多参数磁共振成像技术在前列腺癌诊断中的应用价值

目的:研究多参数磁共振成像技术(MP-MRI)诊断前列腺癌(PCa)的应用价值。方法:分析62例PCa临床疑似患者的T2加权成像、弥散加权成像、体素内无规则运动核磁成像及动态对比增强成像等MRI数据。结果:62例患者中,MP-MRI诊断PCa的诊断符合率为87.1%,灵敏度为90.5%,特异度为85.4%。结论:MP-MRI在PCa的临床诊断中具有重要价值。     

前列腺特异性抗原联合肿瘤异常蛋白对前列腺癌的诊断价值

目的:探讨前列腺特异性抗原(PSA)水平、游离PSA/总PSA(F/T)比值及肿瘤异常蛋白(TAP)3种肿瘤相关指标单独或联合诊断早期前列腺癌(PCa)的临床价值。方法:随机选取2016年10月～2017年10月安徽医科大学第一附属医院泌尿外科收治的120例PCa患者(PCa组)和192例良性前列腺增生患者(BPH组)为研究对象。所有纳入研究者均行血清PSA、游离PSA(f-PSA)及TAP水平的检测,并计算F/T比值。比较两组PSA水平、F/T比值以及TAP含量分布的差异,分析这3种指标单独或联合对PCa辅助诊断或早期诊断的灵敏度、特异度及准确度。结果:PCa组患者的血清PSA水平高于BPH组(P0.001),而F/T比值小于BPH组(P0.001)。PCa组的TAP阳性表达率明显高于BPH组(P0.001)。PSA诊断PCa的灵敏度、特异度及准确度分别为85.83%、39.06%及57.05%,TAP诊断PCa的灵敏度、特异度和准确度分别为92.5%、49.48%和66.03%,PSA联合TAP诊断PCa的灵敏度、特异度和准确度分别为80.80%、67.19%和72.12%,其特异度和准确度高于单独PSA或TAP对PCa的诊断。TAP对PSA介于4～10 ng/ml灰区内PCa的诊断灵敏度高于F/T比值,特异度及准确度均低于F/T比值,但约登指数高于F/T比值。结论:PSA联合TAP诊断PCa具有灵敏度、特异度和准确度高的特点,对PCa的早期筛查及诊断具有一定临床价值。     

HR-HPV联合液基细胞学在宫颈癌诊断中的价值

目的探讨高危型人乳头瘤病毒(high-risk human papilloma virus,HR-HPV)联合液基细胞学在宫颈癌诊断中的临床价值。方法回顾性分析2015年1月至2017年8月期间在本院接受机会性防癌筛查的9221例妇女的临床资料,其中159例液基细胞学检测异常和/或HR-HPV阳性者接受了阴道镜下活检。观察HR-HPV检测、液基细胞学检测及两种方法共同检查的诊断结果。并以病理检查CINⅡ及以上病变为阳性作为标准,比较不同诊断方法的特异度、灵敏度、阳性预测值、阴性预测值以及准确度。结果 159例受检者中,病理检查结果阴性57例(35.85%),阳性102例(64.15%),其中宫颈癌80例(50.31%)。HR-HPV检测阴性62例,阳性97例,灵敏度为81.37%,特异度为47.37%,阳性预测值为85.57%,阴性预测值为43.55%,准确度为69.78%。液基细胞学检测阴性58例,阳性101例,灵敏度为74.51%,特异度为56.14%,阳性预测值为75.25%,阴性预测值为55.17%,准确度为67.92%。联合检测阴性64例,阳性95例,灵敏度为91.18%,特异度为96.49%,阳性预测值为97.89%,阴性预测值为85.94%,准确度为93.08%。两者联合的诊断灵敏度、特异度、阳性预测值、阴性预测值及准确度均显著高于单独应用HR-HPV或者细胞学检查,差异有统计学意义(P0.05)。结论 HR-HPV联合液基细胞学应用于宫颈癌的诊断,可显著改善诊断效果,降低漏诊率,有较高的临床推广价值。     

