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MRT/TRUS-fusionierte Biopsiesysteme

Stellenwert bei der fokalen Therapie des Prostatakarzinoms

MRI/TRUS fusion-guided prostate biopsy

Value in the context of focal therapy

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Zusammenfassung

Hintergrund

Es existieren zahlreiche Systeme zur MRT/TRUS-fusionierten Biopsie der Prostata. Insgesamt liegt ausreichend Literatur zur Fusionsbiopsie vor, die einen Vorteil bei der Tumordetektion und der Diagnosequalität gegenüber der Randombiopsie belegt. Der Nutzen der Systeme im Rahmen der fokalen Therapie des Prostatakarzinoms (PC) ist unklar.

Ziel der Arbeit

Ziel war die kritische Prüfung der vorhandenen Fusionssysteme für die Planung und Verlaufskontrolle einer fokalen Therapie des PC.

Material und Methoden

Es erfolgte eine systematische Literaturrecherche zu den erhältlichen Fusionssystemen für den Zeitraum 2013–5/2016. Durch den Arbeitskreis „Fokale und Mikrotherapie“ wurde ein Kriterienkatalog zu technischen Details, der Eignung in speziellen Situationen und der Eignung im Rahmen der fokalen Therapie des PC erstellt.

Ergebnisse

Acht Fusionssysteme wurden betrachtet (Artemis™, BioJet, BiopSee®, iSR’obot™ Mona Lisa, Hitachi HI-RVS, UroNav und Urostation®). Unterschiede zwischen den Systemen bestehen u. a. in der Art der Biopsie (transrektal, perineal, beides möglich), im Fusionsmodus (starr bzw. elastisch), in der Navigationsart (bildbasiert, elektromagnetisch bzw. mechanisch) sowie im Platzbedarf.

Diskussion

Fusionssysteme werden im Rahmen der fokalen Therapie des PC von verschiedenen Konsensusgruppen empfohlen. Wünschenswerte Eigenschaften sind neben dem „needle tracking“ die Übertragbarkeit des Biopsiedatensatzes in ein Behandlungsgerät (Artemis™, BiopSee® und Urostation®: jeweils mit Focal One®, BiopSee®, Hitachi HI-RVS: jeweils mit Nanoknife®, BioJet und BiopSee®: Kryoablation, Brachytherapie).

Schlussfolgerung

Studien zur Planung einer fokalen Therapie liegen nur für vereinzelte Systeme vor und fehlen für die Verlaufskontrolle nach fokaler Therapie.

Abstract

Background

Several systems for MRI/TRUS fusion-guided biopsy of the prostate are commercially available. Many studies have shown superiority of fusion systems for tumor detection and diagnostic quality compared to random biopsy. The benefit of fusion systems in focal therapy of prostate cancer (PC) is less clear.

Objectives

Critical considerations of fusion systems for planning and monitoring of focal therapy of PC were investigated.

Materials and methods

A systematic literature review of available fusion systems for the period 2013–5/2016 was performed. A checklist of technical details, suitability for special anatomic situations and suitability for focal therapy was established by the German working group for focal therapy (Arbeitskreis fokale und Mikrotherapie).

Results

Eight fusion systems were considered (Artemis™, BioJet, BiopSee®, iSR´obot™ Mona Lisa, Hitachi HI-RVS, UroNav and Urostation®). Differences were found for biopsy mode (transrectal, perineal, both), fusion mode (elastic or rigid), navigation (image-based, electromagnetic sensor-based or mechanical sensor-based) and space requirements.

Discussion

Several consensus groups recommend fusion systems for focal therapy. Useful features are “needle tracking” and compatibility between fusion system and treatment device (available for Artemis™, BiopSee® and Urostation® with Focal One®; BiopSee®, Hitachi HI-RVS with NanoKnife®; BioJet, BiopSee® with cryoablation, brachytherapy).

Conclusions

There are a few studies for treatment planning. However, studies on treatment monitoring after focal therapy are missing.

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Correspondence to R. Ganzer.

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Interessenkonflikt

D. Baumunk, R. Ganzer und A. Blana sind Trainer für die Geräte Ablatherm™ und FocalOne™ und erhalten in dieser Funktion Honorare der Firma EDAP-TMS. M. Schostak und A. Blana sind Berater für EDAP-TMS. B. Hadaschik ist als Berater für MedCom tätig gewesen. T. Franz, J. von Hardenberg, H. Cash, G. Salomon, T. Henkel, J. Herrmann, F. Kahmann, K.-U. Köhrmann, J. Köllermann, S. Kruck, U.-B. Liehr, S. Machtens, I. Peters, J.P. Radtke, A. Roosen, H.-P. Schlemmer, L. Sentker, J.J. Wendler, U. Witzsch, J.-U. Stolzenburg, und geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Die Autoren T. Franz, J. von Hardenberg, M. Schostak und R. Ganzer haben zu gleichen Teilen zum Manuskript beigetragen.

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Franz, T., von Hardenberg, J., Blana, A. et al. MRT/TRUS-fusionierte Biopsiesysteme. Urologe 56, 208–216 (2017). https://doi.org/10.1007/s00120-016-0268-1

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  • DOI: https://doi.org/10.1007/s00120-016-0268-1

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