经直肠与超声引导下经会阴前列腺穿刺活检的比较

目的 :比较直肠指检引导下经直肠前列腺穿刺与超声引导下经会阴前列腺穿刺两种活检方法的阳性率和安全性。方法 :对 136例PSA >4ng /ml或直肠指检异常的患者进行前列腺穿刺活检 ,其中经直肠 2 2例 ,经会阴 114例。结果 :根据不同PSA水平及直肠指检结果分组 ,两组穿刺活检阳性率差异无统计学意义。超声引导下经会阴穿刺感染及便血发生率明显低于直肠指检引导下经直肠穿刺。结论 :直肠指检引导下经直肠前列腺穿刺和超声引导下经会阴前列腺穿刺都是进行前列腺活检的有效方法 ,应根据患者直肠指检、经直肠超声表现以及PSA水平选择穿刺方法 ,而后者的安全性高于前者     

经直肠超声及其穿刺活检对前列腺增生与前列腺癌的鉴别诊断价值

目的 评价经直肠超声检查及其穿刺活检对鉴别前列腺增生症与前列腺癌的价值。方法 将40例前列腺疾病患者术后病理分组，与术前经直肠超声检查声像图以及13例穿刺活检结果对照分析。结果 术后前列腺增生组27例，前列腺增生伴炎症组4例，前列腺癌组9例，术前经直肠超声检查诊断前列腺增生27例，疑诊前列腺癌13例并行穿刺活检，其中6例术前穿刺确诊为前列腺癌，3例前列腺癌未穿刺，但术后病理证实，经直肠前列腺癌超声诊断敏感性66．7％，特异性77．4％，准确性75％；而本组穿刺活检对前列腺癌选择性检出率为46．2％，其准确性、敏感性、特异性均为100％。结论 经直肠二维及彩色多普勒超声检查对于鉴别良性前列腺增生症与前列腺癌有着重要价值，可以选择性提高穿刺活检中前列腺癌的检出率，而结合经直肠超声检查的前列腺穿刺活检术则是发现并确诊前列腺癌的有效方法。     

Specificity and accuracy of TRUS-measured PSA-density and transition zone-PSA in the diagnosis of prostate cancer

Between 4 and 15 ng/ml serum prostate-specific antigen (PSA) has a low specificity for prostate cancer (PCa). One accepted method to enhance this specificity is transrectal ultrasonography (TRUS)-measured PSA-density (PSA-D). We compared this method with a new alternative, transition zone PSA (PSA-TZ). We measured total and transition zone prostatic volumes by TRUS and calculated PSA-D and PSA-TZ in 59 patients with suspicion of PCa and PSA between 4 and 15 ng/ml. All patients then had sextant biopsies of the prostate, 30 were positive for PCa and 29 showed benign tissue. With a cut-off value of 0.35, PSA-TZ had a positive predicted value of 77% for PCa, whereas PSA-D, with a cut-off value of 0.12, had a positive predicted value of 55%. Our data suggest PSA-TZ to be more reliable for avoiding unnecessary biopsies in patients with PCa suspicion and serum PSA below 15 ng/ml. PSA-TZ, calculated by TRUS, enhances the specificity of PSA for needle biopsy diagnosis of PCa.     

改制单角穿刺架经直肠超声引导前列腺随机活检的应用研究

目的探讨改制单角穿刺架在直肠内超声（endorectal ultrasound,TRUS）引导下对前列腺进行随机活检的应用价值。方法选择有TRUS导向穿刺活检适应证的72例,将改制后的经阴道导向的单角穿刺架,在TRUS引导下采用Stamey的10点法做前列腺穿刺活检,并对取样标本、TRUS表现、血浆前列腺特异性抗原（PSA）浓度与前列腺癌的关系进行分析比较。结果本组用改制单角穿刺架作TRUS导向前列腺穿刺取材的成功率为99.23%,取样标本平均长度为（1.25±0.32）cm,能满足病理科的诊断要求。本组活检诊断为前列腺癌34例（47.22%）,其中TRUS示弥漫性病变20例（58.82%）,无明确占位病变的8例（23.53%）,局灶性病变6例（17.64%）。弥漫性病变者穿刺活检7个穿刺点以上均找到癌细胞,无占位病变和局灶性病变半数以上病例癌灶受累范围≤4个穿刺点,但仍分别有37.50%（3/8）、33.33%（2/6）的病例癌灶受累范围≥7个点,前者与无占位病变、局灶性病变比较差异有统计学意义（P〈0.01）。PSA浓度与前列腺癌的受累范围呈线性相关（α=0.51,P〈0.05）,局灶性前列腺癌的平均PSA值与前列腺增生者比较差异无统计学意义（P〉0.05）。结论釆用改制单角穿刺架作TRUS引导前列腺随机活检,方法简便、安全,对早期诊断前列腺癌具有十分重要的临床价值。     