基于磁共振表观扩散系数图像的影像组学模型对鉴别前列腺癌和前列腺增生的价值

目的探讨基于磁共振表观扩散系数（ADC）图像的影像组学模型对鉴别前列腺癌（PCa）和前列腺增生（BPH）的诊断价值。 方法回顾性分析2018年12月至2019年5月在南通大学附属建湖医院，经手术病理证实且能确定病理分级的42例患者（PCa 21例、BPH 21例）的ADC图像。应用ITK-SNAP软件勾画兴趣区（ROI），将ADC图像导入Analysis-Kinetics分析软件，进行影像特征提取。采用Lasso回归分析进行特征降维。通过Lasso降维筛选出的特征和相应加权系数乘积的线性组合来建立鉴别PCa和BPH的模型，绘制ROC曲线评价模型鉴别PCa和BPH的预测效能。 结果共提取396个影像组学特征，通过特征筛选后最后筛选出5个影像组学特征。建模后影像组学特征对鉴别PCa和BPH具有较好的预测效能，预测模型在训练组中鉴别效能的曲线下面积、准确度、敏感度、特异度、阳性预测值和阴性预测值分别为0.89、90%、80%、100%、100%和83%；在验证组中的曲线下面积、准确度、敏感度、特异度、阳性预测值和阴性预测值分别为0.96、83%、83%、83%、83%和83%。 结论基于磁共振ADC图像的影像组学模型对诊断前列腺癌和前列腺增生具有一定价值。     

FNAC联合BRAF~(V600E)基因检测对甲状腺癌颈部淋巴结转移的诊断价值

目的探讨细针穿刺细胞学(FNAC)检查联合BRAF~(V600E)基因检测对甲状腺癌颈部淋巴结转移的诊断价值。方法回顾性收集2016年1月至2017年6月期间于江苏省中西医结合医院行甲状腺癌根治术的140例可疑淋巴结转移的甲状腺癌患者,所有患者术前均行超声引导下颈部淋巴结FNAC检查以及BRAF~(V600E)基因检测。以术后病理检查为"金标准",分析FNAC检查和BRAF~(V600E)基因检测单独及联用对甲状腺癌淋巴结转移的诊断价值。结果淋巴结FNAC诊断甲状腺癌淋巴结转移的灵敏度为63.6%(84/132),特异度为100%(8/8),准确率为65.7%(92/140),阳性预测值为100%(84/84),阴性预测值为14.3%(8/56)。BRAF~(V600E)基因检测诊断甲状腺癌淋巴结转移的灵敏度为84.8%(112/132),特异度为100%(8/8),准确率为85.7%(120/140),阳性预测值为100%(112/112),阴性预测值为28.5%(8/28)。FNAC检查联合BRAF~(V600E)基因检测诊断甲状腺癌淋巴结转移的灵敏度为90.9%(120/132),特异度为100%(8/8),准确率为91.4%(128/140),阳性预测值为100%(120/120),阴性预测值为40.0%(8/20)。FNAC检查联合BRAF~(V600E)基因检测(0.955)的受试者工作特征曲线下面积高于FNAC检查(0.818)和BRAF~(V600E)基因检测(0.924)。结论超声引导下颈部淋巴结FNAC检查联合BRAF~(V600E)基因检测提高了甲状腺癌颈部淋巴结转移的诊断效能,值得临床推广。     

结核分枝杆菌相关γ-干扰素定量检测在脊柱结核诊断中的应用

目的探讨结核分枝杆菌相关γ-干扰素定量检测(TB-IGRA)在脊柱结核诊断中的应用价值。方法分析44例疑似脊柱结核病例资料,结合最终临床诊断,分为脊柱结核组和非脊柱结核组,计算TB-IGRA、抗结核抗体(TB-Ab)检测、利福平耐药实时荧光定量核酸扩增检测(Xpert MTB/RIF)及病理学检测4种方法诊断脊柱结核的灵敏度、特异度、阳性预测值和阴性预测值,采用kappa一致性检验评估TB-IGRA与TB-Ab检测、Xpert MTB/RIF及病理学检测结果的一致性。结果纳入的44例患者中,确诊或高度怀疑脊柱结核病28例,确诊非脊柱结核16例。TB-IGRA的灵敏度、特异度、阳性预测值和阴性预测值分别为85.7%、68.8%、82.8%和73.3%;TB-Ab检测的灵敏度、特异度、阳性预测值和阴性预测值分别为53.6%、87.5%、88.2%和51.9%;Xpert MTB/RIF的灵敏度、特异度、阳性预测值和阴性预测值分别为68.8%、71.4%、84.6%和50.0%;病理学检测的灵敏度、特异度、阳性预测值和阴性预测值分别为92.9%、100%、100%和88.9%。TB-IGRA与TB-Ab诊断结果一致性较差(κ=0.25),与Xpert MTB/RIF及病理学诊断结果一致性较高(κ=0.68、0.71)。结论TB-IGRA作为脊柱结核的辅助诊断手段,简便、快速,灵敏度和特异度较高,尤其适用于不方便获取病灶组织的患者。     

