应用整体组织病理切片评估相关辅助检查在前列腺癌定位诊断中的价值

目的:探讨以前列腺癌根治术后整体组织病理切片(前列腺大切片)作为"金标准"分别评估DRE、前列腺穿刺活检、MRI、DWI在前列腺癌定位诊断中的价值。方法:回顾性分析2009年10月～2010年3月行腹腔镜前列腺癌根治术19例患者临床资料,除外未行MRI/DWI检查、前列腺手术史、已行内分泌治疗等患者9例,符合条件患者10例,于前列腺癌根治术前收集患者的DRE、前列腺穿刺活检、MRI、DWI资料,术后将前列腺标本制成前列腺大切片。应用"六分区法"对前列腺进行分区,DRE检查记录前列腺结节所在区域,前列腺穿刺活检12针依位置编号将阳性者归入相应区域,与术后整体组织病理进行比对。两位阅片者"盲法"进行阅MRI和MRI/DWI片,每个分区分为5档进行评价:1.正常;2.可能正常;3.不确定;4.可能是癌;5.肯定是癌,当两位阅片者所得结果的平均值≥4时,认定该区域是MRI或MRI+DWI评估为前列腺癌的区域。结果:在10例前列腺癌患者共60个分区中前列腺大切片证实的前列腺癌区域为27个(45%),基底部、中部、尖部的前列腺癌区域分别为8个(40%)、11个(55%)和8个(40%),前列腺癌呈明显的多灶性分布。DRE定位诊断前列腺癌的敏感性、特异性分别为29.6%、72.7%,低于其他检查方法,前列腺穿刺活检定位诊断前列腺癌的敏感性、特异性分别为55.6%、81.8%,与MRI的诊断价值类似(51.9%和84.9%),引入DWI参与前列腺癌的定位诊断,可维持特异性不变的情况下,提高MRI的敏感性至77.8%。对于前列腺尖部、中部MRI诊断的敏感性较差(37.5%和45.5%),但特异性和阳性预测值高(100%和100%),引入DWI可将前列腺尖部、中部MRI诊断的敏感性提高至75%和81.8%。结论:MRI在前列腺癌定位中的价值与前列腺穿刺活检相似,但明显优于DRE;引入DWI可以明显提高MRI定位诊断前列腺癌的敏感性,特别是对于前列腺尖部和中部的肿瘤。

Comparison of digital rectal examination,guided prostate biopsy,magnetic resonance imaging and diffusion weighted imaging in localization of prostate cancer with whole-mount step section pathology

Objective:To evaluate the accuracy of digital rectal examination,transrectal ultrosound-guided biopsy,magnetic resonance imaging and diffusion weighted imaging in localization of prostate cancer with the whole-mount step section pathology.Method:There are 19 patients treated by laparoscopic radical prostatectomy between Oct.2009 and Mar.2010.With the exclusion of absence of MRI/DWI examination,surgery history of prostate and previous hormonal therapy,10 patients were included finally.We collected the information of DRE,TRUS-guided biopsy,MRI and DWI before the radical prostatectomy and made the whole mount step section pathology after surgery.We divided the prostatic gland into sextants,followed by using DRE to locate the nodules,doing 12 TRUS-guided biopsies and numbering them,putting the positive ones into the right sextants.Two doctors read the MRI/DWI without knowing the patients’ information and scored for each sextant.There were 5 point-scales,that was: 1-definitely no cancer,2-probably no cancer,3-possible cancer,4-probable cancer and 5-definite cancer.When the average score=4,we assumed that sextant was evaluated as the prostate cancer region by MRI or MRI/DWI.Result:In 10 patients with 60 sextants,there were 27(45%) prostate cancer sextants approved by whole-mount step section pathologic.The number of prostate cancer sextant was 8(40%),11(55%) and 8(40%) in base,mid and apex part respectively.The sensitivity and specificity of DRE was 29.6% and 72.7%,lower than the other methods.The sensitivity and specificity of the TRUB-guided biopsy localized diagnosis was 55.6% and 81.8%,similar with MRI(51.9% and 84.9%).When considered DWI,the specificity was the same while the sensitivity elevated to 77.8%.As for the apex and mid parts,the sensitivities of MRI were a little bit low(37.5% and 45.5%),but the specificities and positive predictive value were high(100% and 100%).And the sensitivities of MRI for the apex and mid parts were elevate to 75% and 81.8% respectively when DWI was involved.Conclusion:The value of MRI in diagnosing prostate cancer have accuracy similar to TRUB-guided biopsy and better than DRE,the combination of MRI and DWI can elevate the sensitivity of MRI for localized diagnosis in prostate cancer,especially in apex and mid parts of the prostate.