不同针组系统穿刺对高PSA值患者前列腺癌诊断效能的研究  

Research on the Diagnostic Efficacy of Prostate Cancer by Using Different Systematic Biopsy Schemes in Patients with Elevated PSA Values

作　　者：纪献浦 李楠 罗渝昆 李秋洋 Ji Xianpu;Li Nan;Luo Yukun;Li Qiuyang(Department of Ultrasound,The First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第一医学中心超声科,北京市100853

出　　处：《中国超声医学杂志》2024年第5期577-581,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的比较前列腺6针、8~10针及12针系统穿刺对血清前列腺特异度抗原(PSA)>20 ng/mL患者前列腺癌的诊断效能,优化穿刺方案,减少术后并发症。方法回顾性分析行前列腺穿刺活检的患者资料,筛选出多参数磁共振检查前列腺影像报告和数据系统(PI-RADS)评分4~5分且PSA>20 ng/mL的患者37例,对比3种系统穿刺方案对该特殊区间患者临床有意义前列腺癌(CsPCa)的诊断效能,病理采用Gleason≥7分为CsPCa,Gleason≤6分为临床无意义前列腺癌(CisPCa),通过Kruskal-Wallis H秩和检验分析患者基本资料,通过卡方检验分析3种方案诊断差异。结果入组患者37例,穿刺阳性34例(91.9%),其中CsPCa 33例(89.2%),CisPCa 1例(2.7%),穿刺阴性3例(8.1%)。6针组、多针组及12针组检出率分别为93.3%(14/15)、100%(9/9)、84.6%(11/13),差异无明显统计学意义(P>0.05);6针组、多针组及12针组单针穿刺阳性率分别为84.4%(76/90)、79.7%(63/79)、55.8%(87/156),6针组单针阳性率最高,差异具有统计学意义(P<0.01)。结论对于PSA>20 ng/mL的患者,3种方案对前列腺癌具有相近的诊断效能且6针系统穿刺单针阳性率最高,其可作为临床选择的方案。Objective To compare the diagnostic efficacy of 6-core,8-10-core and 12-core systematic biopsy(SBx)in patients with prostate specific antigen(PSA)>20 ng/mL,and optimize the sampling scheme to mitigate postoperative complications.Methods A retrospective analysis was conducted on patients who underwent prostate biopsy.All patients underwent multiparametric magnetic resonance imaging(mpMRI)before the procedure.37 Patients with The prostate imaging reporting and data system(PI-RADS)scores of 4-5 and PSA>20 ng/mL were selected.The diagnostic efficacy of 6,8-10,and 12-core SBx for clinically significant prostate cancer(CsPCa)in this specific range was analyzed.The pathological report adopted the Gleason scoring system:Gleason score≥7 indicated CsPCa,Gleason score≤6 indicated clinically insignificant prostate cancer(CisPCa).The basic data of the three groups of patients were analyzed by Kruskal-Wallis H rank sum test,Chi-square tests were used to analyze the detection rates of different schemes for CsPCa.Results A total of 37 patients were included,with 34(91.9%)having positive biopsy results and 3(8.1%)having negative biopsy results.CsPCa was detected in 33 cases(89.2%),and CisPCa in 1 case(2.7%).The detection rates for the 6,8-10 and 12-core SBx were 93.3%(14/15),100%(9/9),and 84.6%(11/13),respectively.There was no statistically significant difference in PCa detection rates among the three sampling schemes(P>0.05).The single positive core rates were 84.4%(76/90)of the 6-core SBx group,79.7%(63/79)of the 8-10-core SBx group,and 55.8%(87/156)of the 12-core SBx group.The 6-core SBx group had a higher single-core positive rate with fewer average biopsy cores(P<0.01).Conclusions For patients with PSA>20 ng/mL,the 6-core SBx has a higher single-core positive rate and comparable diagnostic efficacy to the other two groups.It can be considered as an option for prostate biopsy in patients with elevated PSA values.

关 键 词：前列腺癌 活检 前列腺特异度抗原 

分 类 号：R73[医药卫生—肿瘤]