Nonspecific granulomatous prostatitis

Nonspecific granulomatous prostatitis (NSGP) is a relatively uncommon type of chronic inflammation of the prostate, frequently mistaken for carcinoma on digital rectal examination, trans-rectal ultrasound (TRUS) and serum PSA test. It is presently the most frequent variety of granulomatous prostatitis observed at histological examination. The present study reviews the trans-rectal US results and serum PSA levels of 20 patients with biopsy-proven NSGP. Physical findings, laboratory data and US indicated malignancy in all cases. Sonographically (TRUS), the lesions appeared as single or multiple hypoechoic nodules, mainly localised in the peripheral zone of the gland, mimicking carcinoma. Mean serum PSA values were 13.3 ng/ml (range from 3.5 to 34 ng/ml), and only one patient had a value lower than 4 ng/ml. A sufficiently long period of follow-up (mean 19 months; range from 7 to 48 months) with TRUS and PSA was only possible in 11/20 patients. In 8/11 cases, serum PSA returned within normal range, and in 5/11 patients the US features slowly resolved, the hypoechoic nodules disappearing. Final diagnosis can only be obtained by prostatic biopsy. Several questions remain unanswered regarding the relationship between chronic prostatitis and prostatic carcinoma, natural history, the need for specific therapy and also the follow-up of this disease.     

经直肠超声引导前列腺系统活检在前列腺疾病诊断中的应用

目的　探讨经直肠超声引导下前列腺多点系统活检术在前列腺疾病诊断中的应用价值。方法　对 46例前列腺特异抗原 (PSA) >4ng ml或经直肠超声发现前列腺有结节的患者 ,行经直肠超声引导 6针系统活检加结节处1～ 2针活检。结果　 46例经直肠引导前列腺活检 ,检出前列腺癌 16例 ( 3 4.8%) ;恶性淋巴瘤 1例 ( 2 .2 %)。随PSA增高 ,前列腺癌检出率增高。术中及术后严重并发症。结论　经直肠超声引导前列腺多点系统活检术 ,可明显提高前列腺癌的临床检出率 ,有助于前列腺疾病的诊断和鉴别诊断。     

前列腺癌经直肠超声声像特征

本文分析了172例可疑前列腺癌者经腔内超声及其引导下穿刺活检确诊的49例前列腺癌的声像学特征。认为前列腺癌除了主要表现为低回声型特点外,尚可出现其它回声类型改变及一些间接征象。前列腺介入性超声及其指引下的穿刺活检是前列腺癌诊断及疗效随访的主要方法。     

经直肠超声引导前列腺穿刺活检对前列腺特异抗原小于4 ng/ml前列腺癌的诊断

目的探讨经直肠超声引导下前列腺穿刺活检对前列腺特异抗原(PSA)<4ng/ml前列腺癌诊断的临床价值。方法59例PSA<4ng/ml疑为前列腺癌的患者行经直肠超声引导下前列腺多点穿刺活检,观察前列腺内结节声像图特点,并病理分级,对照分析活检术式的检出情况。结果59例患者中经病理证实前列腺癌16例,检出率为27%,其中12例声像图显示前列腺结节性病变,均分布于外腺,且血流增加较良性病变及癌前病变高。结节区域定点穿刺的检出率较六点系统穿刺活检术高(P<0.05);活检阳性点数占所有活检点数比率为51.2%,病理分级中分化程度占56.25%,低分化程度占31.25%。结论结合经直肠超声声像图和前列腺多点穿刺活检可提高PSA<4ng/ml的前列腺癌检出率,对前列腺癌的早期诊断非常必要。     

经直肠超声诊断前列腺癌的临床价值

目的探讨经直肠超声检查前列腺癌的临床价值。方法应用经直肠超声对临床拟诊53例前列腺癌患进行检查，观察前列腺内腺及外腺回声，发现形态不规则低回声区，仔细分辨与周围组织的关系，并行彩色及能量多普勒血流显像。结果经穿刺活检及手术病理证实46例为前列腺癌，7例为前列腺增生，诊断符合率为86．8％。结论经直肠超声显示前列腺癌声像图的敏感性及特征性较腹部超声明显增高，结合直肠指检(DRE)及前列腺特异性抗原(PSA)测定可提高前列腺癌的检出率。     

