超声与MRI融合导航穿刺在前列腺癌Gleason分级中的应用研究

目的采用MRI与经直肠超声（TRUS）影像融合靶向穿刺方法进行前列腺癌筛查，探讨融合导航穿刺在前列腺癌Gleason分级中的应用价值。 方法选取2016年12月至2019年3月于浙江大学医学院附属杭州市第一人民医院因可疑前列腺癌行穿刺活检的患者150例，所有患者均先行MRI/TRUS融合导航穿刺，再行常规10针系统穿刺。所有穿刺阳性患者均行腹腔镜下前列腺癌根治术，并取得手术病理结果。比较融合导航穿刺与系统穿刺2种方法对前列腺癌的检出率，将2种方法分别与根治手术标本的Gleason评分情况进行对比分析。 结果150例患者中，共检出前列腺癌72例，其中导航穿刺方法前列腺癌检出率为45.3%（68/150），系统穿刺方法检出率为40.7%（61/150），2者比较差异无统计学意义（χ²=0.666，P=0.414）。导航穿刺方法对于Gleason评分≥8分的高危前列腺癌患者的检出率高于系统穿刺（33.8% vs 18.0%），2者比较差异有统计学意义（χ²=4.131，P=0.042）。导航穿刺与根治术标本Gleason评分符合率为72.1%（49/68），系统穿刺为54.1%（33/61），导航穿刺Gleason评分符合率高于系统穿刺法（χ²=4.479，P=0.034）。 结论MRI/TRUS融合导航穿刺获得的前列腺组织标本Gleason分级准确性高，可以增加高危前列腺癌的检出率，为临床治疗决策的制定提供客观依据，其对于前列腺癌的准确诊断和合理治疗具有重要的临床应用价值。

Application of ultrasound and MRI image fusion navigation-guided puncture in Gleason classification of prostate cancer

ObjectiveTo evaluate the value of image fusion navigation-guided puncture in Gleason classification of prostate cancer by comparing magnetic resonance imaging (MRI) and trans-rectal ultrasound (TRUS) image fusion-guided puncture method with systemic puncture. MethodsBetween December 2016 and March 2019, a total of 150 patients with suspicious prostate cancer admitted to the Affiliated Hangzhou First People′s Hospital, Zhejiang University School of Medicine were included. All patients received TRUS/MRI image fusion navigation-guided puncture and then 10-needle systemic puncture. All the patients who had positive puncture results underwent laparoscopic radical prostatectomy to obtain pathological results. The detection rates of the two puncture methods and the consistency between puncture and surgical Gleason scores were compared. ResultsOf the 150 patients, 72 were diagnosed with prostate cancer. The detection rate of navigation puncture was 45.3% (68/150), and that of systemic puncture was 40.7% (61/150); there was no significant difference between the two methods (χ²=0.666, P=0.414). The detection rate of high-risk prostate cancer with Gleason score ≥ 8 was significantly higher in the navigation puncture group than in the systemic puncture group (33.8% vs 18.0%, χ²=4.131, P=0.042). The concordance of Gleason scores between prostate biopsy and radical prostatectomy was 72.1% and 54.1% for navigation puncture and systemic puncture, respectively, and the concordance rate was significantly higher in the navigation puncture group than in the systemic puncture group (χ²=4.479, P=0.034). ConclusionMRI/TRUS image fusion navigation-guided puncture is a more accurate method of obtaining prostate tissue specimens, and it can increase the detection rate of high-risk prostate cancer and provide an objective basis for the formulation of clinical treatment decisions.