多模态经直肠超声检查在前列腺穿刺活检中的临床应用

Value of multi-modal guided transrectal ultrasonography prostate biopsies in improving prostate cancer detection

目的 探讨多模态超声检查引导的穿刺活检在前列腺癌诊断中的应用价值。方法2010年10月至2013年5月,115例患者因血清前列腺特异抗原（PSA）升高在首都医科大学宣武医院行前列腺穿刺活检。115例患者分别于经直肠超声检查（TRUS）、经直肠实时组织超声弹性成像（TRTE）及经直肠前列腺超声造影检查（CETRUS）后,行经直肠超声引导下穿刺活检。穿刺方案采用常规6点穿刺加上述检查阳性征象部位针对性靶向活检,通过与前列腺穿刺病理作对照,评价3种检查方式对前列腺癌早期诊断的临床意义。结果 115例疑似前列腺癌患者经穿刺,病理诊断为前列腺癌63例（55%,63/115）。TRTE及CETRUS诊断前列腺周缘区癌灶的敏感度、特异度及准确性分别为71%（45/63）、81%（42/52）、76%（87/115）及65%（41/63）、83%（43/52）、73%（84/115）。经CETRUS及TRTE引导下的靶向穿刺活检可提高前列腺癌的敏感度（χ^2值分别为14.950和10.754,P值分别为0.002和0.013）、特异度（χ^2值分别为10.256和20.021,P值分别为0.006和0.009）、准确性（χ^2值分别为5.735和10.361,P值分别为0.020和0.011）,2种检查方法同时应用靶向穿刺可以明显提高前列腺癌的检出率（χ^2值分别为9.021和23.176,P值分别为0.042和0.000）。对TRTE阳性患者应变率比值绘制受试者操作特性（ROC）曲线,得出曲线下面积为0.834,95%可信区间为0.742～0.926。结论超声新技术的联合应用提高了前列腺癌的阳性检出率,从而提高了多模态超声引导下前列腺穿刺活检的阳性检出率,对早期前列腺癌的筛查及诊断具有重要的临床意义。

Objective To study the utility of multi-modal guiding in tmnsrectal ulwasound-guided prostate biopsies. Methods A total of 115 consecutive patients suspicious for prostate cancer due to elevated serum prostate specific antigen level were enrolled in this prospective study. All patients underwent transrectal ultrasound （TRUS）, transrectal real-time elastography （TRTE） and conwast-enhanced lransrectal ultrasound （CETRUS）. Both positive sites on above imaging studies and 6 core-systematic biopsy sites were included in Wansrectal biopsy. The impact of targeted biopsies on the prostate cancer detection rate was analyzed in comparison with prostate biopsy pathology. Results The overall prostate cancer detection rate was 55% （63/115）. TRTE and CETRUS had a higher sensitivity, specificity and accuracy of 71% （45/63）, 81% （42/52）, 76% （87/115）, and 65% （41/63）, 83% （43/52）, 73% （84/115）, respectively. Compared with TRUS, TRTE and CETRUS guided targeted biopsy improve the sensitivity of prostate cancer （χ^2= 14.950, 10.754, P=0.002, 0.013）, specificity （27=0.256, 20.021, P=0.006, 0.009）, accuracy （χ^2=5.735,10.361, P=0.020, 0.011）. Targeted biopsy could improve the detection rate of prostate cancer （χ^2=9.021, 23.176, P=0.042, 0.000）. On the operating characteristic （ROC） curve of TRTE, the area under the curve was 0.834 with a 95% confidence interval of 0.742-0.926. Conclusion Combined with the application of new technology of ultrasound to improve positive rate of prostate cancer, improving the multi-mode ultrasoundguided prostate biopsy positive rate, and has important clinical significance for early screening and diagnosis of prostate cancer.