PSAD、TRTE联合mpMRI对PSA灰区前列腺癌的诊断价值

Diagnostic value of PSAD,TRTE combined with mpMRI for prostate cancer in grey area of PSA

目的:探讨前列腺特异性抗原密度(prostate-specific antigen density,PSAD)、经直肠实时组织弹性成像(transrectal real-time tissue elastography,TRTE)联合多参数磁共振成像(multiparametric magnetic resonance imaging,mpMRI)对PSA灰区可疑前列腺癌的临床价值。方法:收集昆山市中医医院151例PSA为4~10 ng/mL(PSA灰区)的可疑前列腺癌患者。患者均接受PSA检测、TRTE检查及mpMRI检查,比较前列腺癌组与良性增生组的年龄、PSA、TRTE评分及MRI前列腺影像报告和数据系统(Prostate Imaging Reporting and Data System,PI-RADS)评分的差异,构建受试者工作特征(receiver operating characteristic,ROC)曲线,分析单个指标(PSAD、TRTE和mpMRI)及联合诊断对PSA灰区前列腺癌的诊断效能。结果:两组的PSAD、TRTE评分及MRI PI-RADS评分差异均有统计学意义(Z=4.92、5.97、6.81,均P<0.001);构建PSAD、TRTE评分、MRI PI-RADS评分及三者联合诊断的ROC曲线,获得曲线下面积(area under curve,AUC)分别为0.749、0.79、0.832及0.901,三者联合诊断效能最大,且差异有统计学意义(Z=3.89、2.70、3.99,P均<0.01)。结论:PSAD、TRTE评分和MRI PI-RADS评分对PSA灰区前列腺癌均有较高的诊断价值;三者联合可以明显提高PSA灰区前列腺癌诊断的准确度,避免临床工作中许多不必要的活检穿刺。

Objective:To investigate the clinical value of prostate-specific antigen density(PSAD),transrectal real-time tissue elastography(TRTE)combined with multiparametric magnetic resonance imaging(mpMRI)in the treatment of prostate cancer in the grey area of PSA.Methods:A total of 151 suspected prostate cancer patients with PSA of 4-10 ng/mL(PSA gray area)in Kunshan Hospital of Traditional Chinese Medicine were collected and all received PSA test,TRTE and mpMRI.The differences in age,PSA,TRTE score and MRI Prostate Imaging Reporting and Data System(PI-RADS)score between prostate cancer group and benign hyperplasia group were compared.Receiver operating characteristic(ROC)curve was constructed to analyze the diagnostic efficacy of single indicators(PSAD,TRTE score and MRI PI-RADS score)and combined diagnosis for prostate cancer in the grey area of PSA.Results:There were significant differences in PSAD,TRTE scores and PI-RADS scores between the two groups(Z=4.92,5.97,6.81,all P<0.001).The ROC curves of PSAD,TRTE scores,PI-RADS scores and their combined diagnosis were constructed,and the area under curve(AUC)values were 0.749,0.79,0.832 and 0.901,respectively.The combined diagnosis efficiency of the three was the highest,and the difference was statistically significant(Z=3.89,2.70,3.99,all P<0.01).Conclusion:PSAD,TRTE score and MRI PI-RADS score have high diagnostic value for prostate cancer in grey area of PSA.PSAD,TRTE score combined with MRI PIRADS score can significantly improve the accuracy of prostate cancer in the grey area of PSA,and avoid many unnecessary biopsies in clinical work.