超声引导下12+x针前列腺穿刺活检单中心407例临床分析

郭飞; 刘久敏; 蒲小勇; 黄尚; 李河; 李腾; 余玉明; 张长征; 刘豪圣

doi:10.13201/j.issn.1001-1420.2021.01.003

超声引导下12+x针前列腺穿刺活检单中心407例临床分析

- 1. 广东省人民医院(广东省医学科学院)泌尿外科(广州, 510080);
- 2. 广东省人民医院(广东省医学科学院)广东省心血管病研究所
基金项目:
广东省医学科研基金资助（No：A2018290）

详细信息

通讯作者: 刘久敏,E-mail:jiumin8388@163.com

中图分类号: R697

收稿日期: 2020-03-16

Clinical analysis of 12+x-core prostate biopsy guided by ultrasonography: 407 cases in a single center

- 1. Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080, Guangzhou, China;
- 2. Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences

More Information

Corresponding author: LIU Jiumin, E-mail: jiumin8388@163.com

Received Date: 16 March 2020

摘要

摘要: 目的：分析单中心超声引导下12+x针前列腺穿刺活检结果，比较不同穿刺途径的临床效果。方法：回顾分析2016年6月~2019年12月我院完成的407例前列腺穿刺活检的临床资料，经直肠前列腺穿刺290例（经直肠组），经会阴前列腺穿刺117例（经会阴组），均采用超声引导下12+x针法，前列腺影像学正常者行系统穿刺，影像学异常者行系统+靶向穿刺。比较两组前列腺癌（PCa）的检出率及并发症差异，分析两组按PSA、影像学分层PCa检出率的差异，比较靶向穿刺与系统穿刺癌检出率的差异，分析临床有意义前列腺癌（csPCa）的检出情况。结果：①PCa总检出率为44.0%（179/407），经直肠组与经会阴组PCa检出率比较差异无统计学意义[44.8%（130/290） vs.41.9%（49/117），P>0.05]。其中，PSA≤4 ng/mL、4 ng/mL20 ng/mL各水平分层中，两组PCa检出率比较差异无统计学意义（P>0.05）。两组中前列腺影像学异常者的PCa检出率均高于影像学正常者（P<0.05）。影像学异常者中，经直肠组与经会阴组PCa检出率比较差异无统计学意义（P>0.05）。②前列腺影像学异常者总的PCa检出率为57.5%（111/193），靶向穿刺PCa检出率为42.0%（81/193），系统穿刺为47.7%（92/193），两者比较差异无统计学意义（P>0.05），但靶向穿刺单针阳性率比系统穿刺更高（P<0.01）。同一途径下的靶向穿刺与系统穿刺PCa检出率比较差异无统计学意义（P>0.05）。两组中分别比较靶向穿刺、系统穿刺的PCa检出率，差异均无统计学意义（P>0.05）。③在所有患者中，经直肠途径csPCa检出率为36.9%（107/290），经会阴途径csPCa检出率为40.2%（47/117），两者比较差异无统计学意义（P>0.05）。靶向穿刺与系统穿刺在csPCa的检出率上比较差异无统计学意义。csPCa在诊断出的PCa患者中的占比，经会阴途径占比高于经直肠途径[95.9%（47/49） vs.82.3%（107/130），P<0.05]。④经直肠组总并发症发生率显著高于经会阴组[39.3%（114/290） vs.20.5%（24/117），P<0.01]。经直肠组发热、血便发生率比经会阴组更高，分别为[10.3%（30/290） vs.3.4%（4/117），P<0.05]、[14.1%（41/290） vs.1.7%（2/117），P<0.01]，两组在血尿、下尿路症状、尿潴留、迷走反射发生率上比较差异均无统计学意义（P>0.05）。结论：超声引导下12+x针前列腺穿刺活检PCa检出率较好，影像学异常者靶向穿刺与系统穿刺PCa、csPCa检出率差异均无统计学意义，靶向穿刺单针阳性率较高。经直肠途径与经会阴途径在PCa、csPCa检出率比较差异无统计学意义，经会阴途径并发症更少。在诊断出的PCa中，经会阴途径可检出更多的csPCa。
- 12+x针前列腺活检 /
- 经直肠 /
- 经会阴 /
- 靶向活检 /
- 系统活检
Abstract: Objective: To analyze the clinical outcomes of 12+x-core prostate biopsy guided by ultrasonography in a single center and compare the clinical effect in different biopsy approaches.Methods: We retrospectively analyzed the clinical data of 407 patients who underwent prostate biopsy from June 2016 to December 2019 in our center, of which 290 patients with transrectal prostate biopsy(transrectal group), and 117 patients with transperineal prostate biopsy(transperineal group). All of cases were performed with 12+x-core prostate biopsy guided by ultrasonography. Patients with normal prostate image were performed with systematic prostate biopsy(SPB), those with abnormal prostate image were performed with systematic and targeted/cognitive fusion prostate biopsy(TPB). The difference of detection rate of prostate cancer(PCa) and complications between two groups was analyzed. We especially compared the detection rate of PCa in different PSA levels and in different image findings between them. The difference of detection rate of PCa was compared between SPB and TPB. The clinical significant prostate cancer(csPCa) was analyzed.Results: ①The overall detection rate of PCa was 44.0%(179/407). There was no statistical difference in detection rate of PCa between transrectal group and transperineal group, which was 44.8%(130/290) vs. 41.9%(49/117), respectively(P>0.05). The detection rates of PCa between transrectal group and transperineal group when PSA level was PSA ≤ 4 ng/mL,4 ng/mL20 ng/mL showed no statistical difference(P>0.05). There was higher detection rate of PCa in patients with abnormal prostate image than those with normal prostate image in both of the two groups(P<0.05). There was no significant difference in detection rate of PCa in patients with prostate abnormal image between two groups(P>0.05).②For patients with abnormal prostate image, detection rate of PCa was 57.5%(111/193). The detection rates of PCa by TPB and SPB were 42.0%(81/193) and 47.7%(92/193), respectively. There was no statistical difference between them(P>0.05). The positive rate of single core was significantly higher by TPB than SPB(P<0.01). There was no statistical difference in the detection rate PCa between TPB and SPB in the same biopsy approach(P>0.05). The detection rate of PCa by TPB showed no statistical difference between two groups, that of by SPB showed no statistical difference between two groups(P>0.05).③The detection rates of csPCa were 36.9%(107/290) in transrectal group and 40.2%(47/117) in transperineal group. There was no statistical difference between them(P>0.05). The detection rates of csPCa by TPB and by SPB showed no statistical difference. More csPCa were detected in the transperineal group than in transrectal group among patients detected with PCa. Among the diagnosed cases of PCa, the proportion of csPCa was higher in transperineal group than in tranrectal group, which was 95.9%(47/49) vs. 82.3%(107/130)(P<0.05).④The total incidence of complications in transrectal group was higher than that in transperineal group, which was 39.3%(114/290) vs. 20.5%(24/117)(P<0.01), respectively. The incidences of fever and bloody stool in transrectal group were significantly higher compared to those in transperineal group, which were 10.3%(30/290) vs. 3.4%(4/117)(P<0.05) and 14.1%(41/290) vs. 1.7%(2/117)(P<0.01) in two groups respectively. There was no significant difference in the incidences of hematuria, lower urinary tract symptoms, urine retention or vagus reflex between the two groups(P>0.05).Conclusion: PCa detection rate of the 12+x-core prostate biopsy guided by ultrasonography is good. There is no statistical difference in the detection rate of PCa and csPCa between TPB and SPB in patients with abnormal prostate image, but the positive rate of single core is significantly higher by TPB than by SPB. There is no significant difference in the detection rate of PCa and csPCa between the transrectal approach and the transperineal approach, but the transperineal approach detects more csPCa among patients detected with PCa, and has less complications than the transrectal approach.
- 12+x-core prostate biopsy /
- transrectal approach /
- transperineal approach /
- targeted biopsy /
- systematic biopsy

