不同血清PSA参考值下经直肠系统穿刺活检对成人前列腺癌早期诊断效能的研究

Study on the efficiency of transrectal puncture biopsy under different serum PSA reference values in early diagnosis of adult prostate cancer

目的探讨不同血清前列腺特异性抗原(PSA)参考值下经直肠系统穿刺活检对成人前列腺癌早期诊断的效力,为合理选择穿刺对象,提高穿刺活检的效能提供借鉴。方法选择2016年1月至2017年3月在我院就诊的138疑似前列腺癌患者作为研究对象,所有患者均进行B超引导下经直肠系统穿刺活检和PSA水平检测。比较以不同血清PSA参考值为指标时,B超引导下经直肠系统穿刺活检前列腺癌的结果。结果 138例疑似前列腺癌患者,经术后病理检查115例被确诊为前列腺癌,阳性率为83.33%(115/138)。术前经直肠系统穿刺活检阳性68例,阳性率为49.28%(68/138);阴性70例,阴性率为50.72%(70/138);经直肠穿刺穿刺活检与病理检查阳性符合率为59.13%(68/115)。不同PSA参考值下,患者的术前穿刺活检阳性率、术后病理检查阳性率均有显著性差异(P<0.05);PSA参考值越高,其术前经直肠系统穿刺活检阳性率、术后病理检查阳性率则越高。以不同PSA参考值为指标时,经直肠系统穿刺活检诊断前列腺癌的灵敏度、特异度、诊断符合率均有显著差异(P<0.05);血清PSA>4 ng/mL为指标时,穿刺活检诊断前列腺癌的灵敏度、诊断符合率均最高。结论将血清PSA>4 ng/mL作为成人可疑前列腺癌患者穿刺活检指标时,可实现B超引导下经直肠系统穿刺活检前列腺癌诊断效能的最大化。

Objective To investigate the efficiency of transrectal puncture biopsy under different reference values of serum prostate specific antigen (PSA) in early diagnosis of adult prostate cancer, so as to provide reference for reasonable selection of puncture objects and improvement of puncture biopsy. Methods A total of 138 patients with suspected prostate cancer treated in our hospital from January 2016 to March 2017 were selected as the research objects. All patients underwent B-ultrasound guided transrectal puncture biopsy and PSA level detection. The results of transrectal puncture biopsy of prostate cancer guided by B-ultrasound with different reference values of serum PSA were compared. Results Of 138 suspected prostate cancer patients, 115 cases were diagnosed as prostate cancer by pathological examination after operation, and the positive rate was 83.33%(115/138). There were 68 cases positive by preoperative transrectal puncture biopsy, and the positive rate was 49.28%(68/138);70 cases were negative, and the negative rate was 50.72%(70/138);and positive coincidence rate between transrectal puncture biopsy and pathological examination was 59.13%(68/115). Under different PSA reference values, there were significant differences in the positive rate of preoperative puncture biopsy and pathological examination after operation (P<0.05);the higher the reference value of PSA, the higher the positive rate of preoperative transrectal puncture biopsy and pathological examination after operation. The sensitivity, specificity and coincidence rate of transrectal puncture biopsy in the diagnosis of prostate cancer were significantly different under different PSA reference values (P<0.05). When serum PSA>4 ng/mL was taken as the index, the sensitivity and coincidence rate of puncture biopsy in the diagnosis of prostate cancer were the highest. Conclusion When serum PSA >4 ng/mL is used as a puncture biopsy index for adult suspected prostate cancer patients, the diagnostic efficiency of transrectal puncture biopsy guided by B-mode ultrasound for prostate cancer can be maximized.