MRI/US成像融合引导的经会阴前列腺穿刺活检的单中心研究

目的:评估磁共振/超声(MRI/US)成像融合引导的经会阴前列腺穿刺活检对前列腺癌诊断的价值。方法:回顾性分析2014年9月~2016年3月我院行MRI/US成像融合引导的经会阴前列腺穿刺活检的121例患者资料,每例均行12针系统性穿刺活检(SB)+每个目标靶点(ROI)2针靶向穿刺活检(TB)。活检标本行病理学分析,获知Gleason评分和阳性单针癌组织长度。记录所有患者的临床、影像及病理资料,采用t检验、秩和检验、卡方检验等统计学方法对各项数据进行分析对比。结果:TB的前列腺癌单针阳性率(20.0%)以及高危前列腺癌单针阳性率(10.3%)均明显高于SB(12.7%和5.5%),差异均有统计学意义(P=0.001和P=0.002);TB的阳性单针癌组织长度高于SB,差异有统计学意义(P=0.046);TB的阳性针癌组织主要分化程度的Gleason评分、次要分化程度的Gleason评分、Gleason总评分均高于SB,但差异无统计学意义(P>0.05)。结论:MRI/US成像融合引导的前列腺穿刺活检中的TB较SB能够更有效地检出高危前列腺癌。在条件允许的情况下可推广应用MRI/US成像融合引导的前列腺穿刺活检技术。     

Targeted prostate biopsy： value of multiparametric magnetic resonance imaging in detection of localized cancer

Prostate cancer is the second most common cancer in men, with 1.1 million new cases worldwide reported by the World Health Organization in one recent year. Transrectal ultrasound （TRUS）-guided biopsy has been used for the diagnosis of prostate cancer for over 2 decades, but the technique is usually blind to cancer location. Moreover, the false negative rate of TRUS biopsy has been reported to be as high as 47%. Multiparametric magnetic resonance imaging （mp-MRI） includes T1- and T2-weighted imaging as well as dynamic contrast-enhanced （DCE） and diffusion-weighted imaging （DWI）. mp-MRI is a major advance in the imaging of prostate cancer, enabling targeted biopsy of suspicious lesions. Evolving targeted biopsy techniquesmincluding direct in-bore biopsy, cognitive fusion and software-based MRI-ultrasound （MRI-US） fusion--have led to a several-fold improvement in cancer detection compared to the earlier method. Importantly, the detection of clinically significant cancers has been greatly facilitated by targeting, compared to systematic biopsy alone. Targeted biopsy via MRI-US fusion may dramatically alter the way prostate cancer is diagnosed and managed.     

Prostate volume as an independent predictor of prostate cancer in men with PSA of 10–50?ng ml?1

Prostate volume (PV) has been shown to be associated with prostate cancer (PCa) detection rates in men with a prostate-specific antigen (PSA) in the ‘grey zone'' (2.0–10.0 ng ml⁻¹). However, the PSA ‘grey zone'' in Asian men should be higher because the incidence of PCa in Asian men is relatively low. Therefore, we evaluated the association between PV and PCa detection rates in men with PSAs measuring 10–50 ng ml⁻¹. Men who underwent a 13-core prostatic biopsy with PV documentation participated in the study. A multivariate stepwise regression was used to evaluate whether the PV at time of prostate biopsy could predict the risk of PCa. The rates of PCa among men in different PSA ranges, stratified by PV medians (<60 and ≥60 ml), were calculated. There were 261 men included in the final analysis. PV was the strongest predictor of PCa risk (odds ratio, 0.02; P<0.001) compared to other variables. The PCa rates in men with PVs measuring <60 and ≥60 ml in the 10–19.9 ng ml⁻¹ PSA group were 40.6% and 15.1%, respectively, while the rates for men with PSAs measuring 20–50 ng ml⁻¹ were 65.1% and 26.8%. PV is an independent predictor of PCa in men with PSA measuring 10–50 ng ml⁻¹. In clinical practice, particularly for those countries with lower incidences of PCa, PV should be considered when counselling patients with PSAs measuring 10–50 ng ml⁻¹ regarding their PCa risks.     

磁共振弥散加权结合直肠B超联合定位经会阴前列腺穿刺90例报告

目的：检测前列腺癌影像学诊断新技术一磁共振弥散加权成像（MRDWI）诊断前列腺癌的准确性（敏感度和特异度）,探索TRUS引导的MRDWI图像上可疑病灶穿刺方法,并比较联合MRDWI及TRUS定位与单纯TURS定位经会阴前列腺穿刺活检的准确性。方法：2007年4月～2008年12月间MRDWI或TRUS检查提示可疑前列腺结节的前列腺穿刺患者90例（平均年龄69岁,平均PSA10．9μg／1）;MRI医师、超声医师、泌尿外科医师联合读片确定可疑病灶（MRDwI表观弥散系数减低及B超低回声结节）;穿刺方案为TRUS引导下经会阴可疑病灶穿刺加系统10针前列腺穿刺;MRDWI可疑结节在TRUS图像上的定位方法：在MRDWI上详细定位病灶（病灶直径,病灶中心距中线X,距膀胱颈部L、距前列腺背侧缘距离H）,再在TRUS图像上依据L确定病灶所在横断面,根据X及H确定病灶中心,再测量该横断面上病灶中心距B超探头距离O,在通过病灶中心的纵切面上以高于探头平面O的距离平行进针,即可在TRUS图像上实时精确的穿刺到MRDWI可疑结节。穿刺各针标本注明穿刺部位后分瓶送病理检查;统计各针的影像学诊断及对应的病理,分别计算MRDWI和TRUS的敏感度和特异度。结果：共获963条前列腺穿刺组织标本。前列腺癌阳性针数171个,其中MRDWI阳性123个,敏感度为71．9％（123／171）,阳性预测值（PPV）54．7％（123／225）;B超阳性39个,敏感度为22．8％（39／171）,PPV56．5％（39／69）。阴性针数792个,其中MRDWI阴性690个,特异度为87．1％（690／792）,B超阴性762个,特异度为96．2％（762／792）。MRDWI发现而B超未发现90处（52．6％）,B超发现而MRDWI未发现6处（3．5％）,MRDWI、B超均发现33处,两者均未发现42处（24．6%）。联合定位穿刺敏感度75．4％（129／171）,较之传统B超定位敏感度提高52．6％。结论：MR弥散加权成像诊断前列腺癌的初步结果显示准确性较高,敏感度显著优于TRUS。TRUS引导穿刺MRDWI可疑前列腺结节简单、准确、易行,可藉此联合MRDWI及TRUS联合定位进行前列腺穿刺,提高前列腺癌病灶直接穿刺的敏感度。但目前情况下,仍需要结合系统穿刺来减少漏诊率。