经直肠彩超引导下穿刺活检诊断前列腺微小癌的临床意义

目的探讨经直肠超声引导下前列腺结节穿刺活检对前列腺癌的诊断意义。方法对30例血清前列腺特异性抗原(PSA)<4.0ng/ml经直肠前列腺超声检查中发现的可疑结节进行穿刺活检。结果30例前列腺结节中前列腺增生17例,前列腺增生并炎症11例,前列腺结核1例,前列腺癌2例。结论经直肠超声引导下前列腺结节穿刺活检有助于提高前列腺癌的诊断。     

经直肠超声引导下经会阴前列腺改良穿刺法的价值

目的评价经直肠超声（transrectal ultrasonography，TRUS）引导下经会阴前列腺改良穿刺法在前列腺穿刺活检中的作用，以期寻找有助于提高前列腺癌（Prostatic Cancer PCa）检出率的手段或方法。方法对151例前列腺特异性抗原（prostate specific antigenPSA）升高（〉4ug／L）和（或）TRUS发现有结节的患者在经直肠超声引导下经会阴行前列腺改良穿刺活检，穿刺标本送病理检查。结果151例患者中，共检出PCa49例（32％），上皮内瘤12例（8％），慢性炎症48例（32％），良性增生42例（28％）。与标准系统穿刺法相比，改良穿刺法可将PCa的检出率提高18％。本组资料有25例（17％）的患者术后出现血尿，无其它并发症发生。结论经直肠超声引导下经会阴前列腺改良穿刺法，有助于提高PCa的检出率。     

经直肠超声引导前列腺穿刺并发直肠大出血及其处理

目的　探讨经直肠超声 (transrectal ultrasound,TRUS)引导前列腺穿刺活检引起的直肠大出血及其处理方法。方法　回顾性总结 10 96例次 TRUS引导前列腺穿刺活检引起的 11例直肠大出血的临床资料。结果　在 11例患者中 ,前列腺癌 (prostatic carcinoma,PCA) 5例 ,良性前列腺增生 (benign prostatic hyperplasia,BPH) 4例 ,前列腺上皮内肿瘤 (prostatic intraepithelial neoplasm ,PIN) 1例 ,前列腺炎 1例 ;7例直肠大出血自行停止 ,4例出血不止 ,并出现生命体征异常 ,需要局部止血和输血。结论　尽管 TRUS引导前列腺穿刺活检可能引起多种并发症 ,但一般不需处理 ,即便并发直肠大出血也能有效地治疗 ,因此 ,它仍然是诊断前列腺癌的可靠方法。     

Prostate-specific antigen and prostate volume: A meta-analysis of prostate cancer screening criteria

Objective: To establish the value of serum prostate-specific antigen (PSA) and prostatespecific antigen per unit volume of prostate gland (PSAD) in detecting prostate carcinoma (CaP) in a hypothetical screening algorithm, a meta-analysis of the sensitivities, specificities, predictive values and likelihood ratios were combined from the published data. Data Sources: Journal articles identified by a MEDLINE database search from 1988 to October 1992, using prostate-specific antigen as a key word were used to calculate the distribution of PSA in healthy men, men with benign prostatic hyperplasia (BPH) and men with prostate carcinoma (CaP) Study Selection: Only studies that contained the specified serum PSA values and patient outcomes were included. Data Extraction: The distributions of the serum PSA were plotted versus serum PSA for healthy men (2567), men with BPH (798) and men with CaP (835) from the abstracted data. Prostate volume distributions were estimated from the published transrectal ultrasound (TRUS) calculations. Data Synthesis: Hypothetical cohorts of 1,000 men between the ages of 60 and 70 years were screened using three different screening decision algorithms. Using a serum PSA cutoff of 3.0 ng/ml for referral for transrectal biopsy, 59 of 80 (74%) CaP would be detected and 21 (26%) would be missed. 209 transrectal biopsies would be performed, and 150 (72%) of them would be negative for CaP. Using a serum PSA cutoff of 4.0 ng/ml, 52 of 80 (65%) CaP would be detected and 28 (35%) would be missed. 146 transrectal biopsies would be performed, and 94 (64%) of them would be unnecessary. Using a cutoff of 2.0 ng/ml for serum PSA and 0.1 ng/ml/cc for PSAD, 55 of 80 (69%) of the cancers would be detected and 25 (31%) would be missed. Only 84 transrectal biopsies would be performed, and 29 (35%) of them would be negative for cancer. Conclusion: This algorithm maximizes the number of cancers detected (true-positive cases) and at the same time reduces the number of false-positive cases, minimizing the number of patients who would have to receive an unnecessary transrectal biopsy, compared to using a serum PSA cutoff of 3.0 or 4.0 ng/ml. © 1993 Wiley-Liss, Inc.     