甲状腺影像报告和数据系统分级结合超声弹性成像对甲状腺结节的诊断效能

目的探讨甲状腺影像报告和数据系统（Thyroid Imaging Reporting and Data System,TI-RADS）分级结合超声弹性成像对甲状腺结节的诊断效能。方法回顾性收集2014年1～6月期间在四川大学华西医院行超声检查并进行手术的209例甲状腺结节患者（共222个结节）的临床资料,以病理学结果作为金标准,探讨TI-RDAS分级结合超声弹性成像对≤1 cm结节和〉1 cm结节的诊断价值。结果 222个甲状腺结节中,TI-RDAS分级结合超声弹性成像诊断为恶性结节178个,良性结节44个。对于〉1 cm的甲状腺结节,形态不规则（OR=6.376）、存在微钙化灶（OR=21.525）及有被膜浸润（OR=3.852）者的恶性风险高（P〈0.05）;对于≤1 cm的甲状腺结节,纵横比≥1（OR=3.406）和存在被膜浸润（OR=3.922）者的恶性风险高（P〈0.05）,且弹性评分越高,恶性风险越大（OR=1.606,P=0.045）。对于〉1 cm的甲状腺结节,TI-RADS分级联合超声弹性成像的灵敏度为98.3%（59/60）,特异度为68.6%（24/35）,准确率为87.4%（83/95）,阳性预测值为84.3%（59/70）,阴性预测值为96.0%（24/25）,约登指数为66.9%;对于≤1 cm的甲状腺结节,TI-RADS分级联合超声弹性成像的灵敏度为98.5%（67/68）,特异度为30.5%（18/59）,准确率为66.9%（85/127）,阳性预测值为62.0%（67/108）,阴性预测值为94.7%（18/19）,约登指数为29.0%。结论 TI-RADS分级结合超声弹性成像对≤1 cm与〉1 cm甲状腺结节的诊断价值有所不同,但对〉1 cm甲状腺结节其诊断效能更好。     

MSCT静脉造影在下肢静脉成像中的应用

目的探讨MSCT静脉成像（MSCTV）在下肢静脉成像中的应用价值。方法对临床高度怀疑下肢疾病的54例患者进行MSCTV、超声检查、DSA检查。以DSA检查为金标准,对比分析MSCTV和超声检查的诊断效能。结果 DSA检出39例患者有下肢静脉疾病,MSCTV检出38例患者有下肢静脉疾病,超声检出26例患者有下肢静脉疾病。以DSA检查为金标准,超声检查对下肢静脉疾病的诊断的敏感度66.67%（26/39）,特异度100%（15/15）,阳性预测值100%（26/26）,阴性预测值53.57%（15/28）;MSCTV对下肢静脉疾病的诊断敏感度97.44%（38/39）,特异度100%（15/15）,阳性预测值100%（38/38）,阴性预测值93.75%（15/16）。与DSA检查符合率：超声检查为75.93%（41/54）,MSCTV为98.15%（53/54）。结论 MSCTV是一种无创性成像方法,与DSA的成像结果符合率高,对诊断下肢静脉疾病有重要临床意义。     

