6针系统穿刺联合3针磁共振引导靶向穿刺对前列腺癌的检出效果  

Efficacy of the biopsy strategy combining 6-core systematic and 3-core MRI-targeted biopsy in the detection of prostate cancer

作　　者：涂祥[1] 熊性宇 张驰宸 蔡迪明[2] 白盛江 郑维涛 林天海[1] 刘振华[1] 杨璐[1] 魏强[1] Tu Xiang;Xiong Xingyu;Zhang Chichen;Cai Diming;Bai Shengjiang;Zheng Weitao;Lin Tianhai;Liu Zhenhua;Yang Lu;Wei Qiang(Department of Urology,Institute of Urology,West China Hospital,Sichuan University,Chengdu 610000,China;Department of Ultrasound,West China Hospital,Sichuan University,Chengdu 610000,China)

机构地区：[1]四川大学华西医院泌尿外科,泌尿外科研究所,成都610000 [2]四川大学华西医院超声科,成都610000

出　　处：《中华泌尿外科杂志》2022年第12期914-919,共6页Chinese Journal of Urology

摘　　要：目的探讨6针系统穿刺联合3针磁共振引导靶向穿刺对首次穿刺活检患者的前列腺癌检出效果。方法回顾性分析2018年7月至2020年1月121例于四川大学华西医院首次接受经会阴前列腺穿刺活检患者的临床资料。年龄(64.7±9.1)岁。穿刺前前列腺特异性抗原(PSA)(12.4±7.5)ng/ml,f/t PSA 0.13±0.05。前列腺体积(43.1±26.1)ml。前列腺特异性抗原密度(0.35±0.27)ng/ml2。穿刺前磁共振检查前列腺影像和数据评分系统(PI-RADS)评分3分29例(24.0%)、4分54例(44.6%)、5分38例(31.4%)。121例均行系统穿刺联合3针或5针磁共振引导的靶向穿刺,其中3针靶向穿刺61例,5针靶向穿刺60例,两组穿刺前的临床资料比较差异均无统计学意义(P>0.05)。将12针系统穿刺中的6针定义为6针系统穿刺。比较单纯12针系统穿刺、单纯6针系统穿刺、单纯靶向穿刺(3针/5针),以及不同系统穿刺联合靶向穿刺对前列腺癌和有临床意义前列腺癌的检出效果,比较不同针数靶向穿刺的累积肿瘤检出率。结果本研究121例,穿刺阴性43例(35.5%),阳性78例(64.5%),其中有临床意义前列腺癌检出率为55.4%(67/121)。6针系统联合靶向穿刺的阳性率为62.0%(75/121),有临床意义前列腺癌检出率为55.4%(67/121),与12针系统穿刺联合靶向穿刺相比差异均无统计学意义(P>0.05),且6针系统联合靶向穿刺减少诊断3例Gleason评分3+3分患者。单独靶向穿刺的阳性率为57.9%(70/121),其中第1针为42.1%(51/121),前2针为55.4%(67/121),前3针为57.9%(70/121)。与对可疑病灶单独1针靶向穿刺相比,联合2针(OR=1.7,95%CI 1.0~2.8)或3针(OR=1.9,95%CI 1.1~3.1)靶向穿刺能显著提高前列腺癌检出率,但靶向穿刺第4、5针[均为60.0%(36/60)]不能进一步提高肿瘤检出率。结论对于可疑前列腺癌患者,采用6针系统穿刺联合3针靶向穿刺在肿瘤检出率方面不劣于12针系统穿刺联合靶向穿刺。Objective To investigate the efficacy of the biopsy strategy combining 6-core systematic and 3-core MRI-targeted biopsy on prostate cancer(PCa)detection in biopsy-naïve patients.Methods The clinical data of 121 biopsy-naïve patients who underwent transperineal prostate biopsy in West China Hospital of Sichuan University from July 2018 to January 2020 were retrospectively analyzed.The average age was(64.7±9.1)years old.Pre-biopsy prostate-specific antigen(PSA)was(12.4±7.5)ng/ml,f/t PSA was 0.13±0.05.Prostate volume was(43.1±26.1)ml and PASD was(0.35±0.27)ng/ml2.The prostate-imaging and data system(PI-RADS)score of MRI before biopsy was reported to be 3 for 29 patients(24.0%),4 for 54 patients(44.6%)and 5 for 38 patients(31.8%).All 121 patients underwent 12-core systematic biopsy combined with a 3-core or 5-core MRI-targeted biopsy,of which 61 patients underwent 3-core targeted biopsy and 60 underwent 5-core targeted biopsy.There was no significant difference in the pre-biopsy clinical data between the two groups(P>0.05).A 6-core systematic biopsy was redefined as the results of 6 cores among the 12-core systematic biopsy.We compared the detection rates among the single 12-core systematic biopsy,6-core systematic biopsy,MRI-targeted biopsy(3-core or 5-core),and different systematic biopsy combing with targeted biopsy for any PCa and clinically significant PCa,and we also analyzed the cumulative cancer detection rates for MRI-targeted biopsy of different cores.Results Of the 121 patients in this study,the biopsy results were negative for 43 patients(35.5%)and positive for 78(64.5%).The detection rate of clinically significant PCa was 55.4%(67/121).The detection rate of the 6-core systematic biopsy combined with MRI-targeted biopsy was 62.0%(75/121)for PCa and 55.4%(67/121)for clinically significant PCa,which was of no difference compared with that for the 12-core systematic biopsy combined with MRI-targeted biopsy(P>0.05),but the 6-core systematic biopsy combined with MRI-targeted biopsy avoided the overdiagn

关 键 词：前列腺肿瘤 前列腺癌 穿刺活检 靶向穿刺 多参数磁共振 

分 类 号：R737.25[医药卫生—肿瘤]