经直肠能量多普勒超声在前列腺穿刺活检中的临床价值

目的：探讨经直肠能量多普勒超声（PDU）在前列腺穿刺活检中的临床应用价值,提高前列腺癌的诊断率。方法：对临床高度怀疑前列腺癌的54例病人在穿刺前完成经直肠二维灰阶超声的常规检查、PDU检查,根据检查结果选择经直肠二维灰阶超声、PDU及两者联合使用靶向穿刺结合6点前列腺系统穿刺活检方案。对比分析直肠二维灰阶超声、PDU靶向穿刺活检诊断前列腺癌的敏感性、特异性、阳性预测值、阴性预测值。结果：经直肠PDU检查发现异常血流增多37例,其中前列腺癌23例（包括2例为灰阶超声无异常发现的位于外腺的前列腺癌）,前列腺增生症11例,前列腺癌不能除外1例, 前列腺占位1例（未定）,转移性前列腺癌1例（膀胱癌）。结论：经直肠PDU能提高前列腺癌检测的敏感性与定位适合穿刺点,经直肠PDU靶向穿刺活检病理Gleason评分更高。     

超声引导穿刺活检确诊无症状性炎性前列腺炎

目的回顾性总结无症状性炎性前列腺炎（asymptomatic inflammatory prostatitis，AIP）的临床和声像图特征。 方法1468例次患者因为怀疑前列腺癌而行经直肠超声引导前列腺穿刺活检，其中84例确诊为AIP。 结果59例血清前列腺特异性抗原增高（〉4ng／ml），占70．2％（59／84），范围为4．3～45．3ng／ml，平均17．3ng／ml；32例声像图显示前列腺外腺有局限性低回声病灶，4例为外腺弥漫性低回声病变，另外48例声像图未发现前列腺外腺病灶。 结论AIP患者可以出现前列腺外腺低回声病变，但大部分患者前列腺外腺无声像图异常，AIP的最终确诊仍然需要前列腺液检查或穿刺活检。     

经直肠前列腺超声造影靶向活检诊断前列腺癌的可行性研究

目的评价超声造影对前列腺癌(PCa)的诊断价值,探讨PCa靶向活检(TB)的可行性。方法对164例前列腺特异度抗原(PSA)水平≥4ng/ml患者,在接受前列腺活检前行前臂静脉注射声诺维2.4ml (29.5μg),经直肠超声(TRUS)前列腺超声造影(CEUS)检查,评估CEUS的声像图表现。对92例CEUS显示前列腺异常灌注区行TB;并对260例PSA≥4ng/ml患者行前列腺系统活检(SB),然后对TB和SB的病理结果进行对比分析。结果 92例CEUS显示前列腺异常灌注区的患者于TRUS引导下行TB,平均每位患者取活检标本12.6条,病理诊断PCa阳性率66.3%(61/92),未见癌细胞33.7%(31/92);SB病理诊断PCa 19.6%(51/260),未见癌细胞199例76.5%(199/260),TB对PCa检出率明显高于SB的19.6%(优势比=3.3,P=0.002 7)。CEUS提示PCa的声像图表现多种多样:强对比增强、快速对比增强、血管灌注异常和低对比增强。结论 TRUS引导下CEUS靶向活检,可提高组织材料的质量,使患者避免不必要的穿刺,减少穿刺次数,从而提高PCa的诊断率,超声造影TB和SB结合,可以获得PCa较高的检出率,有较高的临床应用价值。     

