经会阴与经直肠前列腺穿刺活检对前列腺癌的诊断效能和并发症比较

Comparative evaluation of the diagnostic efficacy and associated complications of perineal versus transrectal prostate biopsies in the detection of prostate cancer

目的分析磁共振和超声融合影像引导的经会阴和经直肠途径的前列腺穿刺的诊断效能。方法湖北省武穴市第一人民医院和武汉同济医院2022年1月~2023年11月行融合影像引导的前列腺穿刺的病人271例,根据穿刺路径分为两组,经直肠途径132例,经会阴途径139例。比较不同穿刺途径,不同前列腺影像报告和数据系统(PI-RADS)评分和病灶定位对前列腺癌(PCa)和有临床意义前列腺癌(clinical significant prostate cancer,csPCa)检出率的差异。结果经会阴穿刺组和经直肠穿刺组中PCa的检出率分别为68.3%和59.8%,csPCa检出率分别为64.7%和55.3%,两者比较差异无统计学意义,但经会阴穿刺组并发症较少。对PI-RADS评分4的病人,经会阴联合穿刺比经直肠联合穿刺的PCa(77.2%和56.1%)和csPCa(71.9%和48.8%)的检出率更高(P<0.05)。对于尖端(PCa:84.3%vs.48.7%,P=0.001;csPCa:81.8%vs.48.7%,P=0.004)和前部(PCa:77.1%vs.46.5%,P=0.006;csPCa:68.6%vs.44.2%,P=0.031)的前列腺病灶,经会阴联合穿刺相较于经直肠路径的PCa和csPCa检出率更高。结论对于PI-RADS 4分或前列腺病灶位于尖端或前部的病人,经会阴途径穿刺活检是更合适的方法。

Objective To contrast the diagnostic efficacies of perineal and transrectal approaches for combined prostate biopsies guided via magnetic resonance imaging(MRI)and ultrasound fusion imaging.Method A retrospective analysis of clinical data from 271 patients subjected to combined prostate biopsies guided by MRI and ultrasound fusion imaging at the first people’s hospital of Wuxue city and Wuhan Tongji Hospital from January 2022 to November 2023 was conducted.They were divided into two groups according to the puncture path,132 cases were transrectal and 139 cases were perineal.The differences between the detection rates of prostate cancer(PCa)and clinical significant prostate cancer(csPCa)across different prostate imaging reporting and data system(PI-RADS)scores and lesion localizations within the two puncture paths were compared.Results The detection rates of PCa in the perineal and transrectal puncture groups(68.3%vs.59.8%,P=0.145)and csPCa(64.7%vs.55.3%,P=0.112)did not exhibit statistically significant differences.However,the perineal puncture group experienced fewer complications.For patients with a PI-RADS score of 4,both PCa(77.2%vs.56.1%,P=0.027)and csPCa(71.9%vs.48.8%,P=0.02)detection rates were higher via the perineal combined biopsy),compared to the transrectal path.Additionally,for apical(PCa:84.3%vs.48.7%,P=0.001;csPCa:81.8%vs.48.7%,P=0.004)and anterior(PCa:77.1%vs.46.5%,P=0.006;csPCa:68.6%vs.44.2%,P=0.031)prostate lesions,the detection rates via the perineal combined biopsy were considerably higher than those of the transrectal path.Conclusion For patients carrying a PI-RADS score of 4 or with prostate lesions situated at the apical or anterior section,the perineal approach for biopsy sampling emerges as the most appropriate method.