磁共振与超声认知融合下经直肠前列腺靶向穿刺诊断PCa的单中心研究

Magnetic resonance imaging-transrectal ultrasound cognitive fusion guided targeted prostate biopsy in diagnosis of prostate cancer:A single-center study

目的 比较磁共振与超声认知融合下经直肠前列腺靶向穿刺与系统性前列腺穿刺的差异性,观察靶向穿刺是否可替代系统穿刺。方法 回顾性分析2019年7月—2020年12月本院收治的行前列腺多参数磁共振(mpMRI)检查,根据第2版前列腺影像报告和数据系统(PI-RADS v2)评分≥3分的57例患者的临床资料,同时进行2针靶向穿刺和12针系统穿刺,依据阳性检出情况,分为MRI-TRUS认知融合下前列腺穿刺活检术组(n=26)和TURS系统性前列腺穿刺术组(n=28)两组。比较两组在前列腺癌(prostate cancer,PCa)检出率方面的差异性。结果 共32例证实为PCa,其中经认知融合靶向活检检出PCa 26例(45.6%),漏诊6例(18.8%),系统性穿刺活检检出PCa 28例(49.1%),漏诊4例(14.3%),两组在PCa的检出率无显著差异(χ^(2)=0.14,P=0.71),二者联合检出32例(56.1%)。检出的PCa患者中,两组患者的Gleason评分(t=0.08,P=0.8)和国际泌尿病理协会(International Society of Urological PathologyISUP)分级(t=0.15,P=0.85)均无显著性差异。结论 磁共振与超声认知融合下经直肠前列腺靶向穿刺与系统性经直肠前列腺穿刺活检在PCa的检出率方面差异无统计学意义,可在临床应用。尽管穿刺针数少,患者相对痛苦小,但不能取代系统性前列腺穿刺活检,二者结合可提高PCa的检出率,降低漏诊率,适合在基层医院应用推广。

Objective To compare the difference between magnetic resonance imaging-transrectal ultrasound cognitive fusion guided targeted prostate biopsy and systemic prostate biopsy,and to observe the possibility of systematic puncture replaced by targeted puncture.Methods Clinical data from 57 patients,who were admitted to our hospital and received multiparametric magnetic resonance imaging(mp-MRI) test from July 1,2019 to December 31,2020,with score of prostate imaging reporting and data system version 2(PI-RADSv2) over or equal to 3 points,were retrospectively analyzed.All patients underwent 2 needle of targeted puncture and 12 needle of systematic puncture.Based on the positive detection status,they were divided into MRI-TRUS cognitive fusion guided prostate needle biopsy group(n=26) and TURS systemic prostate biopsy group(n=28).Difference in detection rate of prostate cancer between the two biopsy methods were compared.Results A total of 32 cases were diagnosed with prostate cancer.26 cases of prostate cancer(45.6%) were diagnosed by magnetic resonance imaging-transrectal ultrasound cognitive fusion guided targeted prostate biopsy and 6 cases(18.8%) were missed,28 cases(49.1%) of prostate cancer were diagnosed by systemic prostate biopsy and 4 cases(14.3%) were missed.There was no significant difference in the detection rate of prostate cancer between the two groups(χ^(2)=0.14,P=0.71).32 cases of prostate cancers(56.1%) were diagnosed by combined detection of the two methods.Among the prostate cancer patients,there was no significant difference in Gleason score(t=0.08,P=0.8) and international society of urological pathology grade(t=0.15,P=0.85) between the two groups.Conclusions There is no significant difference in the detection rate of prostate cancer between magnetic resonance imaging-transrectal ultrasound cognitive fusion guided targeted prostate biopsy and systemic prostate biopsy,which can be applied in clinic.Even though magnetic resonance imaging-transrectal ultrasound cognitive fusion guided targeted prostate biopsy need less punctures and patients suffer from less pain,which can not replace systemic prostate biopsy.The combination of them can improve the detection rate of the first diagnosis of prostate cancer,and is suitable for application and promotion in primary hospitals.