Objective To study the rule of lymph node metastasis rate in cN 0 papillary thyroid microcar-cinoma( cN0-PTMC) and to evaluate an appropriate region of neck dissection .Methods Data of 233 cases of cN0-PTMC were retrospectively analyzed .Univariate analysis with chi-square test was used to analyze the statisti-cal correlation between gender , age, tumor diameter and lymph node metastasis respectively .Results 81 out of 233 patients(34.8%)had cervical lymph node metastasis (30.0%in central region and 9.9%in lateral region). For patients with tumor diameter ( D)≤5 mm and D>5 mm, lymph node metastasis rate in central region was 21.6%and 36.6%(χ2 =6.199,P<0.05) and it was 4.9% and 13.7% respectively in lateral region (χ2 =5.035,P<0.05).For male and female patients, lymph node metastasis rate in central region was 42.1% and 26.1%respectively(χ2 =5.224,P<0.05), and it was 21.1% and 6.3% respectively in lateral region (χ2 =10.604,P<0.01).Lymph node metastasis rate in patients≤45 years old and >45 years old was 37.9% and 21.1% respectively (χ2 =7.792, P <0.01 ) .The lateral region lymph node metastasis rate was 17.1% and 6.7%when the central region lymph node was infringed or not (χ2 =5.947, P<0.05).Conclusions All cN0-PTMC patients should have a normative central neck dissection .Male patients with PTMC and tumor diameter >5 mm should receive the lateral neck lymphoid tissue exploration during surgery in order to find subclinical metas -tasis.

BACKGROUND:J2 takes functional domain (MHC CD4-D1/) of complex conjugate of CD4 molecule and MHC class II molecule as a target, and is a smal molecule compound obtained by computer screening from a chemical data containing hundreds of thousands of organic compounds. In the previous study, J2 was used in mouse models of skin transplantation and keratoplasty by oral and intraperitoneal injection. Results verified that J2 could prolong the survival time of grafts, and suppress occurrence of rejection. To better play the role of a drug targeting and to reduce systemic toxicity, J2 wil be further utilized in local treatment of keratoplasty rejection. OBJECTIVE:To investigate the inhibitory effect of new immunosuppressive agent J2 on CD4+ and CD8+T cel immune functions in rat models receiving alogenic penetrating keratoplasty. METHODS:Alogeneic penetrating keratoplasty model was established using the adult female Wistar rats as donors and Sprague-Dawley rats as recipients. Group A: normal Sprague-Dawley rats were injected with 0.05 mL placebo subconjunctivaly. Surgery rats were randomly divided into three groups. Group B: alograft rats were injected with 0.05 mL placebo subconjunctivaly after autologous keratoplasty. Group C: alograft rats were injected with 0.05 mL placebo subconjunctivaly. Group D: alograft rats were injected with 1% J2-nanosuspension 0.05 mL subconjunctivaly. The distribution of T cel subsets in peripheral blood was detected using flow cytometry at 3 days, 1, 2 and 3 weeks after transplantation and compared among groups. RESULTS AND CONCLUSION: There was no significant difference in total CD3+ T cels, CD4+ T cels, CD8+ T cels and CD4+/CD8+ in peripheral blood lymphocytes in group B at various time points. At 3 days and 1 week after surgery in group C, no significant difference in total CD3+ T cels, CD4+ T cels and CD8+ T cels was detected. At 1 and 2 weeks, the number of total CD3+ T cels, CD4+ T cels and CD8+ T cels increased, showing significant differences (P < 0.05). In group D, no significant hyperplasy was found in CD4+ T cels and CD8+ T cels at 1 and 2 weeks. The horizontal comparison of the same time point: the total CD3+ T lymphocytes of group D was significantly less than group C at 3 days, 1 and 2 weeks after operation (P < 0.05), whereas there was no significant difference at 3 weeks between the group D and group C. The number of CD4+ T lymphocytes in group D was less than in group C at 3 days and 1 week, but with no significant difference. The ratio of CD4+/CD8+ had no significant difference in group D compared with group C at 3 days, 1 and 3 weeks. J2 inhibits T lymphocyte proliferation and then inhibits T cel-mediated corneal alograft rejection.

