经直肠超声引导可疑结节加6点改良穿刺前列腺活检术阳性率的影响因素分析

Influencing factors of positive rate in transrectal ultrasound-guided suspicious nodules biopsy plus six-point improved prostate puncture biopsy

目的分析经直肠超声引导可疑结节加6点穿刺改良方法前列腺活检阳性率的影响因素。方法经直肠超声引导下采用可疑癌结节或血流信号异常增多区穿刺2针,加前列腺6点穿刺改良方法,即左右侧前列腺底、体、尖的外周区各穿刺1针,对158例前列腺可疑癌症患者进行活检,结合术前血液前列腺特异抗原(PSA)及经直肠超声检查结果。结果 158例患者中,前列腺癌67例,增生伴前列腺上皮内瘤61例,增生伴炎症19例,单纯性增生11例;经直肠超声发现外腺区可疑结节91例,活检为前列腺癌55例,增生伴前列腺上皮内瘤27例,增生伴炎症7例,单纯性增生2例。PSA>40ng/ml组活检阳性率较<20ng/ml组、20～40ng/ml组增高(P<0.05);前列腺体积>60ml组活检阳性率较<30ml组及30～60ml组降低(P<0.05)。结论 PSA浓度、前列腺体积、前列腺外腺有无可疑结节是影响前列腺癌活检阳性率的主要因素。

Objective To analyze the influencing factors of positive rate in transrectal ultrasound - guided suspicious nodules biopsy plus six - point improved prostate puncture biopsy. Methods One hundred and fifty - eight patients with suspicious prostate cancer underwent transrectal uhrasound -guided prostate biopsy. Two punctures were performed in the suspicious nodules or the area with abnormally increased blood flow signals, 6 punctures were performed in the lateral area of base, mid and apex of each side. By analyzing the biopsy results with those of preoperative prostate specific antigen（PSA） and Iransrectal uhrasound, the influencing factors of positive rate in prostate biopsy were explored. Results In 158 patients, there were 67 cases of prostate cancer, 61 cases of hyperplasia with prostatic intraepithelial neoplasm （PIN） , 19 cases of hyperplasia uith inflammation,and 11 cases of simple hyperplasia. Transrectal uhrasoud showed 91 cases of suspicious nodules in external gland area, 55 cases were proved to be prostate cancer by biopsy,27 cases were hyperplasia with PIN,7 cases were hyperplasia with inflammation, and 2 cases were simple hyperplasia. The positive rate in PSA 〉 40 ng/ml group was higher than that in PSA of 0 -20 ng/ml and 20 - 40 ng/ml group（ P 〈 0.05 ）. While the positive rate in prostate volume 〉 60ml group was lower than that in volume of 0 - 30 ml and 30 - 60ml group（ P 〈 0.05 ）. Conclusion PSA concentration, prostate volume and presence of suspicious nodules are major influencing factors for positive prostate cancer biopsy rate.