mpMRI/TRUS融合引导下前列腺靶向穿刺活检中漏诊原因

Causes of missed diagnosis in targeted prostate biopsy guided by mpMRI/TRUS fusion

目的:研究多参数磁共振成像(mpMRl)/手指引导、经直肠超声(TRUS)融合引导下的前列腺靶向穿刺活检(TB)中漏诊的原因。方法:回顾性分析2021年1月~2023年9月山东省荣军总医院行经会阴前列腺穿刺活检的97例患者的临床资料。在mpMRI和Pl-RADS评分后完成了mpMRI/TRUS融合引导的前列腺经会阴TB+经会阴系统穿刺活检(SB)。比较TB和SB的病理诊断,评价和分析TB漏诊的原因。结果:共有52例患者被确诊为前列腺癌,其中TB漏诊5例(9.62%),SB漏诊6例(11.53%)。TB漏诊组和未漏诊组之间年龄比较差异无统计学意义(P>0.05),但前列腺特异性抗原(PSA)、前列腺体积(PV)、PSA密度(PSAD)及国际泌尿病理学学会(ISUP)等级比较,差异有统计学意义(P<0.05)。将5例TB漏诊的病理结果与磁共振成像(MRI)进行重新比较:3例前列腺癌MRI正常,1例癌灶MRl异常,1例癌灶MRI升级为Pl-RADS 3。结论:早期前列腺癌、大前列腺、局部麻醉及患者的配合、MRI阅读人员和穿刺操作人员的经验都可能是TB漏诊的原因。故个性化的活检计划、更好的成像技术、丰富的操作和阅片经验以及更智能的融合系统能够降低漏诊率,提高TB阳性率。

Objective To investigate the causes of missed diagnosis in targeted prostate biopsy guided by mpMRl/TRUS fusion.Method The clinical data of 97 patients who underwent perineal prostate biopsy in our hospital from January 2021 to September 2023 were retrospectively analyzed.After mpMRI and Pl-RADS scores,mpMRI/TRUS fusion guided transperineal targeted prostate biopsy+transperineal system puncture biopsy was completed.The pathological diagnosis of targeted puncture biopsy and systematic puncture biopsy was compared to evaluate and analyze the causes of missed diagnosis of targeted puncture biopsy.Results A total of 52 patients were diagnosed with prostate cancer,of which 5(9.62%)were missed by targeted puncture and 6(11.53%)were missed by systematic puncture biopsy.There was no significant difference in age between the missed and unmissed groups(P>0.05).But There was a significant difference in Prostate specific antigen(PSA),prostate volume(PV),PSAD,ISUP level(P<0.05).The pathological results of missed diagnosis in 5 cases of targeted needle biopsy were re-compared with MRI:MRI of 3 cases of prostate cancer was normal,MRl of 1 case was abnormal,and MRI of 1 case was upgraded to PL-RADS-3.Conclusion Early prostate cancer,large prostate,local anesthesia and patient cooperation,experience of MRI readers and puncture operators may be the causes of TB missed diagnosis.Therefore,personalized biopsy plans,better imaging techniques,rich experience in operation and film reading,and more intelligent fusion systems will reduce the missed diagnosis rate and increase the TB positive rate.