Objective:To detect the value of utilizing bpMRI in prostate biopsy in the detection of prostate cancer with PSA≤20ng/ml.Methods:The clinical data of 394 patients who underwent prostate biopsy in the First Affiliated Hospital of Nanjing Medical University from November 2017 to October 2019 were retrospectively analyzed. Of all the patients, 177 underwent modified systematic biopsy, named TRUS group, 217 patients accepted pre-biopsy bpMRI examination, undergoing modified systematic biopsy if Prostate Imaging Reporting and Data System (PI-RADS) score < 3 or MRI-TRUS cognitive fusion targeted prostate + systematic biopsy if PI-RADS score ≥ 3, named MRI group. The median age of TRUS group was 66 (61, 74) years old, prostate specific antigen (PSA) was 9.52 (7.26, 12.30) ng / ml, and prostate volume (PV) was 36.84 (28.95, 57.72)ml. The median age of MRI group was 66 (59, 72) years old, PSA was 8.84 (6.65, 12.16) ng/ml, and PV was 39.45 (29.25, 58.69)ml. There was no difference in above parameters between the two groups. The χ 2 test was used to compare the detection rate of prostate cancer and clinically significant prostate cancer (CsPCa) between the two groups. Results:There was no significant difference in the detection rates of prostate cancer between TRUS group and MRI group [51.41% (91/177) vs. 48.39% (105/ 217), P = 0.550], but the detection rates of CsPCa were significantly different [26.55% (47/177) vs. 36.41% (79/217), P = 0.037]. In patients with PSA ≤ 10 ng / ml, there was no significant difference in the detection rates of prostate cancer between the two groups [43.62% (41/94) vs. 43.08% (56/130), P = 0.936], but there was a significant difference in the detection rates of CsPCa [17.02% (16/94) vs. 28.46% (37/130), P = 0.047]. There was no significant difference in the detection rates of prostate cancer [60.24% (50/83) and 56.17% (48/87), P= 0.504] and the detection rates of CsPCa [37.35% (31/83) vs. 48.28% (42/87), P = 0.150] between the two groups. The total detection rates of the last two needles in TRUS group and MRI group were 23.16% (41/177) and 36.63% (86/217), respectively, with significant difference ( P=0.001); the detection rates of CsPCa in the last two needles were 11.86% (26/177) and 29.03% (63/ 217), respectively, with significant difference ( P < 0.001). In MRI group, the detection rates of prostate cancer in patients with PI-RADS score <3, 3, 4, 5 were 21.21% (7/33), 25.84% (23/89), 73.24% (52/71), 95.83% (23/24), respectively; the detection rates of CsPCa were 12.12% (4/33), 17.98% (16/89), 54.93% (39/71), 83.33% (23/24), respectively. Conclusions:In patients with PSA ≤ 20 ng / ml, prostate biopsy based on bpMRI may improve the detection of CsPCa, especially in patients with PSA ≤ 10 ng/ml.

Objective:To study the clinical pathological features of patients with relapsed diffuse large B-celllymphoma (DLBCL) and to provide evidence for early clinical screening of recurrent cases.Methods:The clinical and pathological data of the 20 patients, who had relapsed DLBCL (relapsed group) and were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2019, were included. Meanwhile, other 34 patients with DLBCL who had achieved complete response (CR) for 36 months or more (CR group) were used as controls.Statistical methods were used to retrospectively analyze the differences in general conditions, clinical characteristics, lab resultsand pathological features between the two groups.Results:Clinically, there were 6 males and 14 females with a median age of 55.5 (33-85) years in the relapsed group and 14 males and 20 females with a median age of 53 (15-89) years in the CR group. The relapsed and CR groups had significant difference in Ann Arbor stage ( P=0.001), International Prognostic Index score ( P=0.006), primary lesions ( P=0.003), extranodal involvement ( P=0.002), and hepatitis B viral infection ( P=0.046), β2-MG level ( P=0.029), LDH level ( P=0.005) and CRP level ( P=0.006), while the age ( P=0.732), gender ( P=0.416), ECOG score ( P=0.248), B symptoms ( P=0.511), the presence of hypoalbuminemia ( P=0.279), anemia ( P=0.983) and A/G( P=0.416) showed no statistical difference.Pathologically, compared with the CR group, the relapsed group was mostly non-GCB type (85% vs. 59%, P=0.048), with a higher CD5 positive rate (25% vs.3%, P=0.014) and a lower bcl-6　positive rate (60% vs. 88%, P=0.017), while the expression of Ki-67, CD10, bcl-2, MUM1, CD20 and PAX5 was not different between the two groups. Conclusion:Most of the patients with relapsed DLBCL are non-GCB type. The patients with CD5 positivity, stage III-IV, International Prognostic Index score 3-5, nodal origin, often involving>1 extranodal organ, abnormally elevated LDH, CRP and β2-MG level, and HBV infection are more likely to relapse.

