磁共振靶向前列腺穿刺活检对前列腺癌诊断的研究

Evaluation of MR targeted biopsy for the diagnosis of prostate cancer

目的 比较磁共振（magnetic resonance,MR）引导下经直肠前列腺穿刺活检与经直肠超声（transrectal uhrasonography,TRUS）引导下前列腺系统穿刺活检在前列腺癌诊断中的价值,为临床诊断前列腺癌提供指导.方法 回顾性分析2014年7月至2015年3月接受前列腺穿刺活检的176例患者资料,其中35例行MR引导下经直肠靶向前列腺穿刺（MR组）,141例接受TRUS引导下前列腺系统穿刺（TRUS组）.对MR显像结果及病理资料进行总结,分析2种穿刺方式对前列腺癌诊断的影响.结果 两组患者的年龄、前列腺体积及血清PSA差异无统计学意义（P＞0.05）.所有患者整体诊断阳性率为48.3％,MR组（57.1％）略高于TRUS组（46.1％）,但差异无统计学意义（P＞0.05）.高级别前列腺癌患者检出比例在MR组（60.0％）略高于TRUS组（53.8％）,差异无统计学意义（P＞0.05）;但在PSA＜10 ng/ml的患者中,高级别前列腺癌患者检出比例在MR组（75.0％）高于TRUS组（41.2％）,差异有统计学意义（P＜0.05）.结论 对于PSA＜ 10 ng/ml患者,高级别前列腺癌在MR引导下经直肠靶向前列腺穿刺活检中的检出率高于TRUS引导穿刺;MR引导下经直肠靶向前列腺穿刺活检可有效诊断高危前列腺癌,同时在一定程度上可减少过度诊断及过度治疗.

Objective To evaluate the efficacy of MR targeted and transrectal ultrasond guided prostate biopsy for the diagnosis of prostate cancer.Methods From July 2014 to March 2015,35 patients underwent MR guided prostate biopsy and 141 patients underwent TRUS guided biopsy were retrospectively evaluated.The MRI results and pathology were analyzed.Results There were no statistical differences between the two groups in term of age,prostate volume and serum PSA level （P 〉 0.05）.The overall positive rate for prostate cancer was 48.3%,with a higher positive rate in MR targeted group （57.1%） compared with TRUS group （46.1%）.More patients with high grade prostate cancer were diagnosed by MR targeted biopsy compared with TRUS guided biopsy and statistical significant differences was present in patients with PSA 〈 10 ng/ml.Conclusions The MR targeted biopsy showed a high positive rate for high grade prostate cancer,which is of great value for the prevention of over-diagnosis and overtreatment of prostate cancer.