MRI 3D-LAVA动态增强联合FRFSE序列诊断早期前列腺癌的效能

目的探讨核磁共振成像（MRI）三维容积内插快速扰相梯度回波序列（3D-LAVA）屏气检查动态增强联合快速翻转快速自旋回波序列（FRFSE）对早期前列腺癌的诊断效能。 方法对我院2013年6月至2019年6月210例可疑早期前列腺癌的临床资料进行回顾，均实施MRI 3D-LAVA动态增强、FRFSE序列扫描。总结两种扫描序列的检查结果，分析不同方法诊断早期前列腺癌的效能；另统计多参数磁共振（mpMRI）的诊断结果，绘制受试者工作特征曲线（ROC）评价不同方法诊断早期前列腺癌的效能。 结果早期前列腺癌的构成比为38.10%；早期前列腺癌（+）患者峰值和强化率均高于前列腺癌（-）受检者，且早期前列腺癌（+）患者峰值时间短于后者，强化幅度小于后者，差异均有统计学意义（P<0.05）；MRI 3D-LAVA动态增强联合FRFSE序列诊断早期前列腺癌的灵敏度与MRI 3D-LAVA动态增强、FRFSE序列单独诊断相近，特异度、准确度和曲线下面积（AUC）均高于单独诊断；MRI 3D-LAVA动态增强联合FRFSE序列诊断早期前列腺癌的灵敏度、特异度、准确度均与mpMRI相当，且二者AUC对比差异无统计学意义（P>0.05）。 结论在早期前列腺癌诊断中MRI 3D-LAVA动态增强、FRFSE序列扫描联合检查的效能理想，与病理结果的一致性良好，和mpMRI诊断早期前列腺癌的效能相近。     

PCA3 mRNA与PSA mRNA的联合检测对前列腺癌早期诊断的临床意义

目的评价外周血前列腺癌抗原基因-3（prostate cancer antigen3,PCA3 mRNA）和前列腺特异性抗原基因（prostate specific antigen,PSA mRNA）联合检测对前列腺癌（PCa）早期诊断的价值,及决定是否进行前列腺穿刺活检。方法纳入41例PCa和69例前列腺增生（BPH）患者的外周血,采用RT—PCR方法对其PCA3mRNA和PSAmRNA进行检测,通过受试者工作特征（ROC）曲线评价其在预测前列腺穿刺活检结果和PCa早期诊断的价值。结果PCa组外周血PCA3mRNA含量明显高于BPH组[2362（〈30～7421）拷贝／ml比〈35拷贝／ml,z=-6．66,P〈0．01],而PSAmRNA含量也明显高于BPH组[3425（908～36639）拷贝／ml比〈220拷贝／ml,z=-6．40,P〈0．01];ROC曲线显示当PCA3mRNA和PSAmRNA临界值分别为846拷贝／ml和280拷贝／ml时,诊断早期PCa结果为73．2％（30／41）、85．4％（35／41）,特异度分别为87．0％（60／69）、78．3％（54／69）;而联合检测时其敏感度可增至90．2％（37／41）,特异度上升为89．9％（62／69）。结论外周血PCA3mRNA和PSAmRNA检测都是PCa诊断的良好指标,而它们的联合检测可弥补PCA3mRNA敏感性低和PSAmRNA特异性低的缺点,更有利于早期PCa诊断。     

Validation of an MRI-based prostate cancer prebiopsy Gleason score predictive nomogram

Background:Gleason score grading is a cornerstone of risk stratification and management of patients with prostate cancer (PCa). In this work, we derive and validate a nomogram that uses prostate multiparametric magnetic resonance imaging (MP-MRI) and clinical patient characteristics to predict biopsy Gleason scores (bGS).Materials and methods:A predictive nomogram was derived from 143 men who underwent MP-MRI prior to any prostate biopsy and then validated on an independent cohort of 235 men from a different institution who underwent MP-MRI for PCa workup. Screen positive lesions were defined as lesions positive on T2W and DWI sequences on MP-MRI. Prostate specific antigen (PSA) density, number of screen positive lesions, and MRI suspicion were associated with PCa Gleason score on biopsy and were used to generate a predictive nomogram. The independent cohort was tested on the nomogram and the most likely bGS was noted.Results:The mean PSA in the validation cohort was 9.25ng/mL versus 6.8ng/mL in the original cohort (p = 0.001). The distribution of Gleason scores between the 2 cohorts were not significantly different (p = 0.7). In the original cohort of men, the most probable nomogram generated Gleason score agreed with actual pathologic bGS findings in 61% of the men. In the validation cohort, the most likely nomogram predicted bGS agreed with actual pathologic bGS 51% of the time. The nomogram correctly identified any PCa versus non-PCa 63% of the time and clinically significant (Gleason score ≥ 7) PCa 69% of the time. The negative predictive value for clinically significant PCa using this prebiopsy nomogram was 74% in the validation group.Conclusions:A preintervention nomogram based on PSA and MRI findings can help narrow down the likely pathologic finding on biopsy. Validation of the nomogram demonstrated a significant ability to correctly identify the most likely bGS. This feasibility study demonstrates the potential of a prebiopsy prediction of bGS and based on the high negative predictive value, identification of men who may not need biopsies, which could impact future risk stratification for PCa.     

