超声造影目标穿刺对临床显著前列腺癌的诊断价值  

Contrast-enhanced ultrasound targeted biopsy for the clinically significant prostate cancer detection

作　　者：朱云开[1] 陈亚青[1] 钟芙蓉 管雯斌[2] 屈月红[1] 王立峰[2] Zhu Yunkai;Chen Yaqing;Zhong Furong;Guan Wenbin;Qu Yuehong;Wang Lifeng(Department of Ultrasound in Medicine,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092,China;Department of Pathology,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092,China)

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病理科,200092

出　　处：《中华超声影像学杂志》2020年第5期416-420,共5页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金面上项目(81671708);上海交通大学医工交叉研究基金(YG2014ZD04);上海申康医院发展中心促进市级医院临床技能与临床创新能力三年行动计划(16CR3092B)。

摘　　要：目的:研究超声造影目标穿刺对临床显著前列腺癌的诊断价值。方法:回顾性分析2015年10月至2019年3月于上海交通大学医学院附属新华医院行前列腺穿刺活检术的983例患者。所有患者超声造影检查提示存在前列腺癌可疑病灶,定义为前列腺内局部早增强、高增强或境界不清的低增强病灶。前列腺穿刺采用超声造影目标穿刺联合12点系统穿刺。以Epstein标准为临床显著前列腺癌的诊断标准,比较系统穿刺、超声造影目标穿刺及联合穿刺对临床显著前列腺癌的检出率。结果:983例患者经超声造影目标穿刺联合12点系统穿刺共诊断为前列腺癌502例,其中临床显著前列腺癌445例,临床非显著前列腺癌57例。系统穿刺、超声造影目标穿刺及联合穿刺的临床显著前列腺癌检出率分别为36.8%(362/983)、41.9%(412/983)及45.3%(445/983),超声造影目标穿刺及联合穿刺的临床显著前列腺癌检出率高于系统穿刺(均P<0.001)。与系统穿刺相比,目标穿刺额外诊断了83例临床显著前列腺癌,包括61例系统穿刺漏诊的病例和22例系统穿刺低估的病例。结论:超声造影技术有助于发现前列腺癌可疑病灶,联合应用超声造影目标穿刺与系统穿刺可提高临床显著前列腺癌的检出率。Objective To assess the utility of contrast-enhanced ultrasound(CEUS)targeted biopsy(TB)for clinically significant prostate cancer(PCa)detection.Methods A total of 983 consecutive patients scheduled for prostate biopsy from October 2015 to March 2019 in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine were enrolled in this retrospective study.All patients had suspicious lesions on CEUS,defined as increased focal contrast enhancement,rapid contrast enhancement and low enhancement lesions with ill-defined borders.Suspicious lesions on CEUS were sampled in addition with standard 12-core systematic biopsy(SB).Clinically significant PCa was defined using Epstein criteria.The clinically significant PCa detection rate by CEUS-TB and combined biopsy was evaluated in comparison with SB.Results In 502 of the 983 patients,the diagnosis of PCa was histologically confirmed,including 445 patients with clinically significant PCa and 57 patients with clinically insignificant PCa.The clinically significant PCa by CEUS-TB and combined biopsy were 41.9%(412/983)and 45.3%(445/983)respectively,which was significantly higher than SB(36.8%,362/983)(all P<0.001).CEUS-TB resulted in additional 83 cases of clinically significant PCa,including 61 patients missed by SB and 22 patients under-graded by SB.Conclusions CEUS is helpful in the detection of PCa lesions.Combined CEUS-TB and SB can improve the clinically significant PCa detection rate.

关 键 词：超声造影 前列腺癌 靶向穿刺 临床显著前列腺癌 

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