多参数磁共振与经直肠超声融合前列腺靶向穿刺活检在检测PI-RADS≥3前列腺癌中的临床价值

Clinical value of targeted multiparameter MRI and transrectal ultrasonography fusion prostate biopsy for the detection of PI-RADS≥3 prostate cancer

目的评价多参数磁共振(mpMRI)与经直肠超声(TRUS)融合前列腺靶向穿刺活检在检测前列腺癌(PCa)和临床显著性前列腺癌(csPCa)的临床价值。方法收集2018年9月至2020年6月161例前列腺影像和数据报告系统评分(PI-RADS)≥3的患者资料纳入本研究。随机分为两组,前列腺系统穿刺患者80例(系统穿刺组)和mpMRI/TRUS融合前列腺靶向穿刺活检+前列腺系统穿刺活检患者81例(联合穿刺组)。对活检的临床资料和病理结果进行分析。结果联合穿刺组mpMRI/TRUS融合前列腺靶向穿刺活检的PCa检出率高于前列腺系统穿刺活检,但差异无统计学意义(χ^(2)=0.627,P=0.429)。联合穿刺组PCa检出率高于系统穿刺组(χ^(2)=3.880,P=0.049)。联合穿刺组中有40例被诊断为csPCa,系统穿刺组中有22例被诊断为csPCa,联合穿刺组csPCa检出率高于系统穿刺组(χ^(2)=8.139,P=0.004)。在Gleason评分≤6分时,联合穿刺组中mpMRI/TRUS融合前列腺靶向穿刺活检的检出率明显低于系统前列腺穿刺(P=0.029)。Gleason评分>6分时,mpMRI/TRUS融合前列腺靶向穿刺活检的检出率均高于前列腺系统穿刺(P=0.010)。结论在PI-RADS≥3的患者中,mpMRI/TRUS融合前列腺靶向穿刺活检在PCa和csPCa的检出率上优于系统前列腺活检,但仍遗漏了部分前列腺癌患者,包括csPCa。将mpMRI/TRUS融合前列腺靶向穿刺活检和系统前列腺穿刺活检相结合,可以更好地检测所有前列腺癌,特别是csPCa。

Objective To evaluate the clinical value of multiparameter magnetic resonance imaging(mpMRI)and transrectal ultrasonography(TRUS)fusion prostate biopsy for the detection of prostate cancer(PCa)and clinical significant prostate cancer(csPCa).Methods A total of 161 patients treated during Sep.2018 and Jun.2020 with prostate imaging reporting and data system(PI-RADS)≥3 were enrolled in this study.The patients were randomly assigned to undergo either systematic prostate biopsy(systematic group)or targeted mpMRI/TRUS fusion prostate biopsy+systematic prostate biopsy(combined group).The clinical data and pathological results of biopsies were analyzed.Results The detection rate of PCa by targeted mpMRI/TRUS fusion prostate biopsy was higher than that of systematic prostate biopsy,but there was no significantly difference(χ^(2)=0.627,P=0.429).There were 40 cases in the combined group and 22 in the systematic group diagnosed as csPCa,respectively.The detection rate of csPCa was much higher in the combined group(χ^(2)=8.139,P=0.004).When Gleason score>6,targeted mpMRI/TRUS fusion prostate biopsy had significantly higher detection rate than systematic biopsy(P=0.010).Conclusion In patients with PI-RADS≥3 prostate cancer,targeted mpMRI/TRUS fusion prostate biopsy has higher detection rates of PCa and csPCa than systematic prostate biopsy,but it still misses some cases.Combination of targeted mpMRI/TRUS fusion prostate biopsy and systematic prostate biopsy can improve the detection rate of all prostate cancers,especially csPCa.