经直肠能量多普勒超声在前列腺穿刺活检中的临床价值

Clinical value of prostatic biopsy under the guidance of transrectal power Doppler ultrasonography

目的:探讨经直肠能量多普勒超声(PDU)在前列腺穿刺活检中的临床应用价值,提高前列腺癌的诊断率。方法:对临床高度怀疑前列腺癌的54例病人在穿刺前完成经直肠二维灰阶超声的常规检查、PDU检查,根据检查结果选择经直肠二维灰阶超声、PDU及两者联合使用靶向穿刺结合6点前列腺系统穿刺活检方案。对比分析直肠二维灰阶超声、PDU靶向穿刺活检诊断前列腺癌的敏感性、特异性、阳性预测值、阴性预测值。结果:经直肠PDU检查发现异常血流增多37例,其中前列腺癌23例(包括2例为灰阶超声无异常发现的位于外腺的前列腺癌),前列腺增生症11例,前列腺癌不能除外1例,前列腺占位1例(未定),转移性前列腺癌1例(膀胱癌)。结论:经直肠PDU能提高前列腺癌检测的敏感性与定位适合穿刺点,经直肠PDU靶向穿刺活检病理Gleason评分更高。

Objective： To evaluate the clinical value of transrectal power Doppler uhrasonography （PDU） and PDU-directed prostatic biopsy to improve the diagnosis of prostatic cancer. Methods： Fifly-four patients suspected to be prostatic cancer underwent routine gray-seale TRUS, transreetal PDU of the entire gland before biopsy. According to the result, select the protocols of gray-scale TRUS, transreetal PDU and combined use of six-score transrectal biopsy protocols. The sensitivity, specificity, positive predictive value, negative predietive value were compared and analyzed. Results： Abnormal flow was detected by power Doppler scanning in 37 patients, among them 23 cases were of prostatic cancer （two of them were normal on grayscale image）, BPH in 11 cases, prostatic cancer cannot be ruled out in 1 case, prostatic mass of undetermined nature in 1 case, metastatic prostatic cancer of bladder origin in 1 case. Conclusions： Transrectal PDU ean improve the sensitivity of cancer detection, and can determine the correct site for PDU-direeted biopsy, the Gleason score is significantly higher.