经直肠超声/多参数磁共振融合靶向穿刺在临床显著前列腺癌诊断中的价值  

Transrectal ultrasound/multiparametric magnetic resonance imaging fusion targeted biopsy for the clinically significant prostate cancer detection

作　　者：朱云开[1] 陈亚青[1] 钟芙蓉 李晓明[2] 管雯斌[3] 王立峰[3] Zhu Yunkai;Chen Yaqing;Zhong Furong;Li Xiaoming;Guan Wenbin;Wang Lifeng(Department of Ultrasound in Medicine,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092,China;Department of Radiology,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放射科,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》2021年第2期145-150,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(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：目的通过与前列腺穿刺病理及前列腺根治病理作对照,探讨经直肠超声(TRUS)/多参数磁共振(mpMRI)融合靶向穿刺对临床显著前列腺癌的诊断价值。方法回顾性分析2017年10月至2020年1月因mpMRI发现前列腺癌可疑病灶于上海交通大学医学院附属新华医院行前列腺穿刺的303例患者。穿刺方案采用TRUS/mpMRI融合靶向穿刺联合系统穿刺,通过与前列腺穿刺病理及前列腺根治病理结果作对照,比较TRUS/mpMRI融合靶向穿刺与系统穿刺检出率的差异,研究TRUS/mpMRI融合靶向穿刺对临床显著前列腺癌的诊断价值。结果303例前列腺癌疑似患者经穿刺病理诊断为前列腺癌189例,其中临床显著前列腺癌178例,临床非显著前列腺癌11例。以穿刺病理作为参考标准,TRUS/mpMRI融合靶向穿刺对临床显著前列腺癌的检出率显著高于系统穿刺(57.1%对45.9%,P<0.001)。在189例前列腺癌患者中80例行前列腺根治手术,其中79例经根治病理诊断为临床显著前列腺癌,以前列腺根治病理作为参考标准,TRUS/mpMRI融合靶向穿刺对临床显著前列腺癌的检出率显著高于系统穿刺(91.1%对74.7%,P=0.004)。结论与系统穿刺相比,TRUS/mpMRI融合靶向穿刺能通过对mpMRI所检出前列腺癌可疑病灶的精准穿刺提高临床显著前列腺癌的检出率。Objective To explore the diagnostic value of transrectal ultrasound(TRUS)/multiparametric magnetic resonance imaging(mpMRI)fusion targeted biopsy(FTB)for clinically significant prostate cancer(PCa)detection by using both biopsy histopathology and radical prostatectomy histopathology as reference standards.Methods A total of 303 consecutive patients with suspicious lesions detected by mpMBI and underwent prostate biopsy at Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine between November 2017 to January 2020 were retrospectively analyzed.All the suspicious lesions were sampled by TRUS/mpMRI FTB in addition with standard 12-core systematic biopsy(SB).The clinically significant PCa detection rates by TRUS/mpMRI FTB and SB were compared by using both biopsy histopathology and radical prostatectomy histopathology as reference standards.Results The diagnosis of PCa was histologically confirmed in 189 of 303 patients,including 178 patients with clinically significant PCa and 11 patients with clinically insignificant PCa.With biopsy histopathology as reference standard,the clinically significant PCa detection rate of TRUS/mpMRI FTB was statistically higher than SB(57.1%vs 45.9%,P<0.001).Among 189 patients with biopsy proven PCa,80 patients underwent radical prostatectomy,and the radical prostatectomy histopathology confirmed 79 patients with clinically significant PCa.With radical prostatectomy as reference standard,the clinically significant PCa detection rate of TRUS/mpMRI FTB was statistically higher than SB(91.1%vs 74.7%,P<0.001).Conclusions Compared with SB,MRI/US FTB can offer more accurate sampling of suspicious lesions on mpMRI,and consequently improve the clinically significant PCa detection rate.

关 键 词：超声检查 经直肠 多参数磁共振 前列腺癌 融合靶向穿刺 临床显著前列腺癌 

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