3D空间分布模型及体外定位穿刺技术在前列腺癌中的应用初探

Application of 3D spatial distribution model and in vitro location saturation biopsy in prostate cancer

目的:初步探讨前列腺癌3D空间分布模型的临床应用价值及体外定位饱和穿刺技术定位前列腺癌病灶的准确性。方法:对2017年10月~2018年9月在我院行腹腔镜下解剖性前列腺根治术的30例患者行术后离体组织体外定位饱和穿刺病理检查及大组织切片病理检查,再根据大组织切片病理结果利用计算机软件建立前列腺癌3D空间分布模型。并利用此模型评估单纯体外定位饱和穿刺在常规病理检查前定位癌灶的准确性及应用价值。结果:30例前列腺癌患者共发现有临床意义的癌灶69个,平均2.3个,其中位于尖部5个,基底部3个,外周带35个,中央带及移行带26例;病灶大小2~20 mL,平均5.2 mL,单病灶整体Gleason评分平均7.9(3+4~5+4)分。单纯利用体外饱和穿刺技术对有临床意义病灶的发现率为97%。结论:利用前列腺大组织切片技术及计算机软件制作前列腺癌3D空间分布模型可真实还原前列腺癌病灶的空间分布,单纯体外饱和穿刺技术能在一定程度上弥补常规前列腺癌根治术后病理检查的缺陷,为临床医师提供更多有价值的信息。

Objective: To explore the clinical value of 3 D spatial distribution model of prostate cancer and the accuracy of in vitro location saturation biopsy for locating prostate cancer lesions. Method: A total of 30 patients who underwent laparoscopic anatomic radical prostatectomy at the Northern Jiangsu People’s Hospital from October 2017 to September 2018 were included. After the surgery, pathological examination of in vitro location saturation biopsy and whole-mounted radical prostatectomy specimens were conducted. Then, according to the pathological results of whole-mounted radical prostatectomy specimens, 3 D spatial distribution model of prostate cancer was established by computer software. This model was used to evaluate the accuracy and application value of in vitro saturation biopsy in locating cancer lesions before routine pathological examination. Result: A total of 69 clinically significant lesions were found in 30 patients with prostate cancer, with an average of 2.3 lesions, including 5 on the tip, 3 on the base, 35 on the peripheral zone, and 26 on the central zone and the transitional zone. The average lesion size was 5.2(range, 2-20) mL, and the overall Gleason score was 7.9(3+4-5+4). The rate of detection of clinically significant lesions by in vitro location saturation biopsy was 97%. Conclusion: The 3 D spatial distribution model of prostate cancer can simulate the spatial distribution of prostate cancer lesions. In vitro saturation puncture technique can make up for the defects of routine pathological examination after radical surgery of prostate cancer to a certain extent, providing more valuable information for clinicians.