经会阴磁共振超声三维定位靶向前列腺穿刺技术对既往穿刺阴性患者的初步应用

目的 验证经会阴磁共振超声三维矩阵定位靶向穿刺技术对提高前列腺穿刺活检阳性率的价值.方法 选取第二军医大学长海医院泌尿外科2015年2月至6月行经会阴磁共振超声三维定位靶向前列腺穿刺活检十系统性前列腺穿刺活检的患者共15例.15例患者既往有至少1次阴性穿刺的病史,有行再次前列腺穿刺活检的指证,且穿刺前多参数磁共振检查提示有可疑发生前列腺癌的位点,前列腺影像报告和数据系统(PI-RADS)评分4～5分,根据磁共振图像对前列腺腺体中的可疑位点进行三维定位(X、y、Z轴3个坐标).全麻后,在经直肠超声引导下行系统性前列腺穿刺活检,后根据三维定位的坐标在经直肠超声图像中进行定位,并根据定位的位置行超声引导下的经会阴前列腺靶向穿刺活检.结果 15例患者中有14例确诊为前列腺癌(93.3％),单纯靶向穿刺活检阳性13例(86.7％),单纯系统性穿刺活检阳性6例(40.0％),系统性穿刺活检阳性而靶向穿刺活检阴性1例(6.7％),靶向穿刺活检阳性而系统性穿刺活检阴性8例(53.3％),系统性穿刺活检和靶向穿刺活检均为阴性1例(6.7％).两种穿刺方法阳性率差异有统计学意义(P=0.002).结论 经会阴磁共振超声三维定位靶向前列腺穿刺技术可以准确定位并靶向穿刺磁共振显示的可疑位点,对经直肠系统性穿刺活检易漏诊的位置具有较好的诊断效能,但其确切的效果仍需大样本的病例验证.

Initial application of MRI and ultrasound three-dimensional matrix positioning technique for transperineal targeted prostate biopsy in patients with previous negative prostate biopsy

Objective: to validate the transperineal targeted prostate biopsy with MRI and ultrasound three-dimensional matrix positioning technique, in increasing the positive rate of prostate biopsy. Methods: From 2015.2-2015.6, 15 patient were performed targeted prostate biopsy with this technique plus traditional systemic prostate biopsy. And all the 15 patient met the following criteria: (1) at least one negative prostate biopsy; (2) have the indications to be performed re-biopsy; (3) the MRI showed suspective site of prostate cancer (the PI-RADS scores are 4-5). Before biopsy, all the MRI images were reconstructed and the three-dimensional coordinates(X,Y,Z Axis) were confirmed. After general anesthesia, the biopsy would be performed with the guidence of transrectal ultrasound which could confirm the suspected site in the MRI according to the previous three-dimensional coordinates(X,Y,Z Axis). Results: 14 in 15 were finally diagnosed prostate cancer. 13 targeted biopsies were positive, and 6 systemic biopsies were positive. There is only 1 cases whose targeted biopsy result was negative and systemic biopsy result was positive. And 8 cases with positive targeted biopsy and negative systemic biopsy. Only 1 case was both negative in targeted biopsy and systemic prostate biopsy. Conclusion: MRI and ultrasound three-dimensional matrix positioning technique could accurately locate and targeted puncture the suspected site of prostate cancer in MRI, and it had higher diagnostic efficiency than the traditional transrectal systemic prostate biopsy, especially for the sites which were relatively easy to be missed by systemic prostate biopsy.