MR弥散加权成像在前列腺癌诊断中的应用价值

目的 探讨MR弥散加权成像(MRDWI)在前列腺癌(PCa)诊断中的应用价值. 方法 临床怀疑PCa患者57例行MRDWI与T_2 WI检查,通过表观弥散系数(ADC)图对可疑病灶进行良恶性评判.并与穿刺或手术病理结果 进行比较,利用曲线下面积(ROC)分析比较MRDWI与T_2 WI在PCa病灶检出中的价值.同时对30例直肠指检无结节,前列腺穿刺活检阴性患者行MRDWI检查,通过ADC值将可疑病灶按照Ⅰ(良性)～Ⅴ(恶性)级标准划分,在经直肠超声横断面上对异常区域进行定位穿刺.评价以MRDWI定位再次穿刺的价值. 结果 57例患者MRDWI与T_2WI的ROC分别为0.830和0.742,MRDWI诊断敏感性为85%、特异性为82%、阳性预测值80%、阴性预测值86%、准确率为83%;T_2 WI的敏感性为77%、特异性为71%、阳性预测值69%、阴性预测值79%、准确率为74%.MRDWI诊断准确性优于TzWl(P<0.05).30例穿刺定位患者中ADC图诊断为PCa 24例(≥Ⅳ级),BPH 6例(Ⅰ～Ⅲ级).穿刺病理证实为PCa 17例(85%),以Ⅳ级为界划分良恶性,诊断敏感性100%、特异性46%、阳性预测值71%、阴性预测值100%、准确率77%.如果以至少有1个区域为V级划为恶性,则17例PCa患者中DWI诊断恶性13例,敏感性77%、特异性85%、阳性预测值87%、阴性预测值73%、准确率80%. 结论 MR弥散加权成像诊断PCa准确性优于T2加权成像,能有效提高PSA持续升高患者前列腺再次穿刺活检的检出率.     

血清结合PSA对前列腺疾病诊断价值的探讨

目的 :探讨血清中结合前列腺特异性抗原 (cPSA)在前列腺癌 (PCa)诊断中的临床价值。　方法 :用磁微粒子免疫化学发光法测定 110例良性前列腺增生 (BPH)病人和 78例PCa病人cPSA、tPSA ,并计算cPSA/tPSA比值。　结果 :cPSA及cPSA/tPSA比值可有效地区分BPH和PCa(P <0 .0 0 5 ) ,尤其是在诊断灰值区 (tPSA为 4～10 μg/L)时效果更显著。在以tPSA≤10 .0 μg/L和cPSA/tPSA≥0 .78为筛选界值联合对PCa进行筛选时 ,临床概率敏感度为 97.8%,特异性为 95 .8%,阴性预示值为 81.9%,阳性预示值为 96 .5 %。　结论 :cPSA的引入及cPSA/tPSA比值的应用 ,对PCa的诊断具有重要临床意义 ,尤其是在tPSA的诊断灰值区。     

