多模态经直肠超声靶向穿刺在首次诊断性前列腺穿刺中的价值

The value of multi-modal guiding in transrectal ultrasound-guided prostate targeted biopsies in the biopsy naive patients

目的评估经直肠多模态超声靶向穿刺在首次诊断性前列腺穿刺中的价值。 方法回顾性分析2016年6月至2017年12月我院178例疑诊前列腺癌患者的临床资料，所有患者均为首次行诊断性穿刺。年龄54～87岁，中位年龄70岁；穿刺前血清PSA 1.5～95.0 ng/ml，中位PSA 13.2 ng/ml，其中PSA〈10 ng/ml者70例，10～20 ng/ml者58例，〉20 ng/ml者50例。对经直肠二维超声、彩色多普勒超声联合弹性成像及超声造影提示的可疑病灶进行经会阴靶向穿刺1～2针，同时进行常规10针的经会阴系统穿刺。自身对照研究比较靶向穿刺和系统穿刺的前列腺癌和临床有意义前列腺癌（CsPCa）的检出率和穿刺针数阳性率，以及高危前列腺癌穿刺针数阳性率和阳性针癌组织长度。 结果本组178例的前列腺癌检出率为48.8%（87/178）。靶向穿刺和系统穿刺前列腺癌的检出率分别为35.5%（63/178）和42.8%（76/178），差异无统计学意义（P＝0.14）。靶向穿刺和系统穿刺CsPCa检出率分别为80%（50/63）和66%（50/76），差异无统计学意义（P＝0.21）。靶向穿刺的穿刺针数阳性率明显高于系统穿刺[60.6%（449/740）与29.7%（530/1 780）, P〈0.001]，并且靶向穿刺检出高危前列腺癌的穿刺针数阳性率也明显高于系统穿刺[10.3%（76/740）与5.5%（98/1 780），P＝0.002]，差异均有统计学意义。靶向穿刺和系统穿刺的阳性针癌组织长度中位值分别为6.8 mm（0.20～15.00 mm）和5.5 mm（0.06～18.00 mm），差异有统计学意义（P〈0.05）。 结论多模态经直肠超声成像技术引导靶向穿刺前列腺可以获得与系统穿刺相似的前列腺癌检出率，同时，靶向穿刺可检出的高危前列腺癌比例更高。

ObjectiveTo estimate the value of multi-modal guiding in transrectal ultrasound-guided prostate targeted biopsies（TB） in the biopsy naive patients. MethodsFrom June 2016 to December 2017, 178 patients with suspicious prostate cancer were retrospectively evaluated. The age of patients was 54-87 years（median 70 yesrs）. Serum PSA level before biopsy was 1.5-95.0 ng/ml（median 13.2 ng/ml）, in which 70 cases with PSA〈10 ng/ml, 58 cases 10-20 ng/ml, and 50 cases 〉20 ng/ml.All patients underwent transrectal ultrasound（TRUS）, real-time tissue elastography （RTE） and contrast-enhanced ultrasonography（CEUS）. All positive sites on imaging undergoing two-core TB and 10 core-systematic biopsy （SB）. The detection rates and positive rates of biopsy for any cancer（PCa） and clinically significant prostate cancer （CsPCa） were compared between TB and SB. Pathological findings of each biopsy core was analyzed for Gleason grade and the single-core length of prostate cancer. ResultsThe total detection rate for PCa was 48.8%（87/178）. The diagnostic accuracy of PCa did not significantly differ between TB 35.5%（63/178） and SB 42.8%（76/178） groups. There was no significant difference between the proportion of CsPCa in TB group and SB group [80%（50/63） vs. 66%（50/76）, P=0.21]. TB had an obvious higher single-core positive rate for prostate cancer 60.6%（449/740）and an obvious higher single-core positive rate for high-risk prostate cancer[10.3%（76/740）] than SB [29.7%（530/1 780） and 5.5%（98/1 780） ], with statistically signficant difference （P〈0.001, P=0.002）. TB also had a higher single-core length of prostate cancer than SB [6.80（0.20-15.00）mm vs. 5.50（0.06-18.00）mm, P〈0.05]. ConclusionsThis study revealed a similar rate of prostate cancer detection between multi-modal guiding in transrectal ultrasound-guided prostate targeted biopsies（TB） and 10 core-systematic biopsy （SB）. TB maybe tend to detect higher proportion of high-risk PCa.