Role of transrectal ultrasonography in the prediction of prostate cancer: artificial neural network analysis.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic performance of an artificial neural network (ANN) model with and without transrectal ultrasonographic (TRUS) data. METHODS: Six hundred eighty-four consecutive patients who had undergone TRUS-guided prostate biopsy from May 2003 to January 2005 were enrolled. We constructed 2 ANN models. One (ANN_1) incorporated patient age, digital rectal examination findings, prostate-specific antigen (PSA) level, PSA density, transitional zone volume, and PSA density in the transitional zone as input data, whereas the other (ANN_2) was constructed with the above and TRUS findings as input data. The performances of these 2 ANN models according to PSA levels (group A, 0-4 ng/mL; group B, 4-10 ng/mL; and group C, >10 ng/mL) were evaluated using receiver operating characteristic analysis. RESULTS: Of the 684 patients who underwent prostate biopsy, 214 (31.3%) were confirmed to have prostate cancer; of 137 patients with positive digital rectal examination results, 60 (43.8%) were confirmed to have prostate cancer; and of 131 patients with positive TRUS findings, 93 (71%) were confirmed to have prostate cancer. In groups A, B, and C, the AUCs for ANN_1 were 0.738, 0.753, and 0.774, respectively; the AUCs for ANN_2 were 0.859, 0.797, and 0.894. In all groups, ANN_2 showed better accuracy than ANN_1 (P < .05). CONCLUSIONS: According to receiver operating characteristic analysis, ANN with TRUS findings was found to be more accurate than ANN without. We conclude that TRUS findings should be included as an input data component in ANN models used to diagnose prostate cancer.     

经直肠超声引导下经会阴前列腺10点穿刺活检术对前列腺癌的临床应用

目的探讨经直肠超声（TRUS）引导下经会阴前列腺10点穿刺活检术对前列腺癌的诊断价值。方法对105例前列腺特异性抗原（PSA）〉4 ng/mL、直肠指检异常或TRUS检查发现异常回声的患者行经会阴前列腺10点穿刺活检术,并与病理结果对照分析。结果穿刺活检病理结果证实为前列腺癌42例,阳性率40.0%;前列腺增生50例,占51.4%;不典型增生9例,占8.6%。结论 TRUS引导下经会阴前列腺10点穿刺准确率高,并发症少而轻,是诊断前列腺癌的重要方法之一。     

超声造影诊断前列腺良恶性病变的价值

目的 探讨经直肠超声造影在诊断前列腺良恶性病变中的价值.方法 对60例血清前列腺特异性抗原增高并疑有前列腺疾病患者行经直肠超声榆查,采用SonoVue造影剂结合CPS造影成像技术行超声造影,并观察造影增强方式及增强强度,造影结束同时对患者行经直肠超声引导穿刺活检.对其中38例良、恶性结节患者用ACQ软件绘制时间-强度曲线(TIC),分析造影参数,比较良、恶性间的差异.结果 60例前列腺疾病患者均得到病理证实.良性病变37例,其中结节性病变15例共20个结节,前列腺增生22例.恶性病变23例,结节病灶18例18个,弥漫性病变5例.内腺良性结节超声造影增强方式以均匀增强为主,结节边界清晰;恶性结节以早于正常外腺组织增强为主.恶性结节达峰时间及加速时间均短于良性结节(P<0.05),峰值强度低于良性结节(P<0.05),到达时间良、恶性间差异无统计学意义(P>0.05).超声造影对前列腺病变的良恶性鉴别诊断符合率要高于常规经直肠超声(P<0.05).超声造影诊断的敏感度、特异度和正确率均高于常规经直肠超声,而误诊率、漏诊率均小于常规经直肠超声.结论 经直肠超声造影对前列腺癌的早期发现及对良恶性病变的鉴别诊断均具有一定的临床应用价值.     

超声引导下经会阴部前列腺穿刺活检术的临床应用

目的　探讨超声引导下经会阴部前列腺穿刺活检术临床应用的价值 ,及其与前列腺癌病变之相关因素。方法　回顾性总结了 344例超声引导下经会阴部前列腺穿刺活检的优缺点 ,观察和统计前列腺癌的检出率和发病的相关因素 ,例如 :年龄、 PSA、 PSA密度和前列腺体积。结果　超声引导下经会阴部前列腺穿刺活检的并发症少 ,且没有严重并发症。前列腺癌检出率为 33.72 % ,其检出率与年龄增长密切相关 ,前列腺癌患者血清 PSA和 PSA密度明显高于增生者 ,而前列腺体积不增大。结论　超声引导下经会阴部前列腺穿刺活检因并发症少 ,检出率较高 ,有其自身临床应用的优势。 PSA和 PSA密度是指导穿刺活检的重要指标 ,特别是 PSA>10 ng/ml和 PSAD>0 .15。