基于bpMRI的经会阴与经直肠前列腺认知融合靶向活检的对比研究

A comparative study of pathological results of the transperineal and transrectal cognitive targeted prostate biopsy based on bpMRI

目的比较基于双参数磁共振(bpMRI)的经会阴与经直肠前列腺认知融合靶向活检对前列腺癌和有临床意义前列腺癌(CsPCa)的检出率,以及并发症发生情况。方法回顾性分析2019年1月至2021年6月于南京医科大学第一附属医院首次行前列腺活检的276例患者的临床资料,276例均行基于bpMRI的认知融合靶向活检和系统活检,其中157例采用经会阴途径(经会阴组),119例采用经直肠途径(经直肠组)。经会阴组与经直肠组患者年龄[(66.39±8.31)岁与(66.30±8.42)岁]、体质指数[(23.85±2.49)kg/m^(2)与(23.68±2.61)kg/m^(2)]、前列腺特异性抗原(PSA)[9.43(1.47~19.80)ng/ml与8.94(0.66~19.99)ng/ml]、前列腺体积[37.92(13.99~167.40)cm^(3)与40.78(11.67~188.21)cm^(3)]、PSA密度[0.21(0.04~1.17)ng/(ml·cm^(3))与0.20(0.04~1.04)ng/(ml·cm^(3))]、直肠指检可疑阳性率[17.20%(27/157)与21.10%(25/119)]差异均无统计学意义(P>0.05)。分析两组前列腺癌和CsPCa的检出率以及并发症发生率的差异。结果经会阴组与经直肠组前列腺癌检出率[49.68%(78/157)与47.06%(56/119),P=0.666]和CsPCa检出率[38.22%(60/157)与34.45%(41/119),P=0.520]差异均无统计学意义。经会阴组前列腺尖部前列腺癌检出率[54.69%(35/64)]和CsPCa检出率[43.75%(28/64)]均显著高于经直肠组[39.62%(21/53)和20.75%(11/53),均P<0.05]。经会阴组与经直肠组并发症发生率差异无统计学意义[10.19%(16/157)与12.61%(15/119),P=0.567]。结论经会阴与经直肠前列腺认知融合靶向活检对前列腺癌和CsPCa的检出率无显著差异,术后并发症发生率也无显著差异。对于尖部前列腺癌和CsPCa,经会阴途径有更高的检出率。

Objective To compare the differences of prostate cancer(PCa)and elinically significant prostate cancer(CsPCa)positive rate and postoperative complications between transperineal cognitive prostate biopsy(COG-TPBx)and transrectal cognitive prostate biopsy(COC-TRBx)based on biparametrie magnetie resonance imaging(bpMRI).Methods The data of 276 patients undergoing prostate biopsy from January 2019 to June 2021 in the First Afiliated Hospital of Nanjing Medical University were retrospectively reviewed.157 patients underwent COG-TPBx(TPBx group)and 119 patients underwent COG-TRBx(TRBx group).The average age[(66.39±8.31)vs.(66.30±8.42)years],body mass index(BMI)[(23.85±2.49)vs.(23.68±2.61)kg/m^(2)],PSA values[9.43(1.47-19.80)vs.8.94(0.66-19.99)ng/ml],prostate volume[37.92(13.99-167.40)vs.40.78(11.67-188.21)cm^(3)],PSA densily[0.21(0.04-1.17)vs.0.20(0.04-1.04)ng/(ml·cm^(3))],and suspicious digital reetal examination[17.20%(27/157)vs.21.10%(25/119)]were not signifceantly different between TPBx group and TRBx group.The positive rate of PCa,CsPCa,as well as post-biopsy complications of the lwo groups were compared.Results There were no significant diferences in the positive rate of PCa[49.68%(78/157)vs.47.06%(56/119).P=0.666]and CsPCa[38.22%(60/157)vs.34.45%(41/119).P=0.520]between the two groups.In stratification analysis,TPBx group has a significantly higher positive rate of both PCa[54.69%(35/64)]and CsPCa[43.75%(28/64)]in apex zone than TRBx group[39.62%(21/53)and 20.75%(11/53).all P<0.05).Moreover,the postoperative complications were not significantly different in TPBx group compared to that in TRBx group[10.19%(16/157)vs.12.61%(15/119),P=0.567].Conclusions Our investigations revealed that the overall positive rate of PCa,CsPCa,and the complications were not statistically different between COC-TPBx and COG-TRBx.COG-TPBx has a signifcantly higher positive rate of both PCa and CsPCa in apex zone.