认知融合MRI和超声引导靶向穿刺在前列腺前部肿瘤诊断中的临床应用

Clinical study of magnetic resonance imaging-transrectal ultrasound cognitive fusion targeted biopsy on the diagnosis of anterior prostate cancer

目的:探讨认知融合MRI和超声图像靶向前列腺穿刺对前列腺前部肿瘤诊断的临床应用价值。方法:回顾性分析我院2015年1月—2021年12月行前列腺穿刺活检的635例患者的临床资料。其中系统穿刺组(systematic prostate biopsy,SPB组)274例,认知融合靶向+系统穿刺(cognitive fusion target biopsy,CTB组)361例。比较两组患者的基线资料、前列腺癌的总体检出率及临床显著性前列腺癌的检出率。分析前部肿瘤穿刺阳性患者的临床特征以及穿刺后的并发症发生率。结果:SPB组前列腺癌检出率为36.5%,临床显著性前列腺癌占比62%;CTB组前列腺癌检出率为45.2%,临床显著性前列腺癌占比80.9%。两组的总体前列腺癌检出率和临床显著性前列腺癌检出率均差异有统计学意义(均P<0.05)。CTB组中仅前叶确诊前列腺癌27例,临床显著性前列腺癌占比77.7%;与除外前叶确诊的患者相比,仅前叶确诊前列腺癌患者的穿刺前平均PSA值较低[(10.8±6.2)ng/mL vs(16.8±12.0)ng/mL,P<0.05],两者年龄、前列腺体积、临床显著性前列腺癌检出率差异无统计学意义。SPB组与CTB组患者穿刺过程中,血尿、发热、急性尿潴留、直肠出血、菌血症等并发症发生率差异无统计学意义。结论:基于MRI和超声图像的认知融合靶向穿刺,能明显增加前列腺前部肿瘤的检出率,尤其是对PSA较低的初次穿刺患者,可减少对临床显著性前列腺癌的漏诊。

Objective To detect the value of utilizing magnetic resonance imaging-transrectal ultrasound cognitive fusion targeted biopsy on the diagnosis of anterior prostate cancer.Methods The clinical date of 635 patients who underwent prostate biopsy in our hospital from Jan.2015 to Oct.2021 were retrospectively analyzed.Among all patients,274 underwent systematic prostate biopsy(SPB group),361 patients accepted cognitive and systematic targeted biopsy(CTB group).Baseline information,the detection rate of prostate cancer and clinically significant prostate cancer between two groups were compared.Clinical features of patients with detected anterior prostate cancer,and the complication after biopsy were analyzed.Results The prostate cancer detection rate was 36.5%,and the rate of clinically significant prostate cancer was 62%in SPB group.The prostate cancer detection rate was 45.2%,and the rate of clinically significant prostate cancer was 80.9%in CTB group.There were significant differences in prostate cancer detection rate and clinically significant prostate cancer rate between two groups(P<0.05).Twenty-seven cases in CTB group were only detected in anterior lobeprostate,and the rate of clinically significant prostate cancer was 77.7%.They had lower PSA compared with those excluding the anterior lobe prostate cancer[(10.8±6.2)ng/mL vs(16.8±12.0)ng/mL,P<0.05],and there was no significant difference in age,prostate volume or detection rate of clinically significant prostate cancer between them.The rate of hematuria,fever,acute urinary retention,rectal blooding,or bacteremia between two groups had no significant difference.Conclusion Magnetic resonance imaging-transrectal ultrasound cognitive fusion targeted biopsy could improve the detection rate of anterior prostate cancer,and reduce the misdiagnosis of clinically significant prostate cancer,especially for patients who undergo biopsy first with low PSA level.