自由臂经会阴多参数磁共振-超声影像融合引导靶向穿刺诊断前列腺癌的前瞻性研究

Free-hand transperineai multiparametric magnetic resonance imaging/transrectal ultrasound fusion- guided targeted biopsy for the diagnosis of prostate cancer： a prospective study

目的探讨＂自由臂＂经会阴多参数磁共振（mpMRI）-超声影像融合引导靶向穿刺在前列腺癌诊断中的意义。 方法选取2015年1月至2016年9月收治的PSA升高或直肠指检阳性患者进行前瞻性研究。患者行前列腺穿刺活检之前均行mpMRI检查，选取前列腺影像报告和数据系统（PI-RADS）评分为2～5分的患者纳入研究。对mpMRI检查的前列腺可疑病灶采用＂自由臂＂经会阴mpMRI-超声影像融合引导前列腺靶向穿刺，每个病灶穿刺2针，然后行12针系统穿刺。对穿刺标本和根治术后全前列腺器官切片标本行病理分析，比较两者的病理符合率和定位符合率。 结果本研究共纳入397例患者。年龄（68.2±7.4）岁，范围42～78岁。PSA（15.0±12.4）ng/ml，范围3.0～88.3 ng/ml。直肠指检阳性28例（7.1%）。前列腺体积（41.6±16.4）cm3，范围24.6～89.8 cm3。靶向穿刺和系统穿刺的前列腺癌检出率分别为44.8%（178/397）和34.8%（138/397）（P＝0.003）；临床有意义的前列腺癌检出率分别为65.7%（121/178）和47.8%（66/138）（P〈0.001）；中、高危前列腺癌检出率分别为72.5%（129/178）和48.6%（67/138）（P＝0.003）；低危前列腺癌检出率分别为27.5%（49/178）和51.4%（71/138）（P〈0.001）。588个mpMRI检查可疑病灶中，277个病理诊断为前列腺癌。105例前列腺癌患者接受了根治性前列腺切除术。靶向穿刺检出区域与大切片病理检出区域符合率为96.6%（85/88）。 结论＂自由臂＂经会阴mpMRI-超声影像融合靶向穿刺显著提高了中、高危前列腺癌的检出率，降低了低危前列腺癌的检出率，且靶向穿刺对于前列腺癌主要病灶有很好的定位能力。

ObjectiveTo assess the value of free-hand transperineal multiparametric magnetic resonance imaging/transrectal ultrasound（mpMRI/TRUS） fusion-guided targeted biopsy（TB） for the diagnosis of prostate cancer（PCa）. MethodsPatients with elevated PSA level and/or an abnormal DRE finding were recruited prospectively between January 2015 and September 2016. Patients were classified to various scores from 2 to 5 according to prebiopsy mpMRI PI-RADS. Based on free-hand transperineal mpMRI/TRUS fusion-guiding, a 2-cores TB for each cancer-suspicious lesion were carried out and followed 12-cores systematic biopsy（SB） protocol. Pathological findings of biopsy and radical prostatectomy （RP） specimens were analyzed. ResultsA total of 397 patients were enrolled in this study. The median age of the patients was （68.2±7.4）years old, ranging 42-78 years. The median PSA level was （15.0±12.4）ng/ml, ranging 3.0-88.3 ng/ml. DRE showed abnormality in 28 patients（7.1%）. The median prostate volume was （41.6±16.4）cm3, ranging 24.6-89.8 cm3. The PCa detection rate of TB was significantly increased compared with SB （44.8 % vs. 34.8%） （P=0.003）, especially in clinically significant PCa （P〈0.001） and intermediate/high-risk PCa （P=0.003）, respectively. Of the all 588 mpMRI targeted lesions, 277 lesions were positive. A total of 105 index tumors were identified in RP specimens, the locations of TB-proven cancer showed 96.6% （85/88） in correspondence with the location of the index lesion in RP specimens. ConclusionsFree-hand transperineal mpMRI/TRUS fusion-guided TB providing greater detection of intermediate-high risk PCa while limits over detection of low risk PCa. Moreover, TB can reliably predict the location of an index tumor.