经直肠实时超声弹性成像结合峰值应变指数引导前列腺活组织检查对前列腺癌的诊断价值  

Value of prostate biopsy guided by transrectal real-time ultrasonic elastography combined with peak strain index in the diagnosis of prostate cancer

作　　者：陆海永 刘伟亮[1] 赵彤[1] 陈云璇[1] 李朝喜[1] 陈怀安[2] Lu Haiyong;Liu Weiliang;Zhao Tong;Chen Yunxuan;Li Chaoxi;Chen Huaian(Department of Ultrasound Medicine,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Department of Urology,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院超声医学科,张家口075000 [2]河北北方学院附属第一医院泌尿外科,张家口075000

出　　处：《肿瘤研究与临床》2022年第10期768-773,共6页Cancer Research and Clinic

基　　金：河北省卫健委青年科技项目(20200555)。

摘　　要：目的探讨经直肠实时超声弹性成像(TRTE)结合峰值应变指数(PSI)引导前列腺活组织检查对前列腺癌的诊断价值以及TRTE评分与病理Gleason评分的相关性。方法选择河北北方学院附属第一医院2019年1月至12月收治的80例疑似前列腺癌患者,所有患者均行TRTE检查,对可疑病灶测定PSI,并行TRTE结合PSI引导靶向性穿刺活组织检查术,再行系统性穿刺活组织检查术。比较两种活组织检查术的诊断结果。以病理活组织检查结果为金标准,比较两种方式对前列腺癌与前列腺良性病变的检出率,比较前列腺癌与前列腺良性病变患者的前列腺体积、血清前列腺特异抗原(PSA)水平及PSI。采用受试者工作曲线(ROC)及曲线下面积(AUC)确定PSI诊断前列腺癌的最佳临界值。比较常规超声与TRTE结合PSI诊断前列腺癌的效能。比较TRTE结合PSI引导下与系统性穿刺术活组织检查穿刺点阳性率,并分析TRTE评分与Gleason评分的相关性。结果80例患者中,前列腺穿刺活组织检查病理诊断为前列腺癌45例(56.25%),前列腺良性病变35例(43.75%)。45例前列腺癌患者中,经TRTE结合PSI引导靶向性穿刺活组织检查术检出前列腺癌42例(93.33%),经系统性穿刺活组织检查术检出前列腺癌38例(84.44%);两种方式穿刺活组织检查前列腺癌检出率比较,差异无统计学意义(χ^(2)=1.80,P=0.180)。前列腺癌组血清PSA水平、PSI均高于前列腺良性病变组,差异均有统计学意义(t值分别为65.28、14.93,均P<0.05)。绘制ROC曲线,AUC为0.857(95%CI 0.772~0.941),确定5.68为PSI最佳临界值,当PSI≥5.68诊断为恶性,PSI<5.68诊断为良性。TRTE结合PSI诊断前列腺癌的灵敏度、特异度和准确度分别为91.11%、94.29%、92.50%,均高于常规超声(73.33%、68.57%、71.25%),差异均有统计学意义(均P<0.05)。80例患者通过TRTE结合PSI检查共发现可疑病灶89个,对每个可疑病灶进行2针靶向穿刺活组织检查术,共穿刺1Objective To investigate the value of prostate biopsy guided by transrectal real-time ultrasonic elastography(TRTE)combined with peak strain index(PSI)in the diagnosis of prostate cancer and the correlation with TRTE score and pathological Gleason score.Methods A total of 80 patients with suspected prostate cancer who underwent TRTE in the First Affiliated Hospital of Hebei North University from January 2019 to December 2019 were selected.The PSI for suspicious lesions was measured,and targeted puncture biopsy guided by TRTE combined with PSI was performed on the patients,and then followed by systematic puncture biopsy.The outcomes of targeted biopsy and systematic biopsy were analyzed.Taking pathological biopsy results as the gold standard,the detection rates of prostate cancer and benign prostate lesions detected by both biopsies methods were compared;the prostate volume,serum prostate specific antigen(PSA)level and PSI were compared between patients with prostate cancer and benign prostatic lesions.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)were used to determine the best cut-off value of PSI in the diagnosis of prostate cancer.The values of conventional ultrasound versus TRTE combined with PSI in the diagnosis of prostate cancer were assessed.The positive rate of biopsy puncture points under the guidance of TRTE combined with PSI was compared with that of systematic biopsy.The correlation between TRTE score and pathological Gleason score of prostate malignant lesions was analyzed.Results Among 80 patients,45 patients(56.25%)were diagnosed as prostate cancer by prostate puncture biopsy,and 35 patients(43.75%)were benign prostate lesions.Among 45 patients with prostate cancer,42 cases(93.33%)of prostate cancer were detected by using TRTE combined with PSI-guided targeted puncture biopsy,and 38 cases(84.44%)of prostate cancer were detected by using systematic puncture biopsy;there was no significant difference in the detection rate of prostate cancer by both biopsies methods

关 键 词：前列腺肿瘤 弹性成像技术 穿刺术 峰值应变指数 GLEASON评分 

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]