智能融合成像技术对中低风险前列腺特异性抗原人群的临床显著性前列腺癌诊断研究

Diagnostic value of Intelligent fusion imaging technology for clinically significant prostate cancer in low-risk patients

目的:探讨核磁联合经直肠超声计算机软件融合成像引导前列腺靶向穿刺活检(software guided magnetic resonance imag⁃ing-ultrasound fusion targeted biopsies,MRUS-TB)在中低风险前列腺特异性抗原(prostate-specific antigen,PSA)患者中的临床应用价值。方法:回顾性分析2015年8月至2020年2月298例于天津医科大学肿瘤医院首次行前列腺靶向穿刺患者的临床资料,分为185例行MRUS-TB联合经直肠超声引导系统穿刺活检(trans rectal ultrasound-guided systematic biopsy,TRUS-SB)组(A组)和113例行核磁联合经直肠超声认知融合成像引导前列腺靶向穿刺活检(cognitive magnetic resonance imaging trans rectal ultrasound fusion targeted biopsy,COG-TB)联合TRUS-SB组(B组),对比分析MRUS-TB和COG-TB对血清PSA水平为4~20 ng/mL人群中前列腺癌(prostate cancer,PCa)检出率的影响。结果:A组与B组相比,PCa及临床显著性PCa(clinically significant prostate cancer,CSPCa)检出率差异均无统计学意义(均P>0.05);肿瘤穿刺组织有效样本长度及穿刺针数检出PCa的阳性比均具有统计学意义(均P<0.05);根据血清PSA表达水平和前列腺体积分层时,PCa及CSPCa检出率差异均具有统计学意义(均P<0.05);行MRI检查结节最大径≤5 mm的CSPCa检出率差异具有统计学意义(P=0.043)。结论:MRUS-TB可提高中低风险PSA及较小前列腺体积的患者中CSPCa的检出率,并可提高结节大小≤5 mm的CSPCa检出率。

Objective:To investigate the clinical application value of software-guided magnetic resonance imaging-ultrasound fusion targeted biopsy(MRUS-TB)in patients with low-and medium-risk prostate-specific antigen(PSA)levels.Methods:The clinical data of 298 patients who underwent prostate-targeted puncture for the first time at Tianjin Medical University Cancer Institute and Hospital from August 2015 to February 2020 were retrospectively analyzed.We compared between MRUS-TB combined with transrectal ultrasound-guided systematic biopsy(TRUS-SB)(Group A)and cognitive magnetic resonance imaging transrectal ultrasound fusion targeted biopsy(COG-TB)combined with TRUS-SB(Group B)to determine the influence of MRUS-TB and COG-TB on the detection rate of prostate cancer(PCa)in patients with PSA levels of 4-20 ng/mL.Results:Cases in Group A and Group B(185 and 113 cases,respectively)were compared;the detection rate between PCa and clinically significant prostate cancer(CSPCa)was not significantly different(P>0.05).The effective sample length of tumor puncture tissue and the positive ratio of PCa detected by the number of puncture were statistically significant(P<0.05).The detection rates of PCa and CSPCa were significantly different according to PSA levels and prostate volumes(P<0.05).The difference in CSPCa detection rates was significant(P=0.043)when the nodule diameter was≤5 mm on magnetic resonance imaging.Conclusions:MRUS-TB can increase the detection rate of CSPCa in patients with medium-and low-risk PSA levels and small prostate volume and can improve the detection rate of CSPCa nodules measuring≤5 mm in diameter.