Objective:To investigate the difference of prostate cancer (PCa) detection rate between transperineal cognitive fusion targeted biopsy (COG-TB) and software fusion targeted (FUS-TB).Methods:We retrospectively analyzed 157 patients accepted transperineal targeted biopsies from December 2018 to December 2019, including 67 cases of COG-TB and 90 cases of FUS-TB. All patients were prostate biopsy na?ve, with PSA levels ≤ 20 ng/ml and prostate imaging reporting and data system version 2.1 (PI-RADS v2.1) scores ≥ 3. There was no significant difference between COG-TB and FUS-TB in the age [(70.78 ± 8.86) vs. (70.52 ± 8.79) years old], body mass index [(24.36 ± 2.69)vs. (24.14 ± 3.15) kg/m 2], prostate volume [36.69 (27.52, 47.40) vs. 38.81 (28.80, 53.46) cm 3], PSA level [8.27 (6.0, 11.65) vs. 8.88 (6.40, 13.54) ng/ml], PSAD [0.23 (0.15, 0.36) vs. 0.21 (0.14, 0.34) ng/ml 2], suspicious digital rectal examination findings [16 (23.9%) vs. 17 (18.9%)] and PI-RADS scores [24 (35.8%), 24 (35.8%), 19 (28.4%) and 21 (23.3%) vs. 21 (23.3%), 42 (46.7%), 27 (30.0%) for PI-RADS 3, 4, and 5, respectively]. There was no significant difference in baseline characteristics between the two groups (all P<0.05). The overall and stratified detection rates of PCa and clinically significant prostate cancer (CsPCa) were compared between the two groups. The upgrading rates of Gleason score after radical prostatectomy against biopsy Gleason score were compared between the two groups. Results:There was no significant difference between COG-TB and FUS-TB in the detection rate of PCa [76.1% (51/67) vs. 68.9% (62/90), P=0.32]. Also, no significant difference was found in the detection rate of PCa stratified by PSA [0-10ng/ml: 69.1% (29/42) vs. 57.1% (28/49); 10-20ng/ml: 88.0% (22/25) vs. 82.9% (34/41); all P>0.05] and PI-RADS score [3: 45.8% (11/24) vs. 23.8% (5/21); 4: 91.7% (22/24) vs. 81.0% (34/42); 5: 94.7% (18/19) vs. 85.2% (23/27); all P>0.05]. Similarly, there was no dramatically difference between COG-TB and FUS-TB in the detection rate of CsPCa [58.2% (39//67) vs. 50.0% (45/90), P>0.05]. No significant difference was found in the detection of CsPCa stratified by PSA [0-10ng/ml: 45.2% (19/42) vs.36.7% (18/49); 10-20 ng/ml: 80.0% (20/25) vs. 65.9% (27/41) ; all P>0.05] and PI-RADS score [3: 29.2% (7/24) vs. 9.5% (2/21), 4: 66.7% (16/24) vs. 57.1% (24/42), 5: 84.2%(16/19) vs. 70.4% (19/27) ; all P>0.05]. Additionally, the two technique was not different significantly in the upgrading rate [28.9% (13/45) vs. 26.2% (11/42), P=0.78]. Conclusions:There is no significant difference between FUS-TB and COG-TB in the detection rate of PCa and CsPCa, along with the upgrading rate after RP in patients with PSA ≤ 20 ng / ml and PI-RADS v2.1 score≥3.