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参考文献(14)

[1]	Bjurlin MA, Taneja SS.Standards for prostate biopsy[J].Curr Opin Urol, 2014, 24(2):155-161.
[2]	Ploussard G, Nicolaiew N, Marchand C, et al.Prospective evaluation of an extended 21-core biopsy scheme as initial prostate cancer diagnostic strategy[J].Eur Urol, 2014, 65(1):154-161.
[3]	Matoso A, Epstein JI.Defining clinically significant prostate cancer on the basis of pathological findings[J].Histopathology, 2019, 74(1):135-145.
[4]	Mabjeesh NJ, Lidawi G, Chen J, et al.High detection rate of significant prostate tumours in anterior zones using transperineal ultrasound-guided template saturation biopsy[J].BJU Int, 2012, 110(7):993-997.
[5]	Mortezavi A, Märzendorfer O, Donati OF, et al.Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging and Fusion Guided Targeted Biopsy Evaluated by Transperineal Template Saturation Prostate Biopsy for the Detection and Characterization of Prostate Cancer[J].J Urol, 2018, 200(2):309-318.
[6]	Ahdoot M, Wilbur AR, Reese SE, et al.MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis[J].N Engl J Med, 2020, 382(10):917-928.
[7]	Hu Y, Ahmed HU, Carter T, et al.A biopsy simulation study to assess the accuracy of several transrectal ultrasonography(TRUS)-biopsy strategies compared with template prostate mapping biopsies in patients who have undergone radical prostatectomy[J].BJU Int, 2012, 110(6):812-820.
[8]	Xiang J, Yan H, Li J, et al.Transperineal versus transrectal prostate biopsy in the diagnosis of prostate cancer:a systematic review and meta-analysis[J].World J Surg Oncol, 2019, 17(1):31.
[9]	樊松强, 魏金星.直肠超声引导下经会阴与经直肠前列腺穿刺活检效果比较[J].新乡医学院学报, 2017, 34(3):197-199.
[10]	魏云飞, 卢超, 马雪中, 等.直肠超声引导下经直肠与经会阴前列腺穿刺活检术的临床分析[J].临床泌尿外科杂志, 2019, 34(8):613-616, 620.
[11]	彭毓璐, 麦海星, 董金凯, 等.超声引导下经会阴前列腺穿刺活检与经直肠穿刺活检安全性研究[J].微创泌尿外科杂志, 2018, 7(2):112-115.
[12]	Borghesi M, Ahmed H, Nam R, et al.Complications After Systematic, Random, and Image-guided Prostate Biopsy[J].Eur Urol, 2017, 71(3):353-365.
[13]	Roberts MJ, Bennett HY, Harris PN, et al.Prostate Biopsy-related Infection:A Systematic Review of Risk Factors, Prevention Strategies, and Management Approaches[J].Urology, 2017, 104:11-21.
[14]	Skouteris VM, Crawford ED, Mouraviev V, et al.Transrectal Ultrasound-guided Versus Transperineal Mapping Prostate Biopsy:Complication Comparison[J].Rev Urol, 2018, 20(1):19-25.