Clinical value of combined MRI/ultrasound fusion guided targeted prostate biopsy with systemic biopsy in repeated biopsy
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摘要: 目的 探讨超声磁共振认知融合联合系统穿刺在既往前列腺活检阴性但前列腺特异性抗原(prostate specific antigen，PSA)持续升高(>4 ng/mL)患者中的应用价值。方法 回顾性分析2019年9月—2021年6月烟台毓璜顶医院收治的可疑前列腺癌(PSA>4 ng/mL)但既往活检阴性患者的临床资料。对磁共振评分≥3分的患者行超声磁共振认知融合前列腺靶向穿刺2~4针，并对所有患者行12针系统穿刺。对比不同方法总体前列腺癌检出率及临床显著前列腺癌(Gleason评分≥7分)检出率。结果 133例患者顺利完成前列腺穿刺活检。前列腺癌的整体检出率为42.9%(57/133)，临床显著前列腺癌占66.7%(38/57)。认知融合和系统穿刺前列腺癌检出率分别为27.8%(37/133)和35.3%(47/133)，临床显著前列腺癌分别占86.4%(32/37)和46.8%(22/47)。两种穿刺方法对前列腺癌的总检出率差异无统计学意义，但临床显著前列腺癌的检出率占比差异有统计学意义(P < 0.05)。共计6例前列腺癌患者由系统穿刺独立检出。术后无严重并发症发生。结论 对既往前列腺活检阴性但PSA异常的患者，超声磁共振认知融合穿刺联合系统穿刺是一种简便、高效、安全的检测方法。Abstract: Objective To determine clinical value of combined MRI/ultrasound fusion guided targeted prostate biopsy with systemic prostate biopsy in cancer detection rates in patients with elevated prostate specific antigen (PSA > 4 ng/mL) and prior-negative biopsy.Methods A total of 133 men from the Yantai Yuhuangding Hospital undergoing combined MRI/ultrasound fusion guided targeted prostate biopsy and 12-core systemic biopsy from September 2019 to June 2021 were analysed. The detection of any prostate cancer and clinically significant prostate cancer (Gleason score ≥ 3 + 4) was stratified by multiparametric magnetic resonance imaging (mpMRI) in the prior negative settings.Results A total of 133 patients involved had at least one prior biopsy. The overall cancer detection rate was 42.9% (57/133) and cancer detection rate for significant prostate cancer was 66.7% (38/57). Cancer detection rates of MRI/ultrasound fusion guided targeted prostate biopsy and systemic prostate biopsy were 27.8% (37/133) and 35.3%(47/133), respectively, and the cancer detection rates for significant prostate cancer were 86.4% (32/37) and 46.8% (22/47), respectively. Two biopsies showed no significant difference (P > 0.05). MRI/ultrasound fusion guided targeted prostate biopsy was significantly superior to systemic biopsy in significant prostate cancers detection (P < 0.05). A total of 6 prostate cancers were detected by systemic biopsy only.Conclusion Combined MRI/ultrasound fusion guided targeted prostate biopsy with the systemic biopsy technique would avoid the misdiagnosis of prostate cancers safely and efficiently.
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Key words:
- prostate cancer /
- prostate biopsy /
- transperineal /
- MRI /
- PSA
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表 1 前列腺穿刺结果
例 认知融合靶向穿刺 系统穿刺 阴性 临床非显著前列腺癌 临床显著前列腺癌 阴性 69 12 2 临床非显著前列腺癌 2 1 2 临床显著前列腺癌 8 8 16 PI-RADS < 3分 7 4 2 
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表 2 穿刺结果统计学分析
M(P25，P75) 项目 总体(133例) 阴性(76例) 阳性(57例) 年龄/岁 66(59，74) 65(58，72) 67(61，77)1) PSA/(ng/mL) 8.86(6.62，11.65) 8.09(5.63，10.37) 9.97(7.68，13.92)1) PV/mL 39(35，56) 44(35，60) 38(34，48)1) PI-RADS 3(3，4) 3(3，4) 4(3，5)1) 与阴性比较，1)P < 0.05。
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表 3 多因素logistic回归分析结果
项目 χ2 OR P 年龄 2.90 1.04 0.088 PSA 6.44 1.17 0.011 PV 10.45 0.95 0.001 PI-RADS 5.25 1.86 0.016
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