Comparative study on transperineal mpMRI-ultrasound imaging fusion-guided prostate biopsy versus transrectal cognitive fusion prostate biopsy
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摘要: 目的 对比研究经会阴多参数磁共振(multiparametric magnetic resonance imaging，mpMRI)-超声图像融合前列腺穿刺活检术与经直肠认知融合前列腺穿刺活检术的诊断价值和安全性。方法 回顾性分析2022年1月—2024年1月于中山大学附属第七医院泌尿外科住院行前列腺穿刺活检术的184例患者临床资料，将其中行经会阴mpMRI-超声图像融合前列腺穿刺术的68例作为病例组，行经直肠认知融合前列腺穿刺术的116例作为对照组，2组患者均为靶向穿刺1~3针后行12针系统穿刺。比较2组患者一般临床资料、前列腺癌(prostate cancer，PCa)检出率、临床显著性前列腺癌(clinical significant prostate cancer，csPCa)检出率及并发症发生情况。结果 2组一般临床资料比较差异无统计学意义。病例组靶向穿刺PCa检出率和csPCa检出率(42.65%、36.76%)均显著高于对照组(27.59%、22.41%)。2组总体穿刺(靶向+系统)PCa检出率和csPCa检出率差异均无统计学意义。病例组的并发症发生率(10.29%)显著低于对照组(23.28%)。结论 经会阴mpMRI-超声图像融合前列腺穿刺活检术较经直肠认知融合前列腺穿刺活检术可进一步提高靶向穿刺的准确度，且具有更好的安全性。目前靶向穿刺联合系统穿刺可能是前列腺穿刺活检更好的方案。Abstract: Objective To comparatively investigate the diagnostic value and safety between transperineal multiparametric magnetic resonance imaging(mpMRI) -ultrasound imaging fusion-guided prostate biopsy and transrectal cognitive fusion prostate biopsy.Methods A retrospective analysis was conducted on prostate biopsy 184 patients admitted to the Department of Urology, Seventh Affiliated Hospital of Sun Yat-sen University, from January 2022 to January 2024. Among them, 68 patients who underwent transperineal mpMRI-ultrasound imaging fusion-guided prostate biopsy were designated as the case group, and 116 patients who underwent transrectal cognitive fusion prostate biopsy were designated as the control group. Both groups underwent targeted biopsy with 1-3 needles followed by a systematic 12-needle biopsy. The general clinical data, prostate cancer(PCa) detection rate, clinically significant prostate cancer(csPCa) detection rate, and complication occurrence were compared between the two groups.Results No significant differences were observed in the general clinical data between the two groups. The PCa and csPCa detection rates(42.65%, 36.76%) of targeted biopsy in the case group were both significantly higher than those in the control group(27.59%, 22.41%). However, no statistically significant differences were found in the overall(targeted+systematic biopsy) PCa and csPCa detection rates between the two groups. The complication rate in the case group(10.29%) was significantly lower than that in the control group(23.28%).Conclusion Transperineal mpMRI-ultrasound imaging fusion-guided prostate biopsy can further improve the accuracy of targeted biopsy and demonstrate better safety compared to transrectal cognitive fusion prostate biopsy. Targeted biopsy combined with systematic biopsy may be a better strategy for prostate biopsy.
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表 1 2组患者一般临床资料比较
例(%)，X±S 指标 病例组(68例) 对照组(116例) t/χ2 P值 年龄/岁 68.19±10.94 70.65±10.02 -1.518 0.131 前列腺体积/mL 44.32±15.85 45.08±17.64 -0.301 0.764 tPSA/(ng/mL) 12.62±10.38 11.78±13.20 0.469 0.640 PI-RADS≥3分结节/个 1.23±0.95 1.19±1.03 0.267 0.790 PI-RADS评分 0.265 0.607 3分 29(42.6) 45(38.8) 4~5分 39(57.4) 71(61.2) 靶向穿刺针数/针 2.13±1.18 2.06±1.26 0.379 0.705 
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表 2 2组患者穿刺病理结果比较
例(%) 组别 例数 总体结果(靶向+系统) 靶向结果 PCa csPCa PCa csPCa 病例组 68 31(45.59) 26(38.24) 29(42.65) 25(36.76) 对照组 116 52(44.83) 43(37.07) 32(27.59) 26(22.41) χ2 0.01 0.03 4.39 4.41 P值 0.92 0.88 0.04 0.04
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表 3 2组并发症发生情况比较
例(%) 组别 例数 明显肉眼血尿 发热 尿潴留 穿刺部位疼痛 下尿路刺激症状 出现并发症例数 病例组 68 3(4.41) 1(1.47) 1(1.47) 2(2.94) 2(2.94) 7(10.29) 对照组 116 8(6.90) 9(7.76) 4(3.45) 6(5.17) 5(4.31) 27(23.28) χ2 0.47 3.30 0.63 0.51 0.22 4.80 P值 0.72 0.14 0.74 0.73 0.95 0.03
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