多参数MRI与超声认知融合引导下前列腺靶向穿刺的前瞻性研究

A prospective randomized controlled study of mpMRI-TRUS-guided cognitive fusion targeted prostate biopsies

目的探讨多参数磁共振(mpMRI)-经直肠超声(TRUS)影像认知融合引导下前列腺靶向穿刺联合系统穿刺活检术在诊断前列腺癌方面的可行性及有效性。方法选取2020年3月至2022年3月在阳江市人民医院首次行前列腺穿刺活检的患者111例,随机分组,观察组56例,对照组55例。观察组患者行mpMRI-TRUS影像认知融合引导下前列腺靶向穿刺联合系统性穿刺术,对照组患者单纯行12针TRUS引导下系统性穿刺活检术。比较两组患者在总体穿刺阳性率、有临床意义前列腺癌的检出率、漏诊率、单针阳性率、标本肿瘤组织长度、标本癌占比、并发症及在二次穿刺、经尿道前列腺剜除或根治术后病理升级的例数等方面的差异。结果两组患者在年龄、直肠指检阳性率、前列腺体积、前列腺特异性抗原(PSA)、穿刺针数、mpMRI前列腺影像报告和数据评分系统(PI-RADS)及术后并发症方面差异均无统计学意义。但观察组在总体穿刺阳性率(50.0% vs 27.3%,P=0.014)、有临床意义前列腺癌的检出率(50.0% vs 25.5%,P=0.008)及单针阳性率(26.8% vs 16.0%,P<0.001)方面明显高于对照组。此外,观察组病理标本还表现出更长的肿瘤组织长度[(8±4)mm vs (4±3)mm,P=0.001]、更高的癌占比[(64.5±20.7)% vs (40.0±23.8)%,P=0.002],更低的漏诊率(0% vs 25.0%,P=0.021),以及出现更少的二次穿刺、经尿道前列腺剜除或根治术后病理升级的情况(0例vs 8例,P=0.009)。结论mpMRI-TRUS影像认知融合引导下前列腺靶向穿刺联合系统穿刺活检术能明显提高总体穿刺阳性率及有临床意义前列腺癌的检出率,降低前列腺癌穿刺活检的漏诊率,同时还能减少二次穿刺、经尿道前列腺剜除或根治术后病理升级的情况,且操作简单、便捷、安全,适合临床推广。

ObjectiveTo investigate the feasibility and effectiveness of the mpMRI-TRUS-guided cognitive fusion targeted prostate biopsies combined with systematic biopsies in the diagnosis of prostate carcinoma.MethodsA prospective and randomized study of 111 patients who underwent prostate biopsy for the first time in Yangjiang People's Hospital from March 2020 to March 2022 randomly assigned into two groups, with 56 cases in observation group and 55 cases in control group. The observation group adopted mpMRI-TRUS-guided cognitive fusion targeted prostate biopsies combined with systematic biopsies, whereas the control group performed 12-needle systematic biopsies. The differences of overall puncture positive rate, the detection rate of clinically significant prostate cancer, the rate of missed diagnosis, the positive rate of single core, the tumor tissue length of specimen, the tumor proportion of specimen, postoperative complications and the cases of pathological upgrading after secondary puncture, transurethral enucleation or radical resection were compared between the two groups.ResultsThere were no significant differences in age, the positive rate of digital rectal examination,prostate volume, prostate-specific antigen (PSA), the cores of biopsies, PI-RADS scores and postoperative complications between the two groups. However, in the observation group, the overall puncture positive rate (50.0% vs 27.3%, P=0.014), the detection rate of clinically significant prostate cancer (50.0% vs 25.5%, P=0.008) and the positive rate of single core (26.8% vs 16.0%, P<0.001) was significantly higher than the control group. Moreover, the observation group showed longer tumor tissue length of specimen [(8±4) mm vs (4±3) mm, P=0.001], higher tumor proportion of specimen [(64.5±20.7)% vs (40.0±23.8)%, P=0.002], lower missed diagnosis rate (0% vs 25.0%, P=0.021), and less pathological upgrading cases after secondary puncture, transurethral enucleation or radical resection (0 vs 8, P=0.009).ConclusionsThe mpMRI-TRUS-guided cognitive fusion targeted prostate biopsies combined with systematic biopsies can significantly improve the overall puncture positive rate and the detection rate of clinically significant prostate cancer, reduce the rate of missed diagnosis and the cases of pathological upgrading after secondary puncture, enucleation or radical resection, while the operation is simple, convenient, safe and suitable for clinical promotion.