经会阴前列腺磁共振-经直肠超声认知融合引导下靶向穿刺联合系统穿刺的临床价值

Clinical value of targeted biopsy combined with systematic biopsy guided by transperineal prostate MRI-TRUS cognitive fusion

目的探究经会阴前列腺磁共振-经直肠超声(magnetic resonance imaging-transrectal ultrasound,MRI-TRUS)认知融合引导下靶向穿刺(targeted biopsy,TB)联合系统穿刺(systematic biopsy,SB)的临床价值。方法收集2018年1月~2021年10月于溧阳人民医院进行前列腺穿刺197例患者的临床资料,病理学诊断显示89例为前列腺癌(prostate cancer,PCa),患者均行MRI-TRUS认知融合引导下靶向穿刺及系统穿刺。采用Kappa检验,分析MRI-TRUS认知融合引导下靶向穿刺及系统穿刺的符合率、灵敏度及特异度。结果TB诊断出前列腺癌患者79例(43.65%);SB诊断出PCa患者73例(38.58%);联合诊断出PCa患者85例(45.69%),两两比较差异均无统计学意义(P>0.05);TB联合SB诊断PCa的总符合率为83.25%,高于TB的总符合率73.10%及SB的总符合率71.07%(χ^(2)=5.950,P=0.015;χ^(2)=8.295,P=0.004),TB及SB结果符合率比较,差异无显著性(χ^(2)=0.202,P=0.653);TB、SB及联合诊断的约登指数分别为0.454、0.403及0.652,曲线下面积(area under the curve,AUC)值分别为0.722、0.702及0.826,联合诊断的灵敏度为82.02%,高于TB的灵敏度68.54%及SB的灵敏度60.67%(χ^(2)=4.347,P=0.037;χ^(2)=9.921,P=0.002)。结论经会阴前列腺MRI-TRUS认知融合引导下TB联合SB诊断PCa具有更高的灵敏度和准确度,临床价值更高。

Objective To explore the clinical value of targeted biopsy(TB)combined with systematic biopsy(SB)guided by cognitive fusion of transperineal prostate magnetic resonance imaging-transrectal ultrasonography(MRI-TRUS).Methods The clinical data of 197 patients who underwent prostate biopsy in Liyang People’s Hospital from January 2018 to October 2021 were collected.Pathological diagnosis showed that 89 cases were prostate cancer(PCa),and all patients underwent TB and SB under the guidance of MRI-TRUS cognitive fusion.Kappa test was used to analyze the coincidence rate,sensitivity and specificity of targeted biopsy and systematic biopsy guided by MRI-TRUS cognitive fusion.Results There were 79 cases(43.65%)of patients with prostate cancer obtained by TB,73 cases(38.58%)of patients with PCa obtained by SB,and 85 cases(45.69%)of patients with PCa diagnosed jointly(P>0.05).The total coincidence rate of TB combined with SB in the diagnosis of PCa was 83.25%higher than 73.10%of TB and 71.07%of SB(χ^(2)=5.950,P=0.015;χ^(2)=8.295,P=0.004).There was no significant difference in the composite rate of TB and SB results(χ^(2)=0.202,P=0.653).The Youden indices for TB,SB and combined diagnosis were 0.454,0.403 and 0.652,respectively,and the area under the curve(AUC)values were 0.722,0.702 and 0.826,respectively.The sensitivity of combined diagnosis was 82.02%higher than 68.54%of TB and 60.67%of SB(χ^(2)=4.347,P=0.037;χ^(2)=9.921,P=0.002).Conclusion The diagnosis of PCa by TB combined with SB under the guidance of MRI-TRUS cognitive fusion has higher sensitivity and accuracy,and has higher clinical value.