基于bpMRI的认知融合靶向穿刺和系统穿刺在PI-RADS评分≥3分患者中的诊断效率  

Use of bpMRI-based cognitive fusion targeted biopsy and systematic biopsy in patients with PI-RADS≥3

作　　者：祁峰 承逸飞 梁玲辉 张磊[1] 曹栋梁 成功[1] 华立新[1] Qi Feng;Cheng Yifei;Liang Linghui;Zhang Lei;Cao Dongliang;Cheng Gong;Hua Lixin(Department of Urology,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Urologic Surgery,Jiangsu Cancer Hospital,Nanjing 210009,China)

机构地区：[1]南京医科大学第一附属医院泌尿外科,210029 [2]江苏省肿瘤医院泌尿外科,南京210009

出　　处：《中华泌尿外科杂志》2020年第11期840-845,共6页Chinese Journal of Urology

摘　　要：目的探讨基于双参数磁共振(bpMRI)的认知融合靶向穿刺和系统穿刺在前列腺影像报告和数据系统(PI-RADS)评分≥3分前列腺活检患者中的诊断效率。方法回顾性分析2018年5月到2019年11月南京医科大学第一附属医院PI-RADS评分≥3分同时行bpMRI-经直肠超声(TRUS)认知融合靶向穿刺和系统穿刺的220例患者的临床资料。中位年龄66(60,73)岁,中位前列腺特异性抗原(PSA)8.73(6.52,11.93)ng/ml,中位前列腺体积39.25(29.26,58.39)ml,体质指数(24.02±2.60)kg/m2。分别由2名泌尿外科医生独立对每例患者行bpMRI-TRUS认知融合靶向穿刺和系统穿刺。主要研究终点为有临床意义前列腺癌-A[CsPCa-A,定义为国际泌尿病理学会(ISUP)分级分组≥2组]的检出率;次要研究终点为CsPCa-B(ISUP分级分组≥3组)和无临床意义前列腺癌(CIPCa,ISUP分级分组=1组)的检出率。通过McNemar检验和χ2检验比较靶向穿刺和系统穿刺诊断CsPCa-A、CsPCa-B和CIPCa的差异。结果220例中112例(50.91%)诊断为前列腺癌,其中靶向穿刺诊断前列腺癌的阳性率为42.73%(94/220),系统穿刺阳性率为46.82%(103/220)。220例中84例(38.18%)诊断为CsPCa-A,靶向穿刺和系统穿刺对CsPCa-A的检出率差异无统计学意义[30.00%(66/220)与34.09%(75/220),P=0.120]。如仅行靶向穿刺,则有8.18%(18/220)的CsPCa-A会被漏诊;如仅行系统穿刺,则有4.09%(9/220)的CsPCa-A会被漏诊。CsPCa-B的阳性率为26.36%(58/220),靶向穿刺和系统穿刺对CsPCa-B的检出率差异无统计学意义[20.00%(44/220)与23.18%(51/220),P=0.190]。如仅行靶向穿刺,则有6.36%(14/220)的CsPCa-B会被漏诊;如仅行系统穿刺,则有3.18%(7/220)的CsPCa-B会被漏诊。靶向穿刺+系统穿刺、仅靶向穿刺或系统穿刺诊断CIPCa的阳性率差异无统计学意义[三者均为12.73%(28/220),P=1.000]。9例活检后出现并发症,其中5例感染,2例迷走神经反射,2例尿潴留,均予对症治疗后好转。结论bpMRI-TRUS认知融合靶向�Objective To investigate the use of bi-parametric magnetic resonance imaging(bpMRI)-based cognitive fusion targeted biopsy and systematic biopsy in patients with prostate imaging reporting and data system(PI-RADS)≥3.Methods The clinical data of 220 patients with PI-RADS≥3 who underwent bpMRI-transrectal ultrasound(TRUS)cognitive fusion targeted biopsy and systematic biopsy in the First Affiliated Hospital of Nanjing Medical University from May 2018 to November 2019 were retrospectively analyzed.The median age was 66(60,73)years old,median prostate specific antigen(PSA)was 8.73(6.52,11.93)ng/ml,medlian prostate volume was 39.25(29.26,58.39)ml and the mean body mass index(BMI)was(24.02±2.60)kg/m2.For each patient,bpMRI-TRUS cognitive fusion targeted biopsy and systematic biopsy were performed by two independent experienced urologists.The primary endpoint was the detection rate of CsPCa-A[clinically significant prostate cancer-A,defined as International Society of Urological Pathology(ISUP)grade group 2 or higher tumors].The secondary endpoints were the detection rates of CsPCa-B(defined as ISUP grade group 3 or higher tumors)and CIPCa(clinically insignificant prostate cancer,defined as ISUP grade group 1 tumors).McNemar test and Chi-square test were used to compare the positive rates of CsPCa-A,CsPCa-B and CIPCa between targeted biopsy and systematic biopsy.Results In this study,112 patients(50.91%)were diagnosed with prostate cancer,and the detection was 42.73%(94/220)in targeted biopsy and 46.82%(103/220)in systematic biopsy.CsPCa-A was detected in 84(38.18%)patients.Detection of CsPCa-A by targeted biopsy and systematic biopsy was not different significantly[30.00%(66/220)vs.34.09%(75/220),P=0.120].CsPCa-A would have been missed in 8.18%(18/220)patients had not performed systematic biopsy,and in 4.09%(9/220)patients had not performed targeted biopsy.CsPCa-B was detected in 26.36%(58/220)patients.Detection of CsPCa-B by targeted biopsy and systematic biopsy was not different significantly[20.00%(44/220)vs.23

关 键 词：前列腺肿瘤 双参数磁共振 认知融合 靶向穿刺 系统穿刺 

分 类 号：R737.25[医药卫生—肿瘤]