前列腺穿刺活检对根治术后尖部病理结果的预测价值

The significance of needle biopsy in predicting the pathology of prostate apex after radical prostatectomy

目的研究前列腺穿刺活检对前列腺癌根治术后尖部病理结果的预测价值；方法收集2001年1月至2012年7月在本院泌尿外科行前列腺穿刺并行前列腺癌根治术的标本147对，采用四格表法比较穿刺时及根治术后前列腺尖部病理结果；结果穿刺时尖部阳性者共79例，根治术后尖部阳性者共31例，其中切缘阳性9例，占穿刺尖部阳性者11．3％。穿刺时及根治术后尖部均阳性22例，灵敏度70．9％，穿刺时及根治术后尖部均阴性59例，特异度50．8％，穿刺尖部结果和术后病理一致99对，一致率55．1％，穿刺尖部阴性但术后尖部阳性仅9对，假阴性率29．0％，穿刺尖部阳性但术后尖部阴性的57对，假阳性率49．1％；结论前列腺穿刺活检尖部阳性率高并不能预示根治术后尖部切缘阳性率高，加强术前风险评估、术中合理处理前列腺尖部、采取有效措施可以降低尖部切缘阳性率。

Objective To evaluate the value of prostate biopsy in predicting pathology results of prostate apex after radical surgery; Methods A retrospective study on pathology results of prostate apex in 147 prostate cancer patients, who received needle biopsy （NB） test and radical prostatectomy（RP） treatment in our hospital from January 2001 to July 2012 was carried out.The pathological results of prostate apex from needle biopsy（NB） test and radical prostatectomy（RP） were compared. Results Total of 79 positive cases were found in NB test, 31 positive cases after RP, including 9 apex margin positive cases, which accounting for 11.3% of NB apex positive cases. Twenty-two cases were double positive in these two methods, the test sensitivity was 70.9%, 59 cases were double negative, the specificity was 50.8%. The pathological results of 99 cases in NB test were consistent with that of RP, the consistency rate was 55.1%, 9 cases were NB negative but RP positive, the false negative rate was 29.0%, and 57 cases were NB positive but RP negative, the false positive rate was 49.1%; Conclusion The high apex positive rate of Prostate biopsy did not mean high positive rate of prostate apex margin after radical surgery. Careful preoperative risk assessment and proper prostate apex handling during operation will be helpful for decrease the positive of margin rate.