Objective:To explore the influencing factors of clinically significant prostate cancer (CsPCa) in patients with PI-RADS score 3.Methods:The data of 133 consecutive patients with the PI-RADS score 3 from January 2019 to December 2020 were retrospectively analyzed. All patients underwent 4-needle transperineal targeted biopsy and 12-needle systematic prostate biopsy (SB). The overall age was 66 (60-72) years, and the overall PSA value was 8.22 (5.95-11.41) ng/ml. All patients underwent multiparametric magnetic resonance imaging (mpMRI), and PI-RADS v2.0 score was 3. Patients were divided into two mutually exclusive groups: non CsPCa group and CsPCa group. The differences of lesion location, laterality, focality and sequence parameters of mpMRI between the two groups were compared, and multivariate binary logistic regression was used to analyze the independent predictors of PI-RADS score 3 in patients with CsPCa.Results:Biopsy results showed 57 cases of prostate cancer, including 41 cases of CsPCa, and 76 cases of non-prostate cancer. The detection rate of prostate cancer was 46.62 %(57/133), and the detection rate of CsPCa was 30.83 %(41/133). There were 41 cases in CsPCa group and 92 cases in non CsPCa group. There was no significant difference between CsPCa group and non CsPCa group in age [66 (58-70) years vs. 66 (60-72) years], body mass index [24.22 (21.82-25.71) kg/m 2 vs. 23.71 (21.99-26.12) kg/m 2], PSA [9.39 (6.35-12.55) ng/ml vs. 7.67 (5.83-10.51) ng/ml], abnormal rate of rectal digital examination [21.95% (9/41) vs. 9.78% (9/92)] (all P > 0.05). There was significant difference in PSAD [0.40 (0.16-0.65) ng/ml 2 vs. 0.17 (0.12-0.24) ng/ml 2] ( P<0.05). In MRI, PI-RADS=3 lesions were mainly located in the transitional zone [46.62 %(62/133)]. In CsPCa group, MRI lesions were located in peripheral zone in 16 cases, transitional zone in 19 cases, and both areas in 6 cases. There were 16 cases on the right, 15 cases on the left and 10 cases on both sides. The lesions were diffused in 19 cases and localized in 22 cases. In the non CsPCa group, 41 lesions were located in the peripheral zone, 43 in the transitional zone, and 8 in both areas. There were 26 cases on the right, 35 cases on the left and 31 cases on both sides. The lesions were diffuse in 56 cases and localized in 36 cases. There was no significant difference in lesion location, side and diffusion degree between the two groups ( P> 0.05). Compared with the non CsPCa group, the positive rate of all MRI sequences in CsPCa group was higher (82.93% vs. 40.22%, P < 0.001), the positive rate of T2 weighted imaging (T2WI) was higher (92.68% vs. 75.00%, P = 0.018), the positive rate of diffusion weighted imaging (DWI) was higher (90.24% vs. 56.52%, P < 0.001), the maximum diameter was larger[(0.67(0.30-1.19)mm vs. 0.48(0.20-0.62)mm, P < 0.001], and the apparent diffusion coefficient (ADC) was lower[0.70(0.61-0.87) vs. 1.10(0.86-1.50), P < 0.001]. Concurrently, PSAD and lesion ADC were important predictors of CsPCa in logistic regression model [mean 10 fold cross validation AUC: 0.78(95% CI 0.65-0.88)]. Conclusions:Most of the MRI lesions in patients with PI-RADS 3 were located in the transitional zone, and the MRI lesions in CsPCa were more obvious and diffusion limited. PSAD and ADC values are independent predictors for the diagnosis of CsPCa in patients with PI-RADS score 3, and the log 2PSAD-ADC prediction model is helpful to find CsPCa from patients with PI-RADS score 3 and protect patients from unnecessary biopsy.

Objective:To compare the differences of prostate cancer (PCa) and clinically significant prostate cancer (CsPCa) positive rate and postoperative complications between transperineal cognitive prostate biopsy (COG-TPBx) and transrectal cognitive prostate biopsy (COG-TRBx) based on biparametric magnetic resonance imaging (bpMRI).Methods:The data of 276 patients undergoing prostate biopsy from January 2019 to June 2021 in the First Affiliated Hospital of Nanjing Medical University were retrospectively reviewed. 157 patients underwent COG-TPBx(TPBx group) and 119 patients underwent COG-TRBx (TRBx group). The average age [(66.39 ± 8.31) vs. (66.30 ± 8.42)years], body mass index (BMI) [(23.85±2.49) vs. (23.68±2.61) kg/m 2], PSA values [9.43(1.47-19.80) vs. 8.94(0.66-19.99) ng/ml], prostate volume [37.92(13.99-167.40) vs. 40.78(11.67-188.21) cm 3], PSA density [0.21(0.04-1.17) vs. 0.20(0.04-1.04) ng/(ml·cm 3)], and suspicious digital rectal examination [17.20% (27/157) vs. 21.10% (25/119) ] were not significantly different between TPBx group and TRBx group. The positive rate of PCa, CsPCa, as well as post-biopsy complications of the two groups were compared. Results:There were no significant differences in the positive rate of PCa [49.68%(78/157) vs. 47.06%(56/119), P=0.666] and CsPCa [38.22%(60/157) vs. 34.45%(41/119), P=0.520] between the two groups. In stratification analysis, TPBx group has a significantly higher positive rate of both PCa [54.69%(35/64)] and CsPCa[43.75%(28/64)] in apex zone than TRBx group[39.62%(21/53) and 20.75%(11/53), all P<0.05). Moreover, the postoperative complications were not significantly different in TPBx group compared to that in TRBx group [10.19% (16/157) vs. 12.61%(15/119), P= 0.567]. Conclusions:Our investigations revealed that the overall positive rate of PCa, CsPCa, and the complications were not statistically different between COG-TPBx and COG-TRBx. COG-TPBx has a significantly higher positive rate of both PCa and CsPCa in apex zone.

