盆腔MRI辅助模板定位B超引导下经会阴前列腺穿刺活检术的临床应用

Pelvic MRI combined with TRUS-guided transperineal template mapping biopsy for the diagnosis of prostate cancer

目的:评估盆腔MRI辅助模板定位B超引导下经会阴前列腺穿刺活检术的临床价值和安全性。方法:2015年12月至2018年05月,对164例(PSA<10μg/L 28例、PSA 10~20μg/L 56例、PSA 20.01~100μg/L 53例、PSA>100μg/L 27例)可疑前列腺癌患者由同一医疗小组实施盆腔MRI辅助模板定位B超引导经会阴前列腺穿刺活检术。患者平均年龄71.2岁,穿刺前均行血清PSA检测、直肠指检以及盆腔前列腺MRI平扫检查。所有患者均接受截石位穿刺,选择静脉全身麻醉或腰麻,均采用X+12针穿刺。结果:所有患者均顺利完成活检操作,活检针数(2~4)+12针;活检时间15~28 min,平均18 min。术后一过性血尿4例,会阴阴囊皮下淤血12例,发热1例,无尿潴留病例。穿刺病理结果:前列腺腺癌95例,导管上皮癌2例;前列腺增生伴间质慢性炎症63例,前列腺不典型增生症4例。PSA <10、10~20、20.01~100、>100μg/L组穿刺阳性率分别为25.00%、42.86%、73.58%、100.00%。PSA<10μg/L组与PSA10~20μg/L组相比无统计学差异(P=0.086),但与PSA 20.01~100μg/L和>100μg/L组相比差异具有统计学意义(P<0.01)。结论:与目前常规使用的经直肠前列腺穿刺术相比,盆腔MRI辅助模板定位B超引导下经会阴前列腺穿刺活检术并发症发生率更低,且阳性率显著增高同时穿刺方法更简单易掌握,是诊断前列腺癌的理想方法。

Objective: To assess the clinical value and safety of pelvic MRI combined with transurethral ultrasound (TRUS)- guided transperineal template mapping biopsy (TTMB) in the diagnosis of prostate cancer. Methods: A total of 164 men underwent MRI plus TRUS-guided TTMB for the diagnosis of prostate cancer from December 2015 to May 2018. The patients averaged 71.2 years of age and, based on the PSA level, were divided into four groups: PSA < 10 μg/L (n = 28), PSA 10-20 μg/L (n = 56), PSA 20. 01 - 100 μg/L (n = 53) and PSA > 100 μg/L (n = 27). All the patients received digital rectal examination, pelvic MRI and TRUS-guided X + 12-core TTMB. Results: The procedures of TRUS-guided TTMB were successfully completed in all the patients, with an average number of 14. 2 (14-16) cores and mean operation time of 18 (15 -28) minutes. Post-biopsy complications included transient hematuria in 4 cases, perineal hematoma in 12 and fever in 1, but no acute urinary retention. Pathological results revealed 95 cases of prostate cancer, 2 cases of ductal epithelial carcinoma, 63 cases of prostatic hyperplasia with benign interstitial inflammation, and 4 cases of atypical prostatic hyperplasia. The positive biopsy rates in the PSA < 10 μg/L, 10 -20 μg/L, 20. 01 - 100 μg/L and > 100 μg/L groups were 25. 00%, 42. 86%, 73. 58% and 100. 00% respectively, with statistically significant difference between the PSA < 10 μg/L group and the PSA 20. 01 一 100 μg/L and > 100 μg/L groups ( P < 0. 01 ), but not between the PSA < 10 μg/L and PSA 10 - 20 μg/L groups (P = 0. 086). Conclusion: Pelvic MRI combined with TRUS-guided X + 12-core TTMB, with the advantages of high accuracy and low rate of complications, is an ideal approach to the diagnosis of prostate cancer.