经直肠超声与磁共振融合成像靶向穿刺技术在首次诊断性前列腺穿刺中的应用

The value of transrectal ultrasound and magnetic resonance imaging fusion targeted prostate biopsy in biopsy-naive men

目的评估经直肠超声与磁共振融合成像（transrectal ultrasound／magnetic resonance imaging，TRUS／MR）靶向穿刺技术（targetedbiopsy，TB）在首次诊断性前列腺穿刺中的价值。方法回顾性分析2015年9月至2016年9月我院经多参数磁共振（multiparametric magnetic resonanceimaging，mpMRI）扫描发现可疑病灶，且前列腺影像报告和数据系统（prostate imaging and reporting and datasystem，PI—RADS）评分／〉3分的91例患者的临床资料，所有患者均为首次行诊断性穿刺。年龄46～83岁，中位年龄68岁。穿刺前血清PSA1．2～85．0ng／ml，中位PSA11．2ng／ml，其中PSA〈10ng／ml者36例，10～20ng／ml者30例，〉20ng／ml者25例。使用实时超声多影像融合系统对mpMRI提示的可疑病灶进行靶向穿刺2针，同时进行常规12针的系统穿刺。自身对照研究比较TB和系统穿刺的前列腺癌和临床有意义前列腺癌（clinically significant prostate cancer，CsPCa）的检出率。结果本组91例中，总的前列腺癌检出率为57．1％（52／91）。TB和系统穿刺前列腺癌的检出率分别为44．0％（40／91）和51．7％（47／91），差异无统计学意义（P=0．14）。CsPCa检出比例TB高于系统穿刺，分别为80．O％（32／40）和68．1％（32／47），但差异无统计学意义（P=0．21）。对于PI．RADS评分为5分和3分的病灶，TB的前列腺癌检出率分别为77．1％（27／35）和10．3％（3／29），差异有统计学意义（P〈0．001）。TB和系统穿刺前列腺癌的检出率在PSA〈10ng／ml[27．8％（10／36）和36．1％（13／36）]、10～20ng／ml[50．0％（15／30）和56．7％（17／30）]、〉20rig／ml[60．0％（15／25）和68．0％（17／25）]中差异均无统计学意义（均P〉0．05）。结论对位于不同PSA区间的首次诊断性前列腺穿刺患者，2针TRUS／MR融合成像TB可以获得与12针系统穿刺相似的前列腺癌检出率，同时，TB可检出更高比例的CsPCa。PI．RADS评分系统对选择合适患者进行TB穿刺有指导作用。

Objective To estimate the value of transrectal ultrasound/magnetic resonance imaging （TRUS/MR） fusion targeted prostate biopsy（ targeted biopsy, TB） in the biopsy naive patients. Methods Between September 2015 and September 2016, 91 patients with PI-RADS≥ 3 suspicious regions on the multiparametric magnetic resonance imaging （mpMRI） were retrospectively evaluated. The age of patients was 46 - 83 years （ median 68 ）. Serum PSA level before biopsy was 1.2 - 85 ng/ml （ median 11.2 ng/ ml ）, in which 36 eases with PSA 〈 10 ng/ml, 30 eases 10 - 20 ng/ml, and 25 eases 〉 20 ng/ml. Two-core TB using real-time virtual sonography （RVS） platform for mpMRI-suspicious lesions was followed by 12-core systematic biopsy （SB）. The detection rates for any cancer （PCa） and clinically significant prostate cancer （CsPCa） were compared between TB and SB. Results The total detection rate for PCa was 57. 1% , with a comparable positive rate between TB （44.0%） and SB （51.7%） groups which did not significantly differ （P = 0. 14）. The proportion of CsPCa in TB group was higher than that in SB group （80.0% vs. 68.1%, P =0. 21 ）. In TB group, detection of PCa for grade 5 lesions was significantly higher than that for grade 3 lesions （77.1% vs. 10. 3% , P 〈0. 001）. Detection of PCa was comparable between TB and SB groups in different regions of PSA 〈 10 ng/ml, 10 - 20ng/ml and 〉 20ng/ml （27.8% vs. 36. 1% , 50% vs. 56. 7% , 60% vs. 68%, respectively）. Conclusions This study revealed a similar rate of prostate cancer detection between 2-core targeted biopsy guided by TRUS/MR fusion and 12-core random biopsy in different PSA regions for no prior biopsy men. TB maybe tend to detect high proportion of CsPCa. PI-RADS is instructive to select appropriate patients for TB.