经直肠实时超声弹性成像结合峰值应变指数引导前列腺活组织检查对前列腺癌的诊断价值

Value of prostate biopsy guided by transrectal real-time ultrasonic elastography combined with peak strain index in the diagnosis of prostate cancer

目的探讨经直肠实时超声弹性成像(TRTE)结合峰值应变指数(PSI)引导前列腺活组织检查对前列腺癌的诊断价值以及TRTE评分与病理Gleason评分的相关性。方法选择河北北方学院附属第一医院2019年1月至12月收治的80例疑似前列腺癌患者,所有患者均行TRTE检查,对可疑病灶测定PSI,并行TRTE结合PSI引导靶向性穿刺活组织检查术,再行系统性穿刺活组织检查术。比较两种活组织检查术的诊断结果。以病理活组织检查结果为金标准,比较两种方式对前列腺癌与前列腺良性病变的检出率,比较前列腺癌与前列腺良性病变患者的前列腺体积、血清前列腺特异抗原(PSA)水平及PSI。采用受试者工作曲线(ROC)及曲线下面积(AUC)确定PSI诊断前列腺癌的最佳临界值。比较常规超声与TRTE结合PSI诊断前列腺癌的效能。比较TRTE结合PSI引导下与系统性穿刺术活组织检查穿刺点阳性率,并分析TRTE评分与Gleason评分的相关性。结果80例患者中,前列腺穿刺活组织检查病理诊断为前列腺癌45例(56.25%),前列腺良性病变35例(43.75%)。45例前列腺癌患者中,经TRTE结合PSI引导靶向性穿刺活组织检查术检出前列腺癌42例(93.33%),经系统性穿刺活组织检查术检出前列腺癌38例(84.44%);两种方式穿刺活组织检查前列腺癌检出率比较,差异无统计学意义(χ^(2)=1.80,P=0.180)。前列腺癌组血清PSA水平、PSI均高于前列腺良性病变组,差异均有统计学意义(t值分别为65.28、14.93,均P<0.05)。绘制ROC曲线,AUC为0.857(95%CI 0.772~0.941),确定5.68为PSI最佳临界值,当PSI≥5.68诊断为恶性,PSI<5.68诊断为良性。TRTE结合PSI诊断前列腺癌的灵敏度、特异度和准确度分别为91.11%、94.29%、92.50%,均高于常规超声(73.33%、68.57%、71.25%),差异均有统计学意义(均P<0.05)。80例患者通过TRTE结合PSI检查共发现可疑病灶89个,对每个可疑病灶进行2针靶向穿刺活组织检查术,共穿刺178针,其中88针为前列腺癌,穿刺点阳性率为49.44%;随后进行10针系统性穿刺活组织检查术,共穿刺800针,其中203针为前列腺癌,穿刺点阳性率为25.38%;TRTE结合PSI引导下穿刺活组织检查术穿刺点阳性率高于系统性穿刺活组织检查术,差异有统计学意义(χ^(2)=40.34,P<0.05)。在前列腺癌患者中,Spearman相关性分析结果显示,TRTE评分与Gleason评分呈正相关(r=0.618,P<0.05)。结论TRTE结合PSI引导靶向性穿刺活组织检查术对于前列腺癌的诊断具有重要价值,能有效提高穿刺点阳性率。

Objective To investigate the value of prostate biopsy guided by transrectal real-time ultrasonic elastography(TRTE)combined with peak strain index(PSI)in the diagnosis of prostate cancer and the correlation with TRTE score and pathological Gleason score.Methods A total of 80 patients with suspected prostate cancer who underwent TRTE in the First Affiliated Hospital of Hebei North University from January 2019 to December 2019 were selected.The PSI for suspicious lesions was measured,and targeted puncture biopsy guided by TRTE combined with PSI was performed on the patients,and then followed by systematic puncture biopsy.The outcomes of targeted biopsy and systematic biopsy were analyzed.Taking pathological biopsy results as the gold standard,the detection rates of prostate cancer and benign prostate lesions detected by both biopsies methods were compared;the prostate volume,serum prostate specific antigen(PSA)level and PSI were compared between patients with prostate cancer and benign prostatic lesions.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)were used to determine the best cut-off value of PSI in the diagnosis of prostate cancer.The values of conventional ultrasound versus TRTE combined with PSI in the diagnosis of prostate cancer were assessed.The positive rate of biopsy puncture points under the guidance of TRTE combined with PSI was compared with that of systematic biopsy.The correlation between TRTE score and pathological Gleason score of prostate malignant lesions was analyzed.Results Among 80 patients,45 patients(56.25%)were diagnosed as prostate cancer by prostate puncture biopsy,and 35 patients(43.75%)were benign prostate lesions.Among 45 patients with prostate cancer,42 cases(93.33%)of prostate cancer were detected by using TRTE combined with PSI-guided targeted puncture biopsy,and 38 cases(84.44%)of prostate cancer were detected by using systematic puncture biopsy;there was no significant difference in the detection rate of prostate cancer by both biopsies methods(χ^(2)=1.80,P=0.180).The level of serum PSA and PSI value in the prostate cancer group were higher than those in the benign prostate lesion group,and the difference was statistically significant(t value was 65.28 and 14.93,all P<0.05).The clinical value of PSI value in the diagnosis of prostate cancer was analyzed by using ROC curve.The results showed that the AUC was 0.857(95%CI 0.772-0.941),and the optimal cut-off value of PSI was 5.68;PSI≥5.68 was treated as the malignant cancer and PSI<5.68 was treated as the benign cancer.The sensitivity,specificity and accuracy of TRTE combined with PSI in the diagnosis of prostate cancer were 91.11%,94.29%,and 92.50%,respectively,which were higher than those of conventional ultrasound(73.33%,68.57%and 71.25%),and the differences were statistically significant(all P<0.05).A total of 89 suspected lesions were detected in 80 patients through TRTE combined with PSI,and each suspected lesion was detected by using 2-needle targeted puncture biopsy.There were 178 needles in total including 88 needles of prostate cancer and the positive rate of puncture points was 49.44%(88/178);there were 800 needles in total detected by using 10-needle systematic puncture biopsy including 203 needles of prostate cancer and the positive rate of puncture points was 25.38%(203/800);the positive rate of puncture points guided by TRTE combined with PSI puncture biopsy was higher than that by systematic puncture biopsy,and the difference was statistically significant(χ^(2)=40.337,P<0.05).For prostate malignant lesions,the Spearman correlation analysis showed that TRTE score was positively correlated with pathological Gleason score(r=0.618,P<0.05).Conclusion TRTE combined with PSI-guided targeted puncture biopsy plays an important role in the diagnosis of prostate cancer,and it can effectively improve the positive rate of puncture points.