影像融合靶向穿刺、系统穿刺以及联合穿刺诊断前列腺癌的差异

Differences in the diagnosis of prostate cancer by image fusion targeted biopsy, systematic biopsy and combined biopsy

目的:比较采用磁共振与超声融合成像行经会阴前列腺靶向穿刺、系统穿刺以及联合穿刺3种穿刺方式对前列腺癌和有临床意义前列腺癌(CsPCa)检出率的差异。方法:回顾性分析浙江省人民医院2019年4月至2020年4月收治的164例同时行前列腺靶向穿刺和系统穿刺患者的临床资料。中位年龄67(33~90)岁。术前血清tPSA 8.97(0.64~95.63)ng/ml,fPSA 1.31(0.29~9.25)ng/ml。其中,tPSA<10 ng/ml 96例,10≤tPSA<50 ng/ml 65例,tPSA≥50 ng/ml 3例。前列腺体积34.9(11.6~152.0)cm 3。磁共振检查可疑结节PI-RADS评分3分42例,4分66例,5分56例。首先通过磁共振与超声融合成像,对每处可疑病灶靶向穿刺3针,然后在超声引导下行前列腺12针系统穿刺。综合上述两种穿刺结果即为联合穿刺结果。比较3种穿刺结果在全部病例、不同PI-RADS评分病例、不同tPSA病例中对前列腺癌和CsPCa检出率的差异。结果:本组164例中检出前列腺癌126例。靶向穿刺和系统穿刺对前列腺癌的检出率分别为66.46%(109/164)和64.02%(105/164),差异无统计学意义(P=0.64)。联合穿刺前列腺癌的检出率[76.83%(126/164)]高于靶向穿刺(P=0.04)和系统穿刺(P=0.01),差异有统计学意义。靶向穿刺、系统穿刺、联合穿刺CsPCa的检出率分别为50.61%(83/164)、45.12%(74/164)、54.88%(90/164),差异无统计学意义(P>0.05)。PI-RADS 4分组和5分组前列腺癌的检出率,联合穿刺分别为90.91%(60/66)和100.00%(56/56),系统穿刺分别为71.21%(47/66)和87.50%(49/56),差异均有统计学意义(P=0.00,P=0.01)。靶向穿刺对PI-RADS 4~5分组前列腺癌的检出率[86.89%(106/122)]显著高于系统穿刺[78.69%(96/122),P=0.01],但低于联合穿刺[95.08%(116/122),P=0.03]。PI-RADS 3分组靶向穿刺、系统穿刺、联合穿刺CsPCa的检出率分别为2.38%(1/42)、7.14%(3/42)、7.14%(3/42);4分组分别为59.09%(39/66)、46.97%(31/66)、62.12%(41/66);5分组分别为78.57%(44/56)、71.43%(40/56)、82.14%(46/66),差异均无统计学意义(P>0.05)。PI-RADS 4~5分组中,联合穿刺CsPCa的检出率[71.31%(87/122)]高于系统穿刺[58.20%(71/122)],差异有统计学意义(P=0.03)。tPSA<10 ng/ml组中,联合穿刺前列腺癌的检出率[72.92%(70/96)]高于系统穿刺[59.38%(57/96)],差异有统计学意义(P<0.05);与靶向穿刺的检出率[61.43%(59/96)]相比差异无统计学意义(P=0.09)。10ng/ml≤tPSA<50ng/ml组中,靶向穿刺、系统穿刺、联合穿刺前列腺癌的检出率分别为72.31%(47/65)、69.23%(45/65)、81.54%(53/65);tPSA≥50 ng/ml组3种穿刺方法前列腺癌的检出率均为100.00%(3/3),差异均无统计学意义(P>0.05)。结论:对于多参数磁共振检查高度怀疑前列腺癌(PI-RADS 4~5分)或tPSA<10 ng/ml的患者,联合穿刺是一种诊断前列腺癌最合适的方法。

