多参数磁共振成像-经直肠超声认知融合引导下经会阴前列腺靶向穿刺活检在前列腺癌诊断中的应用

Application of transperineal targeted prostate puncture biopsy guided by mpMRI-TRUS cognitive fusion in diagnosis of prostate cancer

目的评价多参数磁共振成像(mpMRI)-经直肠超声(TRUS)认知融合引导下经会阴前列腺靶向穿刺(靶向穿刺)活检在前列腺癌诊断中的临床应用价值。方法可疑前列腺癌患者140例接受mpMRI-TRUS认知融合引导下经会阴靶向穿刺1~2针。靶向穿刺完成后严格按照规范的系统穿刺方案立即进行TRUS引导下经会阴12针系统前列腺穿刺(系统穿刺)活检。回顾性分析穿刺活检资料,比较两种穿刺方法对前列腺癌的检出效能。结果靶向穿刺活检前列腺癌检出率42.86%,与系统穿刺活检前列腺癌检出率43.57%相仿(P>0.05)。两种穿刺方法前列腺癌检出率的总前列腺特异性抗原(tPSA)和Gleason评分分层分析结果也无统计学差异(P>0.05)。靶向穿刺活检穿刺阳性针数比例大于系统穿刺活检(35.33%vs.23.93%)(P<0.01)。两种穿刺方法均未出现严重并发症。结论在tPSA≤50 ng/mL和前列腺影像报告和数据系统≥3分的可疑前列腺癌患者,mpMRI-TRUS认知融合引导下经会阴靶向穿刺活检对前列腺癌的检出率与规范的系统穿刺活检相当,但需要穿刺的针数明显减少,有利于减少穿刺相关并发症的发生。

Objective To evaluate the clinical value of transperineal targeted prostate puncture biopsy(TPPB)guided by multiparameter magnetic resonance imaging-transrectal ultrasound(mpMRI-TRUS)cognitive fusion in the diagnosis of prostate cancer.Methods A total of 140 patients with suspected prostate cancer underwent mpMRI-TRUS TPBB 1 to 2 punctures and conventional 12-needle systematic prostate puncture biopsy(SPPB).The data of puncture biopsy were analyzed retrospectively.The efficacy of the two puncture methods in the diagnosis of prostate cancer was compared.Results The detection rate of prostate cancer by TPPB was 42.86%,which was similar to 43.57% by SPPB(P>0.05).There were no significant differences in total prostate specific antigen(tPSA)and Gleason score stratification analysis results of prostate cancer detection between TPPB and SPPB(P>0.05).The proportion of puncture-positive puncture number by TPPB was more than that by SPPB(35.33%vs.23.93%)(P<0.01).None of the patients punctured by TPPB and SPPB had serious complications.Conclusion For the patients with tPSA≤50 ng/mL and PI-RADS≥3 points,the detection rate of prostate cancer by TPPB is similar to that by SPPB.TPPB has an advantage of less puncture number,which is helpful in reducing the occurrence of puncture-related complications.