经直肠超声引导下前列腺系统穿刺与磁共振可疑病灶靶向穿刺在前列腺癌活检中的价值

The value of transrectal ultrasound-guided systematic prostate biopsy and additional targeted cores from suspicious magnetic resonance imaging in the biopsy of prostate cancer

目的探讨经直肠超声引导下前列腺系统穿刺与磁共振可疑病灶靶向穿刺在前列腺癌活检中的价值。方法回顾性分析2011年9月至2013年9月浙江大学医学院附属第二医院行经直肠超声引导下前列腺穿刺的患者共181例。所有181例患者均行经直肠超声引导下前列腺系统穿刺,其中116例患者磁共振检查时发现可疑病灶而行靶向穿刺。穿刺活检病理检查诊断为前列腺癌97例,前列腺增生84例。采用χ2检验比较经直肠超声引导下前列腺系统穿刺与磁共振可疑病灶靶向穿刺的前列腺癌检出率差异;以穿刺活检病理诊断结果作为金标准,计算经直肠超声引导下前列腺系统穿刺、磁共振可疑病灶靶向穿刺诊断前列腺癌的敏感度、特异度、准确性、阳性预测值及阴性预测值并采用χ2检验进行比较。结果 181例患者穿刺共检出前列腺癌97例,检出率为53.6%(97/181)。其中,经直肠超声引导下前列腺系统穿刺检出前列腺癌63例,检出率为34.8%(63/181);磁共振可疑病灶靶向穿刺检出前列腺癌81例,检出率为44.8%(81/181);磁共振可疑病灶靶向穿刺的前列腺癌检出率高于经直肠超声引导下前列腺系统穿刺,且差异具有统计学意义(χ2=34.830,P=0.015)。其中,经直肠超声引导下前列腺系统穿刺漏诊34例前列腺癌,磁共振可疑病灶靶向穿刺漏诊16例前列腺癌,分别占检出前列腺癌的35.1%(34/97)及16.5%(16/97)。181例患者共穿刺1 896针,其中经直肠超声引导下前列腺系统穿刺1 448针,磁共振可疑病灶靶向穿刺448针。经直肠超声引导下前列腺系统穿刺诊断前列腺癌的敏感度为71.8%(224/312),特异度为22.7%(360/1 584),准确性为30.80%(584/1 896),阳性预测值为15.5%(224/1 448),阴性预测值为80.4%(360/448);磁共振可疑病灶靶向穿刺诊断前列腺癌的敏感度为89.8%(280/312),特异度为87.4%(1 384/1 584),准确性为87.8%(1 664/1 896),阳性预测值为58.3%(280/480),阴性预测值为97.7%(1 384/1 416)。磁共振可疑病灶靶向穿刺诊断前列腺癌的敏感度、特异度、阳性预测值及阴性预测值均高于经直肠超声引导下前列腺系统穿刺,且差异均有统计学意义(χ2值分别为14.008、96.037、143.049、170.729,均P<0.001)。结论磁共振可疑病灶靶向穿刺的前列腺癌检出率高于经直肠超声引导下前列腺系统穿刺,但磁共振可疑病灶靶向穿刺并不能代替经直肠超声引导下前列腺系统穿刺;两种方法互为补充,联合应用才能进一步提高前列腺癌检出率。

Objective To evaluate the value of transrectal ultrasound-guided systematic prostate biopsy and magnetic resonance imaging（MRI） suspicious targeted biopsy in the biopsy of prostate cancer.Methods A retrospective analysis was performed in 181 patients with suspected prostate cancer underwent transrectal ultrasound-guided prostate biopsy from September 2011 to September 2013 in the Second Affiliated Hospital of Zhejiang University School of Medicine.In all the 181 patients had the transrectal ultrasound-guided systematic biopsy,116 patients with suspicious MRI had two additional targeted biopsies.Prostate cancers were detected in 97 of 181 patients,and the prostatic hyperplasia were detected in 84 patients.The detection rate of transrectal ultrasound-guided systematic prostate biopsy,suspicious MRI targeted biopsy and combined biopsy in prostate cancer were tested by χ2 test.Compared with pathological results,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of transrectal ultrasound-guided systematic prostate biopsy and suspicious MRI targeted biopsy were calculated and tested by χ2 test.Results Prostate cancer was detected in 97 of 181 patients（53.6%）,63（34.8%） was detected by transrectal ultrasound-guided systematic prostate biopsy,and 81（44.8%） was detected by suspicious MRI targeted biopsy.The suspicious MRI targeted biopsy detected more prostate cancers which there had statistical differences compared with transrectal ultrasound-guided systematic prostate biopsy（χ2=34.830,P=0.015）.Transrectal ultrasound guided prostate systematic biopsy missed 34 cases of prostate cancer,and suspicious MRI targeted biopsy missed 16 cases,accounting for 35.1%（34/97） and 16.5%（16/97） of prostate cancer.The 181 patients were biopsied a total of 1 896 cores,including transrectal ultrasound guided systematic biopsy 1 448 cores and suspicious MRI targeted biopsy 448 cores.The sensitivity,specifi city,positive predictive value and negative predictive value of suspicious MRI targeted biopsy was 89.8%（280/312）,87.4%（1 384/1 584）,58.3%（280/480）,97.7%（1 384/1 416） compared with the sensitivity of 71.8%（224/312）,specifi city of 22.7%（360/1 584）,positive predictive value of 15.5%（224/1 448） and negative predictive value of 80.4%（360/448） in transrectal ultrasound-guided systematic prostate biopsy（χ2=14.008,96.037,143.049,170.729,all P〈 0.001）.Conclusions The detection rate of prostate cancer of suspicious MRI targeted biopsy is higher than transrectal ultrasound-guided systematic prostate biopsy,but can′t replace transrectal ultrasound-guided systematic prostate biopsy.The two methods are complementary to improve the prostate cancer detection rate.