经直肠实时弹性成像引导靶向穿刺在前列腺病变的应用价值研究

The value of transrectal real-time elastography-targeted biopsy in the detection and diagnosis of prostate lesion

目的本研究主要探讨经直肠实时弹性成像(TRTE)引导靶向穿刺在前列腺病变中的应用价值。方法对符合纳入标准的112例可疑前列腺癌患者进行经直肠前列腺超声检查,在TRTE引导下对可疑病灶进行2针靶向穿刺活检及超声引导下传统12针系统穿刺活检。分析TRTE对前列腺良恶性病变诊断效能及比较TRTE引导下靶向穿刺与系统穿刺诊断的准确性。结果本研究112例患者中,TRTE共诊断前列腺癌54例,良性病变58例,最终病理确诊前列腺癌42例,良性病变70例,诊断的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为88.1%、75.7%、80.3%、0.68、0.91。TRTE引导靶向穿刺诊断前列腺癌针数84针,阳性率37.5%(84/224),系统穿刺诊断前列腺癌针数313针,阳性率23.3%(313/1344),二者具有统计学差异,χ~2=4.08,P<0.05。同时行靶向加系统穿刺诊断前列腺癌针数397针,阳性率25.3%(397/1568)。结论 TRTE在前列腺病变诊断中具有较高的灵敏度、特异度、准确度。利用TRTE引导靶向穿刺诊断Pca拥有比系统穿刺更高的准确性,但就目前来讲TRTE引导靶向穿刺尚无法完全取代系统穿刺法,而两者相结合是减少前列腺癌穿刺假阴性率的主要方案。

Objective To explore predictive value of transrectal real.time elastography(TRTE)tar. geted biopsy in the detection and diagnosis of prostate lesion. Methods 112 patients with suspected prostate cancer included in this study were examined with transrectal ultrasound,two needles targeted bi. opsy for suspicious lesions and traditional 12.needles systemic biopsy were performed under TRTE guid. ance. Moreover,we evaluated the diagnostic value of TRTE for prostate disease and compared accuracy of targeted biopsy and systemic biopsy. Results In this study,54 cases of prostate cancer and 58 cases of benign prostatelesions were diagnosed with TRTE. 70 cases were diagnosed as benign prostate lesions and 42 were diagnosed as prostate cancer according to pathological examination. The sensitivity,specific. ity,accuracy,positive predictive value and negative predictive value were 88.1%,75.7%,80.3%, 0.68,0.91,respectively. TRTE guided targeted biopsy to diagnose prostate cancer with 84 needles,the positive rate was 37.5%(84/224),and the systematic biopsy for prostate cancer diagnosis with 313 nee. dles,the positive rate was 23.3%(313/1344),showing a statistically significant difference(χ^2=4.08, P<0.05). Additionally,the number of needle used for the diagnosis of prostate cancer by targeted and systematic biopsy was 397,and the positive rate was 25.3%(397/1568). Conclusion TRTE has high. er sensitivity,specificity and accuracy in the diagnosis of prostate lesions,and TRTE guided targeted bi. opsy has higher accuracy than systematic biopsy in diagnosing prostate cancer. However,targeted biopsy have not completely replaced systematic biopsy,and combination of them is currently the main way to reduce the false negative rate of prostate cancer.