前列腺异常声像特征及位置对经直肠超声穿刺活检诊断前列腺癌的影响

Compatative study of characteristics of prostate ultrasonic image and location in diagnosis of prostate cancer by transrectal ultrasound biopsy

目的探讨经直肠超声检查中异常声像特征及位置对经直肠超声（TRUS）穿刺活检诊断前列腺癌的影响。方法前列腺特异性抗原（PSA）4~20 ng/ml、发现异常声像和/或合并直肠指检异常的可疑前列腺癌患者410例,根据声像特征分为低回声、等回声、高回声组,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27.07%,低回声组前列腺癌穿刺阳性率（34.27%）明显高于等回声（22.77%）和高回声（13.33%）组（P〈0.05）,Gleason评分在低、等回声组前列腺癌中无明显统计学差异（P〉0.05）。左右侧外周带单独存在低回声病例前列腺癌穿刺阳性率无明显统计差异（P〉0.05）,双侧外周低回声病例前列腺癌穿刺阳性率（46.97%）明显高于左侧（27.27%）与右侧（28.85%）外周带存在低回声病例（P〈0.05）。结论 PSA4-20 ng/ml,TRUS存在低回声声像前列腺穿刺率阳性率明显高于TRUS中等回声、高回声病例病例,双侧外周带存在低回声病例前列腺穿刺阳性率明显高于单侧外周带存在低回声病例。

Objective To assess the efficacy of characteristics of prostate ultrasonic image and location in detection of prostate cancer.Methods Four hundred and ten patients with minimal elevations in serum prostate-specific antigen（PSA） levels（4-20 ng/ml） and doubtful ultrasonic lesions and/or with positive digital examinations,who underwent 8-core transrectal ultrasound（TRUS） guided biopsy plus a separately additional core directed through the suspicious ultrasound area were enrolled in the study.The patients were divided into three groups according to suspect lesions found on TRUS（group 1 with hypoechoic suspect lesions,group 2 with isoechoic suspect lesions and group 3 with hyperechoic suspect lesions）.Comparison of the groups revealed how different suspicious ultrasound area and location affected PCa detection.Results Of the 410 patients with suspicious ultrasound area,111 patients（27.07%） were positive for cancer.Cancer detection rate in group 1 was greater than group 2（22.77 %） and group 3（13.33%）.However there was no statistically significant difference in Gleason score between isoechoic and hypoechoic cancers（P0.05）.The specific probability of finding cancer in a hypoechoic area within the left or right lobe was 27.27%（12 of 44） and 28.85%（15 of 52） of patients,respectively（P0.05）,which was subter to hypoechoic lesions in both lobes（46.97%）.Conclusions Cancer detection rate with hypoechoic suspect lesions is greater than isoechoic suspect lesions and hyperechoic suspect lesions groups by 8-core transrectal ultrasound（TRUS） guided biopsy plus a separately additional core directed through the hypoechoic area.The specific probability of finding cancer in a hypoechoic area within both lobes is greater than a hypoechoic erea within the right or left robe.