超声引导下12+x针前列腺穿刺活检单中心407例临床分析

Clinical analysis of 12+x-core prostate biopsy guided by ultrasonography:407 cases in a single center

目的:分析单中心超声引导下12+x针前列腺穿刺活检结果,比较不同穿刺途径的临床效果。方法:回顾分析2016年6月~2019年12月我院完成的407例前列腺穿刺活检的临床资料,经直肠前列腺穿刺290例(经直肠组),经会阴前列腺穿刺117例(经会阴组),均采用超声引导下12+x针法,前列腺影像学正常者行系统穿刺,影像学异常者行系统+靶向穿刺。比较两组前列腺癌(PCa)的检出率及并发症差异,分析两组按PSA、影像学分层PCa检出率的差异,比较靶向穿刺与系统穿刺癌检出率的差异,分析临床有意义前列腺癌(csPCa)的检出情况。结果:(1)PCa总检出率为44.0%(179/407),经直肠组与经会阴组PCa检出率比较差异无统计学意义[44.8%(130/290)vs.41.9%(49/117),P>0.05]。其中,PSA≤4 ng/mL、4 ng/mL20 ng/mL各水平分层中,两组PCa检出率比较差异无统计学意义(P>0.05)。两组中前列腺影像学异常者的PCa检出率均高于影像学正常者(P<0.05)。影像学异常者中,经直肠组与经会阴组PCa检出率比较差异无统计学意义(P>0.05)。(2)前列腺影像学异常者总的PCa检出率为57.5%(111/193),靶向穿刺PCa检出率为42.0%(81/193),系统穿刺为47.7%(92/193),两者比较差异无统计学意义(P>0.05),但靶向穿刺单针阳性率比系统穿刺更高(P<0.01)。同一途径下的靶向穿刺与系统穿刺PCa检出率比较差异无统计学意义(P>0.05)。两组中分别比较靶向穿刺、系统穿刺的PCa检出率,差异均无统计学意义(P>0.05)。(3)在所有患者中,经直肠途径csPCa检出率为36.9%(107/290),经会阴途径csPCa检出率为40.2%(47/117),两者比较差异无统计学意义(P>0.05)。靶向穿刺与系统穿刺在csPCa的检出率上比较差异无统计学意义。csPCa在诊断出的PCa患者中的占比,经会阴途径占比高于经直肠途径[95.9%(47/49)vs.82.3%(107/130),P<0.05]。(4)经直肠组总并发症发生率显著高于经会阴组[39.3%(114/290)vs.20.5%(24/117),P<0.01]。经直肠组发热、血便发生率比经会阴组更高,分别为[10.3%(30/290)vs.3.4%(4/117),P<0.05]、[14.1%(41/290)vs.1.7%(2/117),P<0.01],两组在血尿、下尿路症状、尿潴留、迷走反射发生率上比较差异均无统计学意义(P>0.05)。结论:超声引导下12+x针前列腺穿刺活检PCa检出率较好,影像学异常者靶向穿刺与系统穿刺PCa、csPCa检出率差异均无统计学意义,靶向穿刺单针阳性率较高。经直肠途径与经会阴途径在PCa、csPCa检出率比较差异无统计学意义,经会阴途径并发症更少。在诊断出的PCa中,经会阴途径可检出更多的csPCa。

Objective:To analyze the clinical outcomes of 12+x-core prostate biopsy guided by ultrasonography in a single center and compare the clinical effect in different biopsy approaches.Methods:We retrospectively analyzed the clinical data of 407 patients who underwent prostate biopsy from June 2016 to December 2019 in our center,of which 290 patients with transrectal prostate biopsy(transrectal group),and 117 patients with transperineal prostate biopsy(transperineal group).All of cases were performed with 12+x-core prostate biopsy guided by ultrasonography.Patients with normal prostate image were performed with systematic prostate biopsy(SPB),those with abnormal prostate image were performed with systematic and targeted/cognitive fusion prostate biopsy(TPB).The difference of detection rate of prostate cancer(PCa)and complications between two groups was analyzed.We especially compared the detection rate of PCa in different PSA levels and in different image findings between them.The difference of detection rate of PCa was compared between SPB and TPB.The clinical significant prostate cancer(csPCa)was analyzed.Results:(1)The overall detection rate of PCa was 44.0%(179/407).There was no statistical difference in detection rate of PCa between transrectal group and transperineal group,which was 44.8%(130/290)vs.41.9%(49/117),respectively(P>0.05).The detection rates of PCa between transrectal group and transperineal group when PSA level was PSA≤4 ng/mL,4 ng/mL20 ng/mL showed no statistical difference(P>0.05).There was higher detection rate of PCa in patients with abnormal prostate image than those with normal prostate image in both of the two groups(P<0.05).There was no significant difference in detection rate of PCa in patients with prostate abnormal image between two groups(P>0.05).(2)For patients with abnormal prostate image,detection rate of PCa was 57.5%(111/193).The detection rates of PCa by TPB and SPB were 42.0%(81/193)and 47.7%(92/193),respectively.There was no statistical difference between them(P>0.05).The positive rate of single core was significantly higher by TPB than SPB(P<0.01).There was no statistical difference in the detection rate PCa between TPB and SPB in the same biopsy approach(P>0.05).The detection rate of PCa by TPB showed no statistical difference between two groups,that of by SPB showed no statistical difference between two groups(P>0.05).(3)The detection rates of csPCa were 36.9%(107/290)in transrectal group and 40.2%(47/117)in transperineal group.There was no statistical difference between them(P>0.05).The detection rates of csPCa by TPB and by SPB showed no statistical difference.More csPCa were detected in the transperineal group than in transrectal group among patients detected with PCa.Among the diagnosed cases of PCa,the proportion of csPCa was higher in transperineal group than in tranrectal group,which was 95.9%(47/49)vs.82.3%(107/130)(P<0.05).(4)The total incidence of complications in transrectal group was higher than that in transperineal group,which was 39.3%(114/290)vs.20.5%(24/117)(P<0.01),respectively.The incidences of fever and bloody stool in transrectal group were significantly higher compared to those in transperineal group,which were 10.3%(30/290)vs.3.4%(4/117)(P<0.05)and 14.1%(41/290)vs.1.7%(2/117)(P<0.01)in two groups respectively.There was no significant difference in the incidences of hematuria,lower urinary tract symptoms,urine retention or vagus reflex between the two groups(P>0.05).Conclusion:PCa detection rate of the 12+x-core prostate biopsy guided by ultrasonography is good.There is no statistical difference in the detection rate of PCa and csPCa between TPB and SPB in patients with abnormal prostate image,but the positive rate of single core is significantly higher by TPB than by SPB.There is no significant difference in the detection rate of PCa and csPCa between the transrectal approach and the transperineal approach,but the transperineal approach detects more csPCa among patients detected with PCa,and has less complications than the transrectal approach.