前列腺低回声结节体积对经直肠超声穿刺活检诊断前列腺癌的影响

Compatative study of different prostate hypoechoic nodule volume in diagnosis of prostate cancer by transrectal ultrasound biopsy

目的探讨经直肠超声检查中前列腺低回声结节体积对经直肠超声穿刺活检诊断前列腺癌的影响。方法 PSA位于灰色区间、直肠指检阴性及超声发现单一低回声结节的可疑前列腺癌患者288例,根据低回声结节大小分为小结节组<0.2cm3及大结节组≥0.2cm3,所有患者均行8+X针的穿刺方法,详细记录患者临床资料及病理结果,比较两组的穿刺结果。结果总的前列腺癌检出率为26.7%,大小结节组之间肿瘤检出率无明显统计学差异(31.5%vs21.8%,P=0.064),小结节组3例(13.0%)仅低回声结节穿刺阳性,大结节组17例(38.6%)仅低回声结节穿刺阳性,两者相比存在统计学差异(P=0.03)。如不进行低回声结节的特异性穿刺,大小漏诊率存在统计学差异(36.9%vs9.7%,P=0.007)。结论经直肠超声中低回声结节体积的大小对PSA灰色期、直肠指检阴性的患者采用8+X针的穿刺方法上对前列腺癌穿刺阳性率无明显影响。在8针穿刺基础上增加低回声结节特异性的穿刺,特别是大的低回声结节(≥0.2cm3)能够明显提高穿刺的阳性率。如不进行低回声特异性穿刺,大结节组的漏诊率较小结节组高。

Objective To assess the influence of different prostate hypoechoic nodule volume in detection of prostate cancer. Methods Two hundred and eighty-eight patients with normal digital examinations, minimal elevations in serum prostate-specific antigen （PSA） levels （4-10 ng/ml） and a hypoechoic lesion who underwent 8-core transrectal ultrasound （TRUS） guided biopsy plus a separately additional core directed through the hypoechoic area were enrolled in the study. The patients were divided into two groups according to prostate hypoechoic nodule volume （group 1 with hypoechoic nodule volume 〈0.2 cm3, and group 2 with hypoechoic nodule volume ≥0.2 cm3）. Results Of the 288 patients with small hypoechoic lesions, 77 （26.7%） were positive for cancer in at least one prostatic core. This difference was not statistically significant between the two groups （P=0.064）. Only 3/23 （13%） patients was diagnosed with PCa only by additional core directed through the hypoechoic area in group 1, whereas 17/44 （38.6%） with PCa in group 2. This difference was statistically significant （P=0.03）. In other words, 3（9.7%） out of 31 cancers would have been missed without hypoechoic lesion biopsy in group 1, while 17（36.9%） out of 46 cancers would have been missed in group 2. This difference was statistically significant in the two groups （P=0.007）. Conclusions There is no influence of different prostate hypoechoic nodule volume indetection of prostate cancer by 8-core transrectal ultrasound （TRUS） guided biopsy plus a separately additional core directed through the hypoechoic area. Targeted biopsies based on transrectal ultrasound detected hypoechoic lesion improved detection rate. The larger volume of the prostate hypoechoic nodule, the higher rate of misdiagnosis without hypoechoic lesion biopsy.