DD3 mRNA在前列腺癌组织中定量表达分析

目的:探讨DD3基因在前列腺组织中表达的临床意义。方法:用荧光定量RT-PCR方法对21例前列腺癌(PCa)组织、27例非前列腺部位的肿瘤组织、39例良性前列腺增生(BPH)组织和15例正常前列腺组织中的DD3的表达进行了定量分析,用ROC曲线对DD3 mRNA诊断PCa的性能进行了分析。结果:27例非前列腺组织中均未检测到DD3基因的表达。DD3在PCa组、BPH组和正常前列腺组表达量的中位数分别为7.2×106、2.5×104、1.5×104拷贝/mg组织。PCa组较BPH组和正常前列腺组DD3的表达量显著增高(P<0.01),而BPH组和正常前列腺组间则差异无显著性(P>0.05)。DD3表达量与临床分期和分化程度之间均无明显相关性。DD3 mRNA曲线下面积(AUC-ROC)为0.937(95%CI:0.879～0.995)。当临界值为1.4×105拷贝/mg组织时,灵敏度、特异度、准确度、阳性预测值(PPV)、阴性预测值(NPV)、阳性拟然比(+LR)、阴性拟然比(-LR)分别为90.5%、85.0%、86.7%、76.0%、94.3%、6.03和0.11。结论:DD3 mRNA的表达仅限于前列腺组织,具有良好的组织特异性。DD3 mRNA表达在PCa组织中显著升高,在正常前列腺和BPH组织中差异无显著性。DD3 mRNA可作为PCa诊断的良好标志物,在PCa早期诊断、微转移诊断、预后判断、指导治疗等方面也具有潜在的应用价值。     

Decision analysis model comparing cost of multiparametric magnetic resonance imaging vs. repeat biopsy for detection of prostate cancer in men with prior negative findings on biopsy

PurposeWe compared cost of multiparametric magnetic resonance imaging (MP-MRI) vs. repeat biopsy in detection of prostate cancer (PCa) in men with prior negative findings on biopsy.MethodsA decision tree model compared the strategy of office-based transrectal ultrasound–guided biopsy (TRUS) for men with prior negative findings on biopsy with a strategy of initial MP-MRI with TRUS performed only in cases of abnormal results on imaging. Study end points were cost, number of biopsies, and cancers detected. Cost was based on Medicare reimbursement. Cost of sepsis and minor complications were incorporated into analysis. Sensitivity analyses were performed by varying model assumptions.ResultsThe baseline model with 24% PCa found that the overall cost for 100 men was $90,400 and $87,700 for TRUS and MP-MRI arms, respectively. The MP-MRI arm resulted in 73 fewer biopsies per 100 men but detected 4 fewer cancers (16 vs. 20.4) than the TRUS arm did. A lower risk of PCa resulted in lower costs for the MP-MRI arm and a small difference in detected cancers. At lower cancer rates, MP-MRI is superior to TRUS over a wide range of sensitivity and specificity of MRI. A lower sensitivity of MP-MRI decreases the cost of the MP-MRI, as fewer biopsies are performed, but this also reduces the number of cancers detected.ConclusionsThe use of MP-MRI to select patients for repeat biopsy reduced the number of biopsies needed by 73% but resulted in a few cancers being missed at lower cost when compared with the TRUS arm. Further studies are required to determine whether cancers missed represent clinically significant tumors.     

Multiparametric magnetic resonance imaging localizes established extracapsular extension of prostate cancer

ObjectiveTo define the accuracy of multiparametric magnetic resonance imaging (MP-MRI) for identifying focal and established extracapsular extension (ECE) in various zones of the prostate.MethodsBetween 2010 and 2013, 342 patients underwent MP-MRI of the prostate (3 T, no endorectal coil with axial perfusion and diffusion images). The findings of the images were reported as negative, suspicious, or positive for ECE by a single expert radiologist. Radical prostatectomy specimens were reviewed to confirm the size and the location of ECE and further defined as focal or established ECE. Established ECE included extension that was multifocal or involving more than 5 glands. The accuracy of MRI in localizing focal and established ECE to each zone of the prostate was determined. Regression analyses were performed to identify predictors of ECE.ResultsWe identified 112 patients who underwent prostate MP-MRI and radical prostatectomy. MRI findings considered suspicious or definite for ECE accurately predicted pathologic ECE (P<0.001). MP-MRI identified established ECE but not focal ECE. Sensitivity, specificity, positive predictive value, and negative predictive value of MP-MRI for established ECE were 70.7%, 90.6%, 57.1%, and 95.1%, respectively. MRI identified ECE to the left vs. right side as well as each zone of the prostate; however, sensitivity was lowest at the apex. On multivariate analysis, MRI was a significant predictor of ECE that was independent of prostate-specific antigen level, Gleason score, and clinical stage.ConclusionMP-MRI is useful for identifying established but not focal ECE in all zones of the prostate. MRI was a significant independent predictor of established ECE and may be a useful adjunct in staging prostate cancer.     

