高度怀疑恶性前列腺肿物6针法穿刺临床分析

Clinical analysis of 6-core biopsy for patients with highly suspected malignant prostate masses

目的探讨对于临床高度怀疑恶性的前列腺肿物6针穿刺法的必要性以及如何提高其阳性诊断率。方法总结我院自2001至2015年345例临床高度怀疑恶性前列腺肿物行6针穿刺病例。所有病例在穿刺前通过直肠指诊或影像学检查均提示前列腺结节。记录患者穿刺病理结果。应用ROC曲线分析前列腺特异性抗原(PSA)、前列腺体积以及PSA/前列腺体积,对此类患者在6针穿刺中出现阳性结果的判断价值。结果病理确诊为前列腺恶性肿物(阳性)309例(89.6%),其中前列腺癌300例,特殊病理类型9例;阴性穿刺36例(10.4%)。阳性组病例的血清PSA水平明显高于阴性组(P<0.001)。通过ROC曲线分析显示,PSA对于6针穿刺阳性结果的判断价值最高,以PSA 22.89ng/mL作为临界值时,其曲线下面积(AUC)达到0.866,敏感性和特异性分别为90.6%和82.6%。结论临床高度怀疑恶性前列腺肿物的患者行6针法穿刺存在合理性。在此类患者人群中,对PSA≥22.89ng/mL的患者进行6针穿刺,整体临床获益可能最高。

Objective To discuss the necessity of 6-core biopsy for patients with highly suspected prostate malignant masses and techniques to improve the positive diagnosis rate. Methods A total of 345 consecutive men with highly suspected malignant prostate masses were included in the study. All patients underwent 8-core prostate biopsies. The digital rectal exami- nation and/or image examination before biopsy indicated prostate nodules in all patients. The pathological results were recorded. Receiver operating characteristic （ROC） curve analysis was used to assess the value of PSA, prostate volume and the ratio of PSA to volume in predicting the positive biopsy result. Results Malignant prostate tumors were detected in 309 patients （89.6 %）. Of them, 300 were confirmed prostate cancer cases, and the other 9 patients had other pathological diagnosis. Negative results were seen in 36 patients （10.4%）. The PSA in the positive result group was higher than that in the negative group （P〈0. 001）. ROC curve analysis revealed that PSA had a high predicting value of positive biopsy results, and the area under curve （AUC） was 0. 886. The cut-off point of PSA was 22.89 ng/mL with a sensitivity of 90.6% and a specificity of 82.6 %. Conclusion The 6-core biopsy is valuable for patients with highly suspected malignant prostate masses, especially for patients with PSA≥22.89 ng/mL.