MRI-经直肠超声融合靶向穿刺对有临床意义前列腺癌的检出价值

目的探讨MRI-经直肠超声(TRUS)融合靶向穿刺对有临床意义前列腺癌(PCa)的检出价值。方法前瞻性收集2015年9月至2017年6月苏州大学附属第一医院临床疑诊的PCa患者168例。对多参数MRI(mpMRI)上的可疑病灶进行第二版前列腺图像报告和数据系统(PI-RADS V2)评分。所有患者均行TRUS引导下前列腺系统穿刺,其中108例PI-RAD V2评分≥3分的患者行MRI-TRUS融合靶向穿刺。以穿刺病理结果为金标准,采用χ2检验比较两种穿刺方法对PCa及有临床意义癌的检出率。结果168例中,PCa患者86例101个病灶,非PCa患者82例91个病灶。TRUS系统穿刺检出PCa 78例(46.43%,78/168),MRI-TRUS靶向穿刺检出PCa 63例(58.33%,63/108),二者间差异有统计学意义(χ2=3.73,P=0.035)。168例患者共穿刺2300针,其中经MRI-TRUS靶向穿刺的单针阳性率(51.76%,147/284)高于TRUS系统穿刺(19.64%,396/2016),差异有统计学意义(χ2=142.38,P<0.05)。在所有穿刺阳性病灶中,MRI-TRUS靶向穿刺阳性率(68.69%,147/214)高于TRUS系统穿刺组(38.37%,396/1032),差异有统计学意义(χ2=66.27,P<0.05)。MRI-TRUS靶向穿刺组检出有临床意义PCa占所有阳性病例穿刺针数的69.74%(106/152),TRUS系统穿刺检出有临床意义PCa为54.50%(351/644),两组间差异有统计学意义(χ2=11.67,P<0.05)。结论MRI-TRUS靶向穿刺与PI-RADS V2相结合较系统穿刺可有效提高前列腺的穿刺阳性率,并且能够提高有临床意义PCa的检出率。

The value of multiparametric MRI and transrectal ultrasound fusion guided biopsy in the detection of clinical significant prostate cancer

Objective To evaluate the application of multiparametric MRI(mpMRI)-transrectal ultrasound(TRUS)fusion guided biopsy in the diagnosis of clinical significant prostate cancer(PCa).Methods A prospective analysis was performed in 168 patients with suspected PCa from September 2015 to June 2017 in the First Affiliated Hospital of Soochow University.Suspicious areas on mpMRl were defined and graded using prostate imaging reporting and data system version 2(PI-RADS V2)score.All the patients had the TRUS-guided systematic biopsy,108 patients with PI-RAD V2 scores≥3 had additional MRI-TRUS targeted biopsies.Taking pathologic results as golden standard,the detection rates were compared between the 2 methods usingχ2 test.Results Initially,all of the 168 patients underwent TRUS biopsy.PCa was detected in 86(101 niduses)of 168 patients(51.19%,86/168),82(91 niduses)(48.81%,82/168)were not prostate cancer.Seventy eight(46.43%,78/168)cases of PCa were detected by TRUS biopsy,and 63(58.33%,63/168)cases of PCa were detected by MRI-TRUS fusion guided biopsy,the difference was statistically significant between TRUS biopsy and MRI-TRUS fusion guided biopsy(χ2=3.73,P=0.035).The 168 patients were biopsied with a total of 2300 cores,including TRUS biopsy 2016 cores and MRI-TRUS fusion targeted biopsy 284 cores.Additionally,the detection rate for per cores for MRI-TRUS fusion targeted biopsy(51.76%,147/284)was significantly higher than that for TRUS biopsy cores(19.64%,396/2016)(χ2=142.38,P<0.05).Among patients with a positive biopsy for PCa,the biopsy cores for conventional TRUS biopsy was 1032 comparing to 214 cores for MRI-TRUS biopsy.The suspicious MRI-TRUS fusion targeted biopsy(68.69%,147/214)detected more PCa compared with TRUS biopsy(38.37%,396/1032)(χ2=66.27,P<0.05).Among patients with a positive biopsy for PCa,MRI-TRUS fusion targeted biopsy[69.74%(106/152)]detected more significant cancer cores than TRUS biopsy[54.50%(351/644)](χ2=11.67,P<0.05).Conclusion MRI-TRUS fusion biopsy combined with PI-RADS V2 increases positive rate markedly and improves the detection rate of clinical significant PCa.