经会阴超声磁共振认知融合前列腺穿刺的应用价值

Value of transperineal ultrasound-magnetic resonance cognitive fusion prostate biopsy

目的探讨经会阴超声磁共振认知融合前列腺靶向穿刺与系统穿刺对前列腺癌的诊断价值。方法回顾性分析379例疑似前列腺癌患者的资料,所有患者行多参数磁共振检查后,对于前列腺影像报告和数据系统(PI-RADS)评分≥3分者行经会阴超声磁共振认知融合前列腺靶向穿刺2针,后均行系统穿刺12针。依据穿刺病理结果将患者分为前列腺癌组、非前列腺癌组;依据PSA水平将患者分为<10 ng/ml组、10~20 ng/ml组和>20 ng/ml组。对穿刺结果中前列腺癌及临床有意义前列腺癌的检出率进行统计学分析。结果前列腺癌组患者年龄、PSA水平均明显高于非前列腺癌组,前列腺癌组患者前列腺体积明显小于非前列腺癌组,组间差异有统计学意义(P<0.05)。认知融合靶向穿刺与系统穿刺诊断前列腺癌分别为200和188例(52.77%vs 42.74%),诊断临床有意义前列腺癌分别为162和142例(49.60%vs 37.47%),两种穿刺方法对前列腺癌的检出率和对临床有意义前列腺癌的检出率差异均无统计学意义(P>0.05)。用卡方检验得出<10 ng/ml组靶向穿刺与系统穿刺对临床有意义前列腺癌的检出率差异有统计学意义(P<0.05),其他PSA水平组两种穿刺方法的检出率差异无统计学意义。结论前列腺癌穿刺检出率与PSA水平呈正相关,与前列腺体积呈负相关;对于PSA<10 ng/ml的患者,会阴超声磁共振认知融合前列腺靶向穿刺对临床有意义前列腺癌的诊断率更高。

Objective To investigate the diagnostic value of transperineal ultrasound-magnetic resonance cognitive fusion prostate targeted biopsy and systemic biopsy.Methods The retrospective study included 379 patients who were suspected of having prostate cancer.MRI was reported following the Prostate Imaging-Reporting and Data System(PI-RADS)criteria.All patients had 12 systematic biopsies(SB)plus 2 targeted biopsies(TB)by MRI cognitive targeting if PI-RADS≥3 lesions were present.Patients were divided into prostate cancer group and non-cancer group based on the pathological results of biopsy.Besides,the patients were divided into three groups according to the prostate-specific antigen(PSA)elevation(<10 ng/ml,10-20 ng/ml and>20 ng/ml).Statistical analysis was performed on the positive rates of diagnosis between the groups.Results With the increase of PSA and age,the decrease of prostate volume,the detection rate of cancer continued to increase,and the difference between the groups was statistically significant(P<0.05).The prostate cancer(PCa)detection rate and the clinically signifcant(cs)PCa detection rate were 52.77%vs 42.74%,49.60%vs 37.47%between the two biopsy methods respectively.There was no significant difference in the detection rate of PCa or csPCa between the two biopsy methods(P>0.05).The chi-square test showed that TB was more accurate than SB in detecting csPCa when PSA<10 ng/ml(P<0.05).Conclusions The higher PSA,older age and smaller volume demonstrated an increased detection rate of cancer.Combined biopsy led to more detection of all prostate cancers.However,when PSA<10 ng/ml,transperineal ultrasound-magnetic resonance cognitive fusion prostate targeted biopsy has a good efficacy in detecting csPCa.