MRI提升经直肠超声前列腺活检穿刺阳性率的临床价值

Clinical Value of MRI in Enhancing the Positive Rate of Transrectal Ultrasound Prostate Biopsy

目的研究MRI提升经直肠超声前列腺活检穿刺阳性率的临床价值。方法收集我院2015年5月至2017年5月93例疑似前列腺癌患者的病历资料,均在我院接受经直肠超声前列腺穿刺活检,术前行MRI检查,标出前列腺癌可疑位点。以最终病理结果为金标准,计算超声靶向穿刺与超声联合MRI靶向穿刺诊断前列腺癌的灵敏度、特异度、阳性预测值、阴性预测值、准确率。结果 93例疑似前列腺癌患者共行系统穿刺1116针,阳性132针,穿刺阳性率为11.8%。93例疑似前列腺癌患者经直肠超声前列腺活检穿刺共靶向穿刺86针,阳性31针,穿刺阳性率为36.0%;经直肠超声联合MRI前列腺活检穿刺共靶向穿刺124针,阳性77针,穿刺阳性率为62.1%。超声联合MRI靶向穿刺阳性率显著高于单纯超声靶向穿刺(P<0.05)。93例疑似前列腺癌最终病理证实为前列腺增生45例,前列腺癌48例,检出率为51.6%。超声联合MRI靶向穿刺诊断前列腺癌的灵敏度、阴性预测值、准确率分别为85.4%、83.3%、81.7%显著高于超声靶向穿刺的52.1%、62.3%、67.7%(P<0.05)。结论 MRI可以指导穿刺活检,提高经直肠超声前列腺活检穿刺阳性率,增加前列腺癌诊断准确性。

Objective To study the clinical value of MRI in enhancing the positive rate of transrectal ultrasound prostate biopsy. Methods The medical records of 93 patients with suspected prostate cancer admitted to the hospital from May 2015 to May 2017 were collected. All patients underwent transrectal ultrasound prostate biopsy in the hospital.MRI was performed before surgery to identify suspicious sites of prostate cancer. With the final pathological results as the golden standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of targeted ultrasound puncture and ultrasound combined with MRI targeted puncture in the diagnosis of prostate cancer were calculated. Results The 93 patients with suspected prostate cancer underwent a total of 1,116 times of systemic puncture and 132 times were positive. The positive rate of puncture was 11.8%. Ninety-three patients with suspected prostate cancer underwent a total of 86 times of targeted transrectal ultrasound prostate biopsy and 31 times were positive. The positive rate of puncture was 36.0%. A total of 124 times of transrectal ultrasound combined with MRI prostate biopsy was performed, 77 times were positive,and the positive rate of puncture was 62.1%. The positive rate of ultrasound combined with targeted MRI biopsy was significantly higher than that of simple ultrasound puncture(P<0.05). In 93 cases of suspected prostate cancer, pathology confirmed 45 cases of benign prostate hyperplasia and 48 cases of prostate cancer. The detection rate was 51.6%.The sensitivity, negative predictive value and accuracy of ultrasound combined with MRI targeted biopsy in the diagnosis of prostate cancer were 85.4%, 83.3% and 81.7%,respectively, which were significantly higher than those of ultrasound targeted puncture(52.1%, 62.3% and 67.7%)(P<0.05). Conclusion MRI can guide the biopsy, increase the positive rate of transrectal ultrasound prostate biopsy and increase the diagnostic accuracy of prostate cancer.