18. Dogan HS, Eskicorapci SY, Ertoy-Baydar D, Akdogan B, Gunay LM, Ozen H. Can we obtain better specimens with an end-cutting prostatic biopsy device? European urology. 2005;47(3):297-301.
19. Ficarra V, Martignoni G, Novella G, Cerruto MA, Galfano A, Novara G, et al. Needle core length is a quality indicator of systematic transperineal prostate biopsy. European urology. 2006;50(2):266-71.
20. Ubhayakar G, Li W, Corbishley C, Patel U. Improving glandular coverage during prostate biopsy using a long‐core needle: technical performance of an end‐cutting needle. BJU international. 2002;89(1):40-3.
21. Hizli F, Argun G, Ozkul F, Guven O, Arik AI, Basay S, et al. Novel Approach for Pain Control in Patients Undergoing Prostate Biopsy: Iliohypogastric Nerve Block with or without Topical Application of Prilocaine-Lidocaine: A Randomized Controlled Trial. Urology journal. 2015;12(1):2014-9.
22. Shakil J, Piracha N, Prasad N, Kopacz J, Tarasuk A, Farrell R, et al. Use of outpatient parenteral antimicrobial therapy for transrectal ultrasound-guided prostate biopsy prophylaxis in the setting of community-associated multidrug-resistant Escherichia coli rectal colonization. Urology. 2014;83(4):710-3.