Objective:To explore the efficacy of single-plane bi-parameter magnetic resonance imaging (bpMRI) in the diagnosis of prostate cancer.Methods:The clinical data of 343 patients who underwent transperineal template prostate magnetic resonance-transrectal ultrasound (MRI-TRUS) cognitive fusion biopsy at the First Affiliated Hospital of Nanjing Medical University from January 2020 to July 2021 were retrospectively analyzed, with median age of [65.0(59.0, 72.0)] years, median body mass index (BMI) of [24.1(22.2, 25.6)]kg/m 2, median prostate volume (PV) of [41.7(29.1, 53.3)]ml, median PSA[6.9 (5.5, 8.4) ng/ml], median PSAD of[0.17(0.12, 0.22) ng/ml 2], and abnormal rate of digital rectal examination (DRE) [6.4%(22/343)]. All patients underwent initial biopsy and bi-parameter magnetic resonance imaging (bpMRI) examination before biopsy, and the images were interpreted using prostate image reporting and data system version 2.1 (PI-RADS v2.1). The detection rates of prostate cancer and clinically significant prostate cancer (csPCa) were compared between single-plane bpMRI and bpMRI. When PI-RADS≥3 score, MRI results were positive; when PI-RADS ≤2 score, MRI results were negative. Results:In the single-plane bpMRI group, 121 MRI results were negative and 222 were positive. Positive patients included 95 with PI-RADS 3 score, 94 with PI-RADS 4 score, and 33 with PI-RADS 5 score. In bpMRI group, 141 MRI results were negative and 202 were positive. Among the positive patients, 67 patients with PI-RADS 3 score, 102 patients with PI-RADS 4 score, and 33 patients with PI-RADS 5 score. The detection rates of single-plane bpMRI and bpMRI for prostate cancer were 22.3% (27/121) and 15.6% (22/141) in MRI negative cases[22.3% (27/121) and 15.6% (22/141), P=0.17], and PI-RADS scores with 3 points [35.8% (34/95) vs. 44.8% (30/67), P=0.25], 4 points [89.4% (84/94)vs. 90.2% (92/102), P=0.85] and 5 points [90.9% (30/33) vs. 93.9% (31/33), P=1.00] showed no significant difference in stratification. The detection rate of csPCa in the single-plane bpMRI group and bpMRI group was significantly different in the MRI negative cases [7.4% (9/121) and 2.1% (3/141), P=0.04]. PI-RADS scores with 3 points [22.1% (21/95) vs. 29.9% (20/67), P=0.27], 4 points [80.9% (76/94) vs. 79.4% (81/102), P=0.80] and 5 points [84.9% (28/33) vs. 90.9% (30/33), P=0.71] showed no significant difference in stratification. Conclusions:For those suspected of prostate cancer patients with PSA 4-10 ng/ml and PI-RADS score ≥3, single-plane bpMRI or bpMRI examination has the same efficacy in term of the detection rate of prostate cancer and csPCa.

