多参数磁共振与经直肠超声图像融合引导经会阴前列腺靶向穿刺在再次穿刺患者中的应用

Application of transperineal targeted prostate biopsy using multiparametric magnetic resonance imaging-transrectal ultrasound fusion in repeated biopsy patients

目的 探讨多参数磁共振（multiparametric magnetic resonance imaging,mpMRI）与经直肠超声（transrectal ultrasound,TRUS）图像融合引导经会阴前列腺穿刺活检在再次穿刺患者中的应用价值.方法 2014年8月至2016年5月收治的101例mpMRI检查有可疑病灶且需再次穿刺活检的患者被纳入研究.患者年龄平均（68.9±8.1）岁;术前PSA平均（10.8 ±6.1）μg/L;术前阴性穿刺次数平均（1.5±0.7）次.对mpMRI上的可疑病灶确认后进行前列腺图像报告和数据系统（PI-RADS）评分.所有患者在全麻下行经会阴标准12针系统穿刺后,进行mpMRI-TRUS图像融合引导的徒手经会阴前列腺靶向穿刺.比较并分析两种穿刺方法的病理结果.结果 两种穿刺方法共确诊41例（40.6％）前列腺癌患者,前列腺癌患者的PI-RADS评分显著高于总入组人群（4.3 ±0.7与3.6±1.0,P＜0.001）.系统穿刺和靶向穿刺结果的一致性达到73.3％（74/101）.靶向穿刺发现31例前列腺癌,系统穿刺发现27例,两者虽然无统计学差异,但靶向穿刺比系统穿刺发现了更多的临床有意义前列腺癌（22例与13例,P=0.012）.结论 mpMRI与TRUS图像融合引导的经会阴前列腺靶向穿刺可以提高再次穿刺患者中临床有意义前列腺癌的检出率.

Objective To evaluate the application of transperineal targeted prostate biopsy using multiparametric magnetic resonance imaging （mpMRI）-transrectal ultrasound （TRUS） fusion in repeated biopsy patients.Methods A total of 101 patients suspicious of prostate cancer （PCa） at the mpMRI scan and with prior negative biopsy were prospectively recruited from August 2014 to May 2016 at two urology centers.The mean age of the patient population was （68.9 ± 8.1） years.The mean pre-fusion-guided biopsy PSA level was （10.8 ± 6.1） μg/L The mean number of prior negative biopsy was （1.5-± 0.7） times.Suspicious areas on mpMRI were defined and graded using PI-RADS score.Standard transperineal 12-core systematic biopsy （SB） were performed for all patients and followed a free-hand transperineal targeted biopsies （TB） using mpMRI-TRUS fusion for each suspicious lesion.Results of biopsy pathology were analyzed and compared between TB and SB.Results Prostate biopsy revealed PCa in 41 of 101 men （40.6%） and the mean PI-RADS score in PCa cohort was significantly higher than whole patients （4.3 ±0.7 vs.3.6 ± 1.0,P 〈0.001）.There was exact agreement between TB and SB in 74 （73.3%） men.TB alone found 31 cancers and SB alone found 27 cancers.Although there was no significant difference of PCa detection between TB and SB,TB diagnosed more significant cancer than SB （22 vs.13 cases,P =0.012）Conclusions Free-hand transperineal prostate TB guided with MRI-TRUS fusion imaging improves detection of clinical significant PCa in repeated biopsy patients.