前列腺体积对实时弹性成像目标穿刺准确性的影响  

The influence of prostate volume on prostate cancer detection using real-time elastography targeted biopsy

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

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》2018年第1期64-68,共5页Chinese Journal of Ultrasonography

基　　金：上海市卫计委青年课题（20134y038）;上海市科委课题（15411961000）

摘　　要：目的研究前列腺体积对实时弹性成像目标穿刺诊断准确性的影响。方法回顾性分析573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的患者，所有患者先行实时弹性成像检查以检出前列腺癌可疑病灶，随后行经直肠超声引导下经会阴穿刺活检术。穿刺方案采用10点系统穿刺加弹性成像异常处目标穿刺。将患者前列腺体积分为≤30 ml、30～50 ml、50～80 ml及〉80 ml四组，比较弹性成像目标穿刺及系统穿刺在各体积组的诊断敏感性。结果573例疑似前列腺癌患者经穿刺病理诊断为前列腺癌246例（42.9%，246/573），通过追加对弹性成像异常发现部位的目标穿刺能提高9.1%（52/573）的穿刺阳性率。弹性成像目标穿刺对前列腺体积≤30 ml、30～50 ml、50～80 ml及〉80 ml四组患者的诊断敏感性分别为91.1%（72/79）、81.3%（87/107）、70.5%（31/44）及50.0%（8/16）（P＝0.000）。而系统穿刺在这四组中的敏感性分别为77.2%（61/79）、77.6%（83/107）、86.4%（38/44）及75.0%（12/16）（P＝0.601）。对于前列腺体积≤30 ml的患者，弹性成像目标穿刺的敏感性显著高于系统穿刺（P＝0.028）。结论弹性成像目标穿刺能提高前列腺癌检出率。前列腺体积与弹性成像目标穿刺诊断敏感性有关，弹性成像对前列腺体积较小的患者诊断敏感性更高。ObjectiveTo retrospectively evaluate the influence of prostate volume on prostate cancer detection using elastography targeted transperineal biopsy.MethodsA total of 573 consecutive patients suspicious for prostate cancer were enrolled in this study. Patients underwent combined elastography-targeted biopsy and 10 core-systematic transperineal biopsy. In correlation with prostate biopsy pathology, the sensitivity of elastography-targeted biopsy and systematic biopsy were compared among four subgroups with different prostate volume.ResultsThe overall prostate cancer detection rate was 42.9% （246/573）. The increase in cancer detection rate by elastography-targeted biopsies was 9.1% （52/573）. In patients with prostate volume of ≤30 ml, 30-50 ml, 50-80 ml and 〉80 ml, the sensitivity of elastography targeted biopsy were 91.1%（72/79）, 81.3%（87/107）, 70.5%（31/44） and 50.0%（8/16）, respectively （P=0.000）. The sensitivity of systematic biopsy were 77.2%（61/79）, 77.6%（83/107）, 86.4%（38/44） and 75.0%（12/16）, respectively, in comparison among these four groups （P=0.601）. For patients with prostate volume ≤30 ml, the sensitivity of elastography targeted biopsy was significantly higher than that of systematic biopsy （P=0.028）.ConclusionsProstate cancer detection rate can be improved by elastography targeted biopsy. Prostate volume is correlated with the accuracy of elastography. The sensitivity of elastography targeted biopsy is higher in patients with a smaller prostate gland.

关 键 词：弹性成像技术 前列腺肿瘤 活组织检查 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.25[医药卫生—诊断学]