前列腺前角穿刺活检在前列腺癌诊断中的价值

Value of prostate anterior horn biopsy in the diagnosis of prostate cancer

目的·探讨前角穿刺活检在前列腺癌诊断中的临床价值。方法·回顾性分析1 679 例在上海交通大学医学院附属仁济医院行超声引导下经会阴12 点初次前列腺穿刺活检患者的临床及病理资料,分析比较12 点(包括前角)穿刺活检方案和10 点(除外前角)穿刺活检方案在总体及不同亚组间前列腺癌检出率的差异。结果· 1 679 例患者经穿刺诊断为前列腺癌者678 例(40.4%),仅前角阳性59 例(8.7%)。排除前角穿刺点后,穿刺阳性率为36.9%(619/1 679),低于包含前角穿刺点的总体阳性率(40.4% vs 36.9%,P=0.046)。在对前列腺特异性抗原(prostate specific antigen,PSA)及前列腺体积分组比较中,对PSA>10 ng/mL 或前列腺体积≥ 30 mL的患者,采用前角穿刺后可提高穿刺阳性率(P<0.05)。在临床特征比较中,仅前角穿刺阳性患者的前列腺体积显著高于除前角穿刺阳性患者(P=0.006),Gleason 评分显著低于除前角穿刺阳性患者(P=0.000)。结论·增加前角穿刺能提高穿刺阳性率,推荐在初次经会阴前列腺穿刺活检中常规应用。

Objective · To evaluate population anterior horn biopsy in the diagnosis of prostate cancer. Methods · The clinical and pathological data of 1 679 patients who underwent ultrasound-guided initial 12-core prostate biopsies at Renji Hospital, Shanghai Jiao Tong University School of Medicine, were retrospectively analyzed. The performances of 12-core (including anterior horn) biopsy and the 10-core (except anterior horn) biopsy were compared in total population and different subgroups for the detection rates of prostate cancer. Results · Of the 1 679 patients, 678 (40.4%) were diagnosed with prostate cancer, and 59 (8.7%) were only positive at anterior horns. After excluding the anterior horn biopsy, the detection rate was 36.9%(619/1 679), which was lower than the overall detection rate including the anterior horn biopsy (40.4% vs 36.9%, P=0.046). In prostate specific antigen (PSA) and prostate volume subgroups, for the patients with PSA>10 ng/mL and prostate volume ≥ 30 mL, the biopsy detection rate was improved by adding the anterior horn biopsy (P<0.05). The patients with only positive anterior horn biopsy had higher prostate volumes and lower Gleason scores, compared with the patients with positive biopasy excluding anterior horn (P=0.006, P=0.000). Conclusion · Adding the anterior horn biopsy could improve the prostate cancer detection rate, recommended to be routinely used in the initial prostate biopsies.