Objective To explore the detection rate of prostate cancer and clinically significant prostate cancer(CsPCa)in three puncture methods:targeted biopsy fusion with MRI and ultrasound imaging,system puncture,and combined puncture.Methods The clinical data of 164 patients who underwent both targeted biopsy and systematic biopsy in Zhejiang Provincial People's Hospital from April 2019 to April 2020 were retrospectively analyzed.The median age was 67(33-90)years.Preoperative serum tPSA was 8.97(0.64-95.63)ng/ml and fPSA was 1.31(0.29-9.25)ng/ml.There were 96 patients result in tPSA<10 ng/ml,65 and 3 patients result in 10≤tPSA<50 ng/ml and tPSA≥50 ng/ml.The prostate volume was 34.9(11.6-152.0)cm3.According to result of PI-RADS score,there were 42 patients got 3 points and 66,56 patients got 4 and 5 points respectively in PI-RADS score of suspicious nodules.First,a targeted puncture(targeted biopsy)was performed on the suspected lesions by fusion imaging of magnetic resonance and ultrasound.Then 12-needle systematic prostate biopsy was performed under the guidance of ultrasound.Those two methods performed together was called combined biopsy.This study compared the detection rates of prostate cancer and CsPCa among the three popular methods in all cases,different PI-RADS cases,and different tPSA cases.Results In this study,patients was detected as positive result in 126 of 164 patients.The detection rates of prostate cancer in targeted biopsy and systematic biopsy were 66.46%(109/164)and 64.02%(105/164),respectively,the result reveals no statistical significance(P=0.64).In contrast,the positive rate of combined biopsy[76.83%(126/164)]was higher than targeted biopsy(P=0.04)and systematic biopsy(P=0.01),and the difference was statistically significant.In the detection rate of CsPCa,the positive detection rates of targeted biopsy group,systematic biopsy group and combined biopsy group were 50.61%(83/164),45.12%(90/164)and 54.88%(126/164),respectively.Moreover,there was no significant statistical significance among the three groups(P>0.05).Group comparison was analyzed according to PI-RADS score.In PI-RADS 4 group and PI-RADS 5 group,combined biopsy was[90.91%(60/66),100.00%(56/56)]and systematic biopsy was[71.21%(47/66),87.50%(49/56)]which reveals significant difference in prostate cancer detection rates(P=0.00,P=0.01).In PI-RADS 4-5 groups,the detection rate of prostate cancer by targeted biopsy[86.89%(106/122)]was significantly higher than systematic biopsy[78.69%(96/122),P=0.01],but still lower than that by combined biopsy[95.08%(116/122),P=0.03].The CsPCa detection rates of PI-RADS 3 group targeted biopsy,systematic biopsy and combined biopsy were 2.38%(1/42),7.14%(3/42)and 7.14%(3/42),respectively.There were 59.09%(39/66),46.97%(31/66)and 62.12%(41/66)in PI-RADS 4 groups,respectively;There were 78.57%(44/56),71.43%(40/56)and 82.14%(46/66)in PI-RADS 5 groups,respectively,with no statistical significance(P>0.05).However,in PI-RADS 4-5 groups,the CsPCa detection rate of combined biopsy[71.31%(87/122)]was higher than that of systematic biopsy[58.20%(71/122)],with statistical significance(P=0.03).In the tPSA<10 ng/ml group,the prostate cancer detection rate of combined biopsy[72.92%(70/96)]was higher than that of systematic biopsy[59.38%(57/96)],and the difference was statistically significant(P<0.05).There was no significant difference between the detection rate of targeted biopsy[61.43%(59/96)]and combined biopsy(P=0.09).In the group of 10ng/ml≤tPSA<50ng/ml,the prostate cancer detection rates of targeted biopsy,systematic biopsy and combined biopsy were 72.31%(47/65),69.23%(45/65)and 81.54%(53/65),respectively,and there was no statistical significance(P>0.05).In tPSA≥50 ng/ml group,the prostate cancer detection rate of the three biopsy methods was 100.00%(3/3),and there was no statistical significance(P>0.05).Conclusion For patients with highly suspected prostate cancer on multiparameter MRI(PI-RADS 4-5)or tPSA<10 ng/ml,combined biopsy was an appropriate method to diagnose the prostate cancer.