Multiparametric magnetic resonance imaging guided in-bore biopsy enhance the diagnostic accuracy of significant prostate cancer
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摘要: 目的:探讨多参数磁共振直接引导下经会阴前列腺靶向穿刺活检在诊断临床显著性前列腺癌中的应用价值。方法:回顾性分析2013年1月~2015年12月期间就诊于我院多参数MRI诊断为可疑前列腺癌的患者229例。其中91例接受经会阴MRI直接引导穿刺活检(MRGB),138例接受标准12针经会阴超声引导穿刺活检(TRUSB)。分析计较两组穿刺标本病理结果。结果:两组患者年龄、BMI、DRE异常、PSA水平、前列腺体积、PSAD、mpMRI可疑病灶数、PI-RADS评分差异无统计学意义(P>0.05)。MRGB组临床显著性PCa患者检出率高于TRUSB组(P＜0.05)。穿刺标本中,MRGB组中穿刺针数阳性率、阳性针癌组织长度、阳性针癌组织比例和临床显著性癌针数阳性率均高于TRUSB组(P＜0.05)。MRGB组行组内比较发现靶向穿刺(TB)与系统穿刺结合靶向穿刺(SB+TB)一致性检验的Kappa值为0.910(P<0.001)。但TB组每例穿刺针数明显低于SB+TB组(P<0.001)。结论:mpMRI直接引导下经会阴靶向穿刺活检能提高临床显著性前列腺癌检出率,并可减少不必要的穿刺针数,具有更高的活检效能。Abstract: Objective: To evaluate the value of multiparametric magnetic resonance imaging (mpMRI) guided in-bore transperineal biopsy in detection of clinically significant prostate cancer. Method: We performed a retrospective study in 229 men with suspected prostate cancer (PCa) from January 2013 to December 2015 in our hospital, in which 91 men underwent transperineal MRI guided in-bore biopsy (MRGB) and 138 men accepted standard systematic transperineal ultrasound guided biopsy (TRUSB). Pathological results of all biopsy specimen were analyzed.Result: There was no significant difference between two groups in age, BMI, abnormal DRE, PSA, PV, PSAD, mpMRI lesions and PI-RADS score (P＞0.05). MRGB provided a higher detection rate of clinically significant PCa than TRUSB, (P＜0.05). Moreover, MRGB also provided a higher detection rate of the percent of PCa cores detected, the positive core length, the positive core percent, the percent of clinically significant PCa cores (P＜0.05). The Kappa consistency test was conducted for targeted biopsy and systematic added targeted biopsy in MRGB group (Kappa value=0.910, P＜0.001). And targeted biopsy required significantly fewer cores(P＜0.001). Conclusion: Transperineal mpMRI guided in-bore biopsy has the ability to detect more clinically significant PCa, need fewer cores, improve sampling quality compared with TRUSB
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