MRI-TRUS融合引导经会阴前列腺靶向结合饱和穿刺活检的临床应用

Clinical application of MRI-TRUS fusion guided transperineal prostate targeting combined with saturation biopsy in patients with suspected prostate cancer

目的探讨磁共振成像-经直肠超声(MRI-TRUS)融合引导经会阴前列腺靶向结合饱和穿刺活检的临床应用价值。方法选取2018年3月至2018年7月在首都医科大学宣武医院泌尿外科收治的可疑前列腺癌患者15例,所有患者均行前列腺MRI和经直肠前列腺超声(TRUS)检查,并进行MRI-TRUS融合引导下经会阴前列腺靶向结合饱和穿刺活检术。根据患者前列腺影像报告和数据系统(PI-RAIDS)评分及MRI-TRUS融合图像,以不同颜色标记出高度怀疑为前列腺癌结节区域及可疑结节区域,作为穿刺靶区及可疑靶区。每例患者于靶区、可疑靶区及非靶区共穿刺30~36针。分析患者的穿刺阳性率、病理结果及并发症。结果15例患者共标记20个靶区和5个可疑靶区,来自12例患者的17个靶区和3个可疑靶区穿刺结果为阳性,靶向穿刺总阳性率为80%(20/25),所有阳性病例的穿刺病理结果均为前列腺腺泡癌。其余3例患者的3个靶区和2个可疑靶区穿刺结果为阴性,病理结果回报为前列腺增生伴炎症改变。5例于非靶区同时发现前列腺癌细胞,于非靶区诊断前列腺癌阳性率为33.3%(5/15)。15例患者中仅1例术后出现血尿,于术后第2天缓解,2例出现会阴区疼痛不适,于术后第3天缓解,所有患者均未出现血便、发热、脓毒血症、急性尿潴留等并发症。结论MRI-TRUS融合引导前列腺靶向结合饱和穿刺活检阳性率高,术后并发症少且轻,安全可行,是临床理想的前列腺穿刺活检方法。

Objective To assess the clinical value of MRI-TRUS fusion guided transperineal prostate targeting combined with saturation biopsy in patients with suspected prostate cancer.Methods From March 2018 to July 2018,15 patients with suspected prostate cancer were treated at the Department of Urology,Xuanwu Hospital of Capital Medical University.All patients underwent prostate MRI and transrectal ultrasound(TRUS).MRI-TRUS fusion guided transperineal prostate targeting combined with saturated prostate biopsy was performed.According to the patient's PI-RAIDS score and MRI-TRUS fusion image,the highly suspected prostate cancer nodule area and suspicious nodule area were marked in different colors,which were used as puncture target and suspicious target areas.A total of 30 or 36 puncture needles were punctured in the target area,suspicious target area,and non-target area in each patient.The positive rate of puncture,pathological results,and complications were analyzed.Results A total of 20 targets and 5 suspicious targets were labeled in 15 patients.The puncture results from 17 targets and 3 suspicious targets in 12 patients were positive.The total positive rate of targeted puncture was 80%(20/25).The pathological results of puncture in all positive cases were prostate acinar carcinoma.The puncture results from 3 target areas and 2 suspicious target areas in the other 3 patients were negative,and the pathological results were reported as benign prostatic hyperplasia(BPH)with inflammatory changes.Prostate cancer cells were found in 5 cases at the same time in non-target area.The positive rate of prostate cancer diagnosed in non-target area was 33.3%(5/15).Of the 15 patients,only 1 developed hematuria after operation,which resolved on the 2nd day after operation,and 2 had perineal pain discomfort,which resolved on the 3rd day after operation.No patients had complications such as bloody stool,fever,sepsis,and acute urinary retention.Conclusion MRI-TRUS fusion guided transperineal prostate targeting combined with saturated biopsy has the advantages of high positive rate,few postoperative complications,and high safety and feasibility,representing an ideal method for prostate biopsy.