经直肠实时超声弹性成像对前列腺增生和前列腺癌鉴别诊断的价值  

The value of transrectal real-time ultrasonic elastography in the differential diagnosis between BPH and PCa

作　　者：肖世伟[1,2,3] 左毅刚[1,2] 王剑松[1,2] 丁明霞[1,2] 冯蕾[4] 刘松[4] 

机构地区：[1]昆明医科大学第二附属医院泌尿外科 [2]云南省泌尿外科研究所,昆明650101 [3]贵州省人民医院泌尿外科 [4]昆明医科大学第二附属医院超声诊断科,昆明650101

出　　处：《临床泌尿外科杂志》2013年第7期513-516,共4页Journal of Clinical Urology

摘　　要：目的:探讨经直肠实时超声弹性成像(transrectal real-time ultrasonic elastography,TRTE)对前列腺增生(BPH)和前列腺癌(PCa)鉴别诊断的价值及TRTE与Gleason评分和临床分期之间的相关性。方法:对我院泌尿外科2011年10月～2012年9月疑诊为PCa的患者常规进行TRTE检查,通过定量分析方法获取应变率值(strain ratio,SR),根据Ophir前列腺弹性评分5分法获取弹性评分,并与病理结果及临床分期进行对比分析,从而探讨SR测值及弹性评分对BPH和PCa鉴别诊断的价值。结果:SR最大值预测前列腺癌存在的ROC曲线下面积为0.704(95%可信区间0.570～0.837,P<0.01),切点值为16.50,灵敏度为64.50%,特异度为82.90%;SR最小值预测前列腺癌存在的ROC曲线下面积为0.723(95%可信区间0.592～0.853,P<0.01),切点值为10.76,灵敏度为61.30%,特异度为85.70%;当弹性评分以3分为分界值时,灵敏度为83.90%,特异度为65.70%。SR最大值与Gleason评分呈低度正相关(r=0.322,P=0.038);SR最小值与Gleason评分呈中度正相关(r=0.413,P=0.021);SR最大值、最小值与临床分期无明显统计学意义的相关性(r=-0.114,P=0.543;r=-0.060,P=0.748)。弹性评分与Gleason评分呈中度正相关(r=0.450,P=0.011),与临床分期呈中度正相关(r=0.595,P<0.001)。结论:TRTE对BPH和PCa有鉴别诊断价值,与Gleason评分及临床分期存在一定程度的相关性。Objective： To investigate the value of transrectal real-time ultrasonic elastography （TRTE） in the differential diagnosis between BPH and PCa, and the correlation of TRTE with Gleason scores and clinical stages. Method： Patients that were doubtful of PCa underwent a conventional TRTE check between October 2011 and September 2012 in our hospital. The results of strain ratio （SR） gained from quantitative analysis and elastic scores gained according to Ophir prostate five points-elastic scores were compared and analyzed with pathologic results and clinical stages to investigate the value of TRTE for BPH and PCa differential diagnosis. Result： The area under the Receiver Operating Characteristic curves （ROC curves） of SR max were 0. 704 for differential diagnosis of BPH and PCa（95%CI 0. 570-0. 837, P〈0.01）, when a cutoff point of 16.50 was used, SR max had a sensitivity of 64.50% and a specificity 82.9%; the area under the ROC curves of SR min were 0. 723 for differential diagnosis of BPH and PCa（95%CI 0. 592-0. 853, P〈0.01）, when a cutoff point of 10. 76 was used, SR min had a sensitivity of 61.30% and a specificity 85.7% ; when a cutoff point of 3 was used, elastic score had a sensitivity of 83.90% and a specificity of 65. 70%. SR max has a low positive correlation with Gleason scores （r=0. 322, P= 0. 038） ; SR min has a moderately positive correlation with Gleason scores （r=0. 413, P=0. 021） ; SR max and SR rain has no significant statistically significant correlation with clinical stages（r= 0. 114, P=0. 543; r= - 0. 060, P=0. 748）. Elastic score has a moderately positive correlation with Gleason scores and clinical stages respectively（r=0. 450, P=0.0113 r=0. 595, P〈0. 001）. Conclusion： TRTE is valuable for differential diagnosis of BPH and PCa, and it has a certain degree of correlation with Gleason scores and clinical stages.

关 键 词：良性前列腺增生 前列腺癌 GLEASON评分 临床分期 弹性成像 应变率值 弹性评分 相关性 

分 类 号：R697[医药卫生—泌尿科学]