靶向穿刺+6针系统穿刺对PI-RADS 5分患者的前列腺癌诊断效能  

Diagnostic efficacy of prostate cancer using targeted biopsy with 6-core systematic biopsy for patients with PI-RADS 5

作　　者：刘毅[1] 袁昌巍 吴静云[2] 沈棋[1] 肖江喜[2] 赵峥[1] 王霄英[2] 李学松[1] 何志嵩[1] 周利群[1] LIU Yi;YUAN Chang-wei;WU Jing-yun;SHEN Qi;XIAO Jiang-xi;ZHAO Zheng;WANG Xiao-ying;LI Xue-song;HE Zhi-song;ZHOU Li-qun(Department of Urology,Peking University First Hospital,Institute of Urology,Peking University,National Urological Cancer Center,Beijing 100034,China;Department of Radiology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿男生殖系肿瘤中心,北京100034 [2]北京大学第一医院医学影像科,北京100034

出　　处：《北京大学学报（医学版）》2023年第5期812-817,共6页Journal of Peking University:Health Sciences

基　　金：北京大学第一医院科研种子基金(2020SF24)。

摘　　要：目的:比较前列腺靶向穿刺、系统穿刺、靶向穿刺+6针系统穿刺活检对前列腺影像报告和数据系统(prostate imaging reporting and data system,PI-RADS)5分患者的前列腺癌(prostate cancer,PCa)及临床有意义前列腺癌(clinically significant prostate cancer,csPCa)的诊断效能,以优化前列腺穿刺方案。方法:回顾性分析2019年1月至2022年6月北京大学第一医院多参数磁共振(multiparametric magnetic resonance imaging,mpMRI)检查PI-RADS评分5分且行前列腺穿刺活检的患者资料。所有患者在mpMRI/经直肠超声(transrectal ultrasound,TRUS)认知融合引导下,行联合穿刺活检(靶向穿刺联合系统穿刺)。以联合穿刺活检病理结果作为金标准,对比靶向穿刺、系统穿刺及靶向穿刺+6针系统穿刺对PCa和csPCa的诊断效能。按mpMRI T分期(cT2,cT3,cT4)进行分组,通过McNemar及Cochran’s Q检验比较不同穿刺方案对PCa和csPCa的检出情况。结果:入组585例患者,联合穿刺阳性560例(95.7%),阴性25例(4.3%)。mpMRI T分期cT2期233例(39.8%),cT3期214例(36.6%),cT4期138例(23.6%)。按临床T分期分层后发现,cT2、cT3、cT4亚组中靶向穿刺与联合穿刺对PCa、csPCa检出率差异无统计学意义(PCa:P=0.203、P=0.250、P>0.999;csPCa:P=0.700、P=0.250、P>0.999),靶向穿刺+6针系统穿刺与联合穿刺对PCa、csPCa检出率差异亦无统计学意义(P均>0.999)。系统穿刺PCa和csPCa漏诊率分别为2.1%(12/560)和1.8%(10/549),靶向穿刺分别为1.8%(10/560)和1.4%(8/549),而靶向穿刺+6针系统穿刺检出了所有的PCa和csPCa。但与联合穿刺相比,靶向穿刺和靶向穿刺+6针系统穿刺的平均穿刺针数更少(P<0.001),单针阳性率更高(P<0.001)。结论:对于PI-RADS 5分患者,靶向穿刺及靶向穿刺+6针系统穿刺有较高的单针阳性率及PCa、csPCa检出率,可作为前列腺穿刺方案的选择之一。Objective:To investigate the diagnostic efficacy of targeted biopsy(TBx),systematic biopsy(SBx),TBx+6-core SBx in prostate cancer(PCa)/clinically significant prostate cancer(cs-PCa)for patients with prostate imaging reporting and data system(PI-RADS)score of 5,and thereby to explore an optimal sampling scheme.Methods:The data of 585 patients who underwent multiparametric magnetic resonance imaging(mpMRI)with at least one lesion of PI-RADS score 5 at Peking University First Hospital from January 2019 to June 2022 were retrospectively analyzed.All patients underwent mpMRI/transrectal ultrasound(TRUS)cognitive guided biopsy(TBx+SBx).With the pathological results of combined biopsy as the gold standard,we compared the diagnostic efficacy of TBx only,SBx only,and TBx+6-core SBx for PCa/csPCa.The patients were grouped according to mpMRI T-stage(cT2,cT3,cT4)and the detection rates of different biopsy schemes for PCa/csPCa were compared using Cochran’s Q and McNemar tests.Results:Among 585 patients with a PI-RADS score of 5,560(95.7%)were positive and 25(4.3%)were negative via TBx+SBx.After stratified according to mpMRI T-stage,233 patients(39.8%)were found in cT2 stage,214 patients(36.6%)in cT3 stage,and 138 patients(23.6%)in cT4 stage.There was no statistically significant difference in the detection rate of PCa/csPCa between TBx+6-core SBx and TBx+SBx(all P>0.999).Also,there was no statistically significant difference in the detection rate of PCa/csPCa between TBx and TBx+SBx in the cT2,cT3,and cT4 subgroups(PCa:P=0.203,P=0.250,P>0.999;csPCa:P=0.700,P=0.250,P>0.999).The missed diagnosis rate of SBx for PCa and csPCa was 2.1%(12/560)and 1.8%(10/549),and that of TBx for PCa and csPCa was 1.8%(10/560)and 1.4%(8/549),respectively.However,the detection rate of TBx+6-core SBx for PCa and csPCa was 100%.Compared with TBx+SBx,TBx and TBx+6-core SBx had a fewer number of cores and a higher detection rate per core(P<0.001).Conclusion:For patients with a PI-RADS score of 5,TBx and TBx+6-core SBx showed the same PCa/csPCa detec

关 键 词：前列腺肿瘤 活组织检查 磁共振成像 前列腺影像报告和数据系统 

分 类 号：R737.25[医药卫生—肿瘤]