Analysis of the safety and effectiveness of ultrasound cognitive fusion transperineal targeted prostate biopsy combined with systematic biopsy based on the second edition of bp-MRI PI-RADS regionalization
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摘要: 目的 探讨基于双参数磁共振(bi-parameter magnetic resonance imaging，bp-MRI)的第2版前列腺影像报告和数据系统(prostate imaging-reporting and data system，PI-RADS)分区结合超声认知融合靶向穿刺联合系统穿刺在经会阴前列腺穿刺中的安全性及有效性。方法 回顾性分析江苏省中医院2020年1月—2022年12月经门诊收治入院行经会阴前列腺穿刺活检的297例患者的临床资料。其中，术前未检查bp-MRI和PI-RADS 1~2分的119例患者仅行传统的12针系统穿刺(系统穿刺组)，PI-RADS 3~5分的178例患者则进行认知融合靶向穿刺联合系统穿刺(联合穿刺组)。2组患者体重指数(body mass index，BMI)、年龄、前列腺体积以及血清前列腺特异性抗原(prostate specific antigen，PSA)水平比较差异无统计学意义。为评价不同穿刺方式的诊断效能，选择2组患者的前列腺癌(prostate cancer，PCa)检出率、有临床意义前列腺癌(clinically significant prostate cancer，csPCa)检出率以及术后并发症作为评价指标。结果 297例患者中检出PCa 131例，阳性率为44.11%；其中联合穿刺组PCa检出率为48.31%(86/178)，高于系统穿刺组的37.82%(45/119)，差异无统计学意义(P=0.074 1)。共检测出csPCa 102例，阳性率为34.34%；其中联合穿刺组的检出率为39.89%(71/178)，高于系统穿刺组的26.05%(31/119)，差异有统计学意义(P=0.019 5)。在联合穿刺组中，单独系统穿刺的PCa检出率为44.38%(79/178)，高于单独认知融合靶向穿刺的40.45%(72/178)；单独认知融合靶向穿刺的csPCa检出率为38.20%(68/178)，显著高于单独系统穿刺的27.53%(49/178)。结论 采用基于bp-MRI第2版PI-RADS分区结合超声认知融合靶向穿刺联合系统穿刺的方法，在csPCa的检出方面具有优势，同时并不增加并发症的发生率。Abstract: Objective To assess the effectiveness and security of the cognitive fusion targeted biopsy combined with systematic biopsy(CFTB+SB) based on the segmentation of PI-RADS v2 for bp-MRI/transrectal ultrasonography(MRI/TRUS) in transperineal prostate biopsy.Methods A retrospective analysis was conducted on 297 cases of transperineal prostate biopsy from Jan. 2020 to Dec. 2022 in Jiangsu Province Hospital of Traditional Chinese Medicine. SB was performed for 119 patients with no preoperative bp-MRI examination or with PI-RADS score of 1-2, while the remaining 178 patients with PI-RADS score of 3-5 received CFTB+SB. There were no significant differences in terms of age, body mass index(BMI), PSA or prostate volume between SB group and CFTB+SB group. Between the two cohorts, the rates of prostate cancer, clinically significant prostate cancer(csPCa), and postoperative complications were compared.Results Among the 297 patients, a positive rate of 44.11% was observed for prostate cancer detection, with 131 cases identified. In comparison, SB group exhibited a detection rate of 37.82%, corresponding to 45 out of 119 cases, while CFTB+SB group demonstrated a higher rate of 48.31%, with 86 out of 178 cases detected. A total of 102 cases of csPCa were detected, with a positive rate of 34.34%. CFTB+SB group had a significantly higher positive rate of 39.89%(71/178) compared to that of SB group(26.05%(31/119), P=0.019 5). In CFTB+SB group, 79 cases(44.38%) of prostate cancer were exclusively detected by SB, which was higher than that of CFTB(40.45%). The positive rate of csPCa in CFTB alone was 38.20%(68/178), which was significantly higher than that in SB alone(27.53%, 49/178).Conclusion The cognitive fusion targeted biopsy combined with systematic biopsy based on the segmentation of PI-RADS v2 for bp-MRI/TRUS has advantages in detecting csPCa without increasing the incidence of complications.
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表 1 2组患者的一般资料
X±S 一般资料 系统穿刺组(119例) 联合穿刺组(178例) P值 年龄/岁 68.33±8.42 69.08±9.20 0.477 0 BMI/(kg/m2) 22.91±2.45 22.77±2.63 0.644 5 前列腺体积/mL 39.65±21.97 42.53±23.59 0.290 2 PSA/(mg/mL) 13.57±6.62 12.10±6.15 0.051 2 
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表 2 2组患者PCa和csPCa检出率比较
例(%) 指标 系统穿刺组(119例) 联合穿刺组(178例) χ2 P值 PCa检出率 45(37.82) 86(48.31) 3.189 0.074 1 csPCa检出率 31(26.05) 71(39.89) 5.458 0.019 5 Gleason评分 6分 14(11.76) 15(8.43) 0.902 0.342 3 7分 21(17.65) 28(15.73) 0.190 0.662 8 ≥8分 10(8.40) 43(24.16) 12.070 0.000 5 术后病理升级率 8(17.78) 5(5.81) 4.730 0.029 6
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表 3 联合穿刺组内不同穿刺方法诊断效能比较
例(%) 指标 认知融合靶向穿刺 系统穿刺 χ2 P值 PCa检出率 72(40.45) 79(44.38) 0.564 0.452 8 csPCa检出率 68(38.20) 49(27.53) 4.596 0.032 0 PCa漏诊率 14(7.87) 7(3.93) 1.822 0.177 1 csPCa漏诊率 3(1.69) 22(12.36) 15.930 ＜0.001
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表 4 2组患者术后并发症发生率比较
例(%) 并发症 系统穿刺组(119例) 联合穿刺组(178例) P值 发热 2(1.64) 3(1.69) 0.997 5 急性尿潴留 2(1.64) 5(2.81) 0.705 7 肉眼血尿 3(2.52) 7(3.93) 0.744 9 直肠损伤 0(0) 1(0.56) ＞0.999 9
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