多模态影像技术在前列腺癌靶向穿刺中的应用

Application of Multimodal Imaging Techniques in Prostate Cancer Targeted Biopsy

目的探讨多模态影像技术下经直肠腔内超声引导在前列腺癌靶向穿刺中的应用。资料与方法回顾性分析2018年12月28日—2019年12月31日于大连医科大学附属第二医院就诊的疑似前列腺癌患者141例,根据影像组合方式不同分成4组:A组[经直肠超声成像(TRUS)+经直肠超声实时组织弹性成像(TRTE)+经直肠前列腺超声造影(TR-CEUS)+MRI]40例、B组(TRUS+TRTE+TR-CEUS)行多模态影像技术下经会阴系统性穿刺+靶向穿刺活检,19例;C组(MRI/TRUS)行融合导航系统引导下经会阴靶向穿刺+系统性穿刺活检,40例;D组(TRUS)行经会阴系统性穿刺活检,42例。采用受试者工作特征曲线和诊断试验评价指标评估各组诊断前列腺癌靶区的价值;分析不同影像技术中阳性个数与恶性率之间的相关性。结果141例疑似前列腺癌经会阴前列腺穿刺活检病理证实良性72例,恶性69例;A组、D组诊断敏感度分别为94.1%、41.7%,差异有统计学意义(χ^(2)=11.80,P<0.002);A组、D组诊断特异度分别为52.2%、88.9%,差异有统计学意义(χ^(2)=6.28,P<0.002);4组受试者工作特征曲线下面积由高到低依次为A组(0.731)>C组(0.697)>B组(0.678)>D组(0.653)。A组、B组影像技术中不同阳性个数与恶性率呈正相关(r=0.567、0.463,P均<0.05)。A、B、C组中靶向穿刺活检与系统性穿刺活检的单针阳性率相比分别为34.5%(38/110)比21.6%(99/458)、60.0%(30/50)比40.2%(82/204)、20.0%(21/105)比12.5%(58/464),差异均有统计学意义(χ^(2)=9.55、6.33、7.80,P均<0.05)。结论TRUS+TRTE+TR-CEUS+MRI诊断前列腺癌是相对更有意义的影像模态组合。当TRUS、TRTE、TR-CEUS、MRI均提示阳性时,可有条件地单独使用靶向穿刺活检以替代系统性穿刺活检。

Purpose To explore the application under multimodal imaging techniques by transrectal ultrasound-guided in targeted prostate cancer biopsy.Materials and Methods 141 patients with suspected prostate cancer in the Second Affiliated Hospital of Dalian Medical University were retrospectively analyzed from December 28,2018 to December 31,2019.According to the different imaging combination,the patients were divided into four groups:there were 40 cases in group A[transrectal ultrasonography(TRUS)+transrectal real-time elastography(TRTE)+transrectal contrast-enhanced ultrasound(TR-CEUS)+MRI],and 19 cases in group B(TRUS+TRTE+TR-CEUS)used multimodal image technology of cognitive fusion to make transperineal systematic biopsy+targeted biopsy;group C(MRI/TRUS)were used fusion navigation system guided to make transperineal targeted biopsy+systematic biopsy in 40 cases;group D(TRUS)were used transperineal systematic biopsy in 42 cases.Receiver operating characteristic curve and diagnostic test evaluation indexes were used to evaluate the value of each group in the diagnosis of the target area of prostatic carcinoma.The correlation between the number of positive images and the rate of malignancy was analyzed.Results Among 141 patients with suspected prostate cancer,72 cases were benign and 69 cases were malignant.The diagnostic sensitivity of group A and group D were 94.1%and 41.7%(χ^(2)=11.80,P<0.002);the diagnostic specificity of group A and group D were 52.2%and 88.9%(χ^(2)=6.28,P<0.002);the AUC of the four groups from high to low was group A(0.731)>group C(0.697)>group B(0.678)>group D(0.653).There was a positive correlation between the number of positive images and the malignant rate in group A and group B(r=0.567,0.463,P<0.05).In group A,B and C,there was a statistically significant difference in the positive rate of single core between targeted biopsy and systematic biopsy(χ^(2)=9.55,6.33,7.80,all P<0.05).Conclusion TRUS+TRTE+TR-CEUS+MRI is most valuable in the diagnosis of prostate cancer.When all TRUS,TRTE,TR-CEUS and MRI results are positive,targeted biopsy can be used to replace systematic biopsy independently,with improving the detection rate and reduce complications.