Objective:To explore the optimal core numbers in targeted prostate biopsy (TB).Methods:The clinical data of 138 patients with prostate cancer diagnosed by six needle trans-perineal TB combined with system biopsy in the First Affiliated Hospital of Nanjing Medical University from October 2018 to March 2020 were retrospectively analyzed. Their age was (69.07 ± 7.97) years old, the PSA value was 9.15 (6.66, 12.95) ng/ml, the prostate volume was 35.01 (27.65, 43.27) cm 3and the PSA density was 0.25 (0.17, 0.36) ng/(ml ·cm 3). All patients accepted bi-parametric magnetic resonance imaging examination and had regions of interests (ROIs) with prostate imaging reporting and data system (PI-RADS) version 2.0 scores ≥ 3. The detective rate of prostate cancer (PCa), clinically significant PCa (CsPCa) and clinically insignificant PCa (CIPCa), along with the Gleason score upgrading rate after radical prostatectomy were compared between different numbers of prostate TB cores. Results:The detective rates for present PCa or CsPCa for the first 1-, 2-, 3-, 4-, 5- and 6-core TB were 74.64%(103/138), 85.51%(118/138), 94.20%(130/138), 98.55%(136/138) and 100.00%(138/138) compared with the total number of cores taken, respectively. The detective rates for CsPCa for the first 1-, 2-, 3-, 4-, 5- and 6-core TB were 67.52%(79/117), 77.78%(91/117), 88.89%(104/117), 93.16%(109/117) and 98.29%(115/117) compared with the total number of cores taken, respectively. Additionally, 20.72%(23/111) patients had Gleason score upgrade after RP. Compared with 6-core TB, the rates of postoperative upgrading for the first 1-, 2-, 3-, 4- and 5-core TB were 50.00%(44/88), 67.05%(59/88), 81.82%(72/88), 88.64%(78/88) and 95.45%(84/88), respectively. For the ROIs with PI-RADS score of 3, 4 and 5, the CsPCa detected by 5, 4 and 3 needles of TB were 95.00% (19/20), 94.92% (56/59) and 94.74% (36/38) respectively. Postoperative upgrading rates were 11.11% (2/18), 9.30% (4/43) and 7.41% (2/27) respectively.Conclusions:For ROIs with PI-RADS score of 3, 4 and 5, TB with 5, 4 and 3 cores respectively is enough to obtain higher diagnostic efficiency and accuracy.

Objective:To investigate the use of bi-parametric magnetic resonance imaging (bpMRI)-based cognitive fusion targeted biopsy and systematic biopsy in patients with prostate imaging reporting and data system (PI-RADS)≥3.Methods:The clinical data of 220 patients with PI-RADS ≥3 who underwent bpMRI-transrectal ultrasound (TRUS) cognitive fusion targeted biopsy and systematic biopsy in the First Affiliated Hospital of Nanjing Medical University from May 2018 to November 2019 were retrospectively analyzed. The median age was 66 (60, 73) years old, median prostate specific antigen (PSA) was 8.73 (6.52, 11.93) ng/ml, medlian prostate volume was 39.25(29.26, 58.39) ml and the mean body mass index (BMI) was (24.02±2.60) kg/m 2. For each patient, bpMRI-TRUS cognitive fusion targeted biopsy and systematic biopsy were performed by two independent experienced urologists. The primary endpoint was the detection rate of CsPCa-A [clinically significant prostate cancer-A, defined as International Society of Urological Pathology (ISUP) grade group 2 or higher tumors]. The secondary endpoints were the detection rates of CsPCa-B (defined as ISUP grade group 3 or higher tumors) and CIPCa (clinically insignificant prostate cancer, defined as ISUP grade group 1 tumors). McNemar test and Chi-square test were used to compare the positive rates of CsPCa-A, CsPCa-B and CIPCa between targeted biopsy and systematic biopsy. Results:In this study, 112 patients (50.91%) were diagnosed with prostate cancer, and the detection was 42.73% (94/220) in targeted biopsy and 46.82% (103/220) in systematic biopsy.CsPCa-A was detected in 84 (38.18%) patients. Detection of CsPCa-A by targeted biopsy and systematic biopsy was not different significantly [30.00% (66/220) vs.34.09% (75/220), P=0.120]. CsPCa-A would have been missed in 8.18% (18/220) patients had not performed systematic biopsy, and in 4.09% (9/220) patients had not performed targeted biopsy. CsPCa-B was detected in 26.36% (58/220) patients. Detection of CsPCa-B by targeted biopsy and systematic biopsy was not different significantly [20.00% (44/220) vs. 23.18% (51/220), P=0.190]. CsPCa-B would have been missed in 6.36% (14/220) patients had not performed systematic biopsy, and in 3.18% (7/220) patients had not performed targeted biopsy. In addition, there was no difference in the positive rates of CIPCa between targeted biopsy combined with systematic biopsy, targeted biopsy only or systematic biopsy only [all three were 12.73% (28/220), P=1.000]. Nine post-biopsy adverse events were reported, including 5 cases of infection, 2 cases of vagal reflex and 2 cases of urinary retention. All of them were improved after symptomatic treatment. Conclusions:No significant difference was identified in the detection rate of CsPCa between targeted biopsy and systematic biopsy. However, combination of targeted biopsy and systematic biopsy could further improve the detection rate of CsPCa without increasing the detection of CIPCa. Therefore, a pre-biopsy bpMRI did have significant importance in the biopsy-na?ve patients, but did not seem to skip the need for systematic biopsy.