经直肠超声造影靶向穿刺在前列腺癌检测中的作用：与系统穿刺方案的对比研究  

Transrectal contrast enhanced ultrasound targeted biopsy for detection prostate cancer： comparison with systematic biopsy

作　　者：朱云开[1] 陈亚青[1] 蒋珺[1] 齐隽[2] 王立峰[3] 管雯斌[3] 

机构地区：[1]上海交通大学医学院附属新华医院超声科,200092 [2]上海交通大学医学院附属新华医院泌尿外科,200092 [3]上海交通大学医学院附属新华医院病理科,200092

出　　处：《中华超声影像学杂志》2014年第11期970-974,共5页Chinese Journal of Ultrasonography

基　　金：上海市科委医学重点项目（10411952000,10JC1411401）,09411963800）;国家自然科学基金（81271595）;上海交通大学医工交叉项目（YG2011MS43,YG2013MSl5）

摘　　要：目的探讨经直肠超声造影靶向穿刺在检测前列腺癌中的作用。方法151例因血清前列腺特异性抗原升高或直肠指检异常拟行前列腺穿刺活检术的患者，在穿刺前行超声造影检查，前列腺内局部高增强、低增强、快速增强或早消退为前列腺癌可疑病灶，穿刺方案采用10点系统穿刺加超声造影发现异常处2～4点靶向穿刺，通过与前列腺穿刺病理作点对点的对照，并定义Gleason评分≥7的癌灶为高级别肿瘤，Gleason〈7分的为低级别肿瘤，分别统计分析超声造影靶向穿刺及系统穿刺在前列腺癌检测中的作用。结果151例前列腺癌可疑患者中经穿刺活检诊断为前列腺癌61例（40．4％），其中靶向穿刺阳性11例（18．0％，11／61），系统穿刺法阳性14例（23．0％，14／61），靶向穿刺和系统穿刺法均阳性36例（59．0％，36／61），采用系统穿刺和超声造影靶向穿刺的前列腺癌检出率分别为33．1％及31．1％（P=0．712）。151例前列腺癌疑似患者共穿刺1755针，其中系统穿刺1510针，靶向穿刺245针，靶向穿刺的穿刺点阳性率显著高于系统穿刺（52．2％对11．5％，P=0．000）。在61例前列腺癌患者中，经穿刺病理诊断为高级别前列腺癌43例（70．5％），低级别前列腺癌18例（29．5％）。超声造影靶向穿刺对高级别前列腺癌的诊断敏感性为86．0％，显著高于其对低级别前列腺癌的敏感性（55．6％，P=0．018）。结论经直肠超声造影靶向穿刺能在与系统穿刺方案保持相同前列腺癌检出率的同时减少穿刺点数。尤其对于高级别前列腺癌，超声造影靶向穿刺有着较高的诊断敏感性。Objective To assess transrectal contrast enhanced ultrasound （CEUS） targeted biopsy （TB） for detection prostate cancer （PCa） by comparing with systematic biopsy （SB）. Methods 151 consecutive patients scheduled for prostate biopsy were enrolled in this prospective study with a mean age of 68.8 ± 8.0 （47 - 86） and prostate specific antigen （11.5 ± 6.9）μg/L （0.3 - 39.8 μg/L）.CEUS was performed by a single experienced radiologist who was blinded to all clinical data with the Sequoia 512 ultrasonography system equipped with EVSC4 endfire probe. Hypoperfusion lesions, hyperperfusion lesions and lesions with rapid wash-in or wash-out were suspicious for malignant,and these lesions were sampled with 2 - 4 cores in addition with 10-core SB.Results The overall PCa detection rate was 40.4% （61/151）.Of 61 PCa patients, 11 （18.0%） had positive cores in TB, 18 （23.0%） had positive cores in SB and 36 （59.0%） had positive cores in both biopsy protocols. The PCa detection rate of TB and SB was 33.1% and 31.1% respectively （P = 0.712）.A total of 1755 cores were sampled including 1 510 SB cores and 245 TB cores. The positive rate for TB was significantly higher than SB （52.2% vs 11.5%, P = 0.000）.Of 61 PCa patients,18 had low- grade cancer （Gleason score〈7） and 43 had high-grade cancer （Gleason score≥7）.The sensitivity for high- grade PCa was 86.0% with TB,which was significantly higher than low-grade cancer （55.6%, P = 0.018）.Conclusions The PCa detection rate of CEUS-TB was equal with SB,whereas the positive rate by core of CEUS-TB was significant higher than SB. Furthermore, CEUS-TB was more sensitive in detection of high grade prostate cancer.

关 键 词：腔内超声检查 前列腺肿瘤 活组织检查 针吸 

分 类 号：R737.25[医药卫生—肿瘤] R445.1[医药卫生—临床医学]