J Korean Med Sci.  2024 Feb;39(7):e63. 10.3346/jkms.2024.39.e63.

Sextant Systematic Biopsy Versus Extended 12-Core Systematic Biopsy in Combined Biopsy for Prostate Cancer

• Chung JH
• Song W
• Kang M
• Sung HH
• Jeon HG
• Jeong BC
• Seo SI
• Jeon SS
• Lee HM
• Park BK

• KMID: 2553316
• DOI: http://doi.org/10.3346/jkms.2024.39.e63

Abstract

Background
This study assessed the comparative effectiveness of sextant and extended 12-core systematic biopsy within combined biopsy for the detection of prostate cancer.
Methods
Patients who underwent combined biopsy targeting lesions with a Prostate Imaging Reporting and Data System (PI-RADS) score of 3–5 were assessed. Two specialists performed all combined cognitive biopsies. Both specialists performed target biopsies with five or more cores. One performed sextant systematic biopsies, and the other performed extended 12-core systematic biopsies. A total of 550 patients were analyzed.
Results
Cases requiring systematic biopsy in combined biopsy exhibited a significant association with age ≥ 65 years (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.25– 4.32; P = 0.008), PI-RADS score (OR, 2.32; 95% CI, 1.25–4.32; P = 0.008), and the number of systematic biopsy cores (OR, 3.69; 95% CI, 2.11–6.44; P < 0.001). In patients with an index lesion of PI-RADS 4, an extended 12-core systematic biopsy was required (target-negative/ systematic-positive or a greater Gleason score in the systematic biopsy than in the targeted biopsy) (P < 0.001).
Conclusion
During combined biopsy for prostate cancer in patients with PI-RADS 3 or 5, sextant systematic biopsy should be recommended over extended 12-core systematic biopsy when an effective targeted biopsy is performed.

Keyword

Prostate Cancer; Diagnosis; Biopsy

Figure

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  Fig. 1 Flow chart.PIRADS = prostate imaging–reporting and data system, mpMRI = multiparametric magnetic resonance imaging.

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  Fig. 2 Comparison of pathologic outcomes between two methods (six-core versus 12-core).

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  Fig. 3 Univariable logistic regression comparing six-core and 12-core systematic biopsies in combined biopsy.PIRADS = prostate imaging reporting and data system.

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