合理选择穿刺针数和位点提高初次及重复前列腺活组织检查的阳性率:1293例临床分析

Proper biopsy cores and sites to improve positive detecting rates of initial and repeated prostate biopsy: a clinical analysis of 1293 cases

目的分析如何通过增加穿刺位点提高前列腺初次穿刺和重复穿刺的阳性率。方法 2006年1月—2009年6月共完成直肠超声引导经会阴前列腺穿刺1 293例,其中采用常规6点法穿刺250例,采用"6+X"法穿刺1 043例。比较不同穿刺方法的阳性率及其与前列腺特异性抗原(PSA)和经直肠超声(TRUS)检查表现的关系,并分析行重复活组织检查病例的阳性率。结果 "6+X"法穿刺的阳性率为46.4%,显著高于常规6点法的42.9%(P<0.05)。PSA≤4 ng/mL、>4且≤10 ng/mL、>10且≤20 ng/mL、>20且≤30 ng/mL4组中"6+X"法穿刺的阳性率均显著高于常规6点法(P值均<0.05);而PSA>30 ng/mL各组中,两种穿刺方法阳性率的差异无统计学意义(P值均>0.05)。超声表现正常、低回声结节、高回声或等回声结节3组的阳性率分别为23.1%、60.3%和32.1%,低回声结节组的阳性率显著高于另两组(P值均<0.05)。重复穿刺共54例,按最终病理检查结果分为良性和恶性组,恶性组首次穿刺发现高级别前列腺上皮内瘤样增生(PIN)、前列腺小腺泡不典型增生(ASAP)以及TRUS发现新的低回声结节的构成比均显著高于良性组(P值均<0.05)。结论 "6+X"法TRUS引导下经会阴前列腺穿刺技术对诊断前列腺癌安全、有效,对于PSA水平较低的患者增加穿刺针数对提高阳性率更有意义,对首次穿刺证实为高级别PIN、ASAP或TRUS发现新的可疑病灶者应积极接受重复活组织检查。

Objective To analyze how to improve the positive detecting rates （PDR） of initial or repeated prostate biopsy by increasing the biopsy cores and sites. Methods A total of 1 293 patients received TRUS-guided transperineal prostate biopsy from Jan 2006 to June 2009, including 250 cases undergoing conventional sextant biopsy and 1 043 cases undergoing extended sextant biopsy. The PDR values were compared between the two groups and their relationship with prostate specific antigen （PSA） and transrectal ultrasound （TRUS） images was analyzed. The positive rate of repeated biopsy cases was analyzed as well. Results The PDR values of sextant and extended sextant groups were 42.9% and 46.4%, respectively （P〈0.05）. According to the PSA levels, PDR of extended sextant biopsy was significantly higher than that of conventional sextant biopsy in the groups of PSA≤4 ng/mL, 〉4 and ≤10 ng/mL, 〉10 and ≤20 ng/mL and 〉20 and ≤30 ng/mL （P〈 0.05）; and the PDR of two biopsies were similar in all the PSA〉30 ng/mL groups （P〉0.05）. When all the cases are grouped according to TRUS images, the PDRs of normal, hypoechoic and hyperechoic/isoechoic groups were 23.1%, 60.3 % and 32. 1%, respectively. The PDR of the hypoechoic group was significantly higher than those of the other two groups （ P〈0.05）. Fifty-four patients underwent repeated biopsy, and they were divided into benign group and malignant group according to the final pathological diagnosis. The detective rates of high grade prostate intraepithelial neoplasm （HGPIN） and atypical small acinar proliferation （ASAP） by the initial biopsy and the detective rate of new hypoechoic nodules by TRUS images were significantly higher in the malignant group than in the benign group （P〈0.05）. Conclusion Extended sextant TRUS-guided transperineal prostate biopsy is safe and effective for prostate cancer diagnosis. Increase of biopsy cores is more significant for patients with low PSA level. Repeated biopsies are recommended for patients who are diagnosed as HGPIN or ASAP in initial biopsy or who have novel suspicious lesions as detected by TRUS images.