Molecular PCA3 diagnostics on prostatic fluid

BACKGROUND: The PCA3 test on urine can improve specificity in prostate cancer (PCa) diagnosis and could prevent unnecessary prostate biopsies. In this study, we evaluated the PCA3 test on prostatic fluid and compared this with the PCA3 test on urine in a clinical research setting. METHODS: Prostatic fluid and urine samples from 67 men were collected following digital rectal examination (DRE). The sediments were analyzed using the quantitative APTIMA PCA3 test. The results were compared with prostate biopsy results. RESULTS: Using a PCA3 score of 66 as a cut-off value, the test on prostatic fluid had 65% sensitivity for the detection of PCa, 82% specificity and a negative predictive value of 82%. At a cut-off value of 43, the test on urine had 61% sensitivity, 80% specificity and a negative predictive value of 80%. CONCLUSIONS: The PCA3 test can be performed on both urine and prostatic fluid in the diagnosis of PCa with comparable results.     

前列腺特异性抗原相关指标检测对于前列腺癌与良性前列腺增生鉴别诊断的意义

目的 探讨前列腺特异性抗原相关指标检测在前列腺癌(PCa)与良性前列腺增生(BPH)鉴别诊断中的作用.方法 对5家医院107例PCa患者和319例BPH患者的血清总前列腺特异性抗原(t-PSA)、游离前列腺特异性抗原(f-PSA)、结合前列腺特异性抗原(c-PSA)、f-PSA/t-PSA和c-PSA/t-PSA的差异进行分析比较.结果 PCa和BPH患者中,血清t-PSA处于4～20 μw,/L区间者分别达到68.2%和32.9%.血清t-PSA、f-PSA和c-PSA以及f-PSA/t-PSA和c-PSA/t-PSA在PCa组和BPH组之间差异均有统计学意义(P<0.05).只有f-PSA/t-PSA和c-PSA/t-PSA在PCa和BPH组内各年龄组之间差异无统计学意义(P>0.05),结果相对稳定.血清t-PSA在4-20μg/L区间时,以f-PSA/t-PSA<0.16作为诊断PCa的指标,诊断PCa的敏感度、特异度、阳性预测值和阴性预测值分别是89.0%、78.0%、60.7%和94.6%,以c-PSA/t-PSA>0.84作为诊断PCa的指标时,分别是91.8%、81.3%、66.3%和96.1%.结论 PCa和BPH患者血清t-PSA在4～20μg/L区间存在较大重叠.在此区间,f-PSA/t-PSA<0.16和c-PSA/t-PSA>0.84可作为诊断PCa较为理想的标准.     

Evaluation of Prostate Specific Antigen Density and Transrectal Ultrasonography-Guided Biopsies in 100 Consecutive Patients with a Negative Digital Rectal Examination and Intermediate Serum Prostate Specific Antigen Levels

Background : This study was undertaken to assess the importance of prostate biopsies in patients with a negative digital rectal examination (DRE) and elevated prostate specific antigen (PSA) levels and to investigate the role of PSA density (PSAD) and hypoechoic lesions on transrectal ultrasound (TRUS) in increasing the diagnostic sensitivity and specificity for prostate cancer (PCa). Methods : One hundred patients with varied initial symptoms who had a negative DRE and a PSA level between 4 and 20ng/mL underwent TRUS-guided systematic and, if present, lesion-directed biopsies. Results : PCa was detected in 11 patients (11%). TRUS examinations revealed hypoechoic lesions in 31 patients. Lesion-directed biopsies revealed PCa in 1 3% (4/31) of patients with abnormal TRUS whereas, 7% (5/69) of patients with negative TRUS findings had PCa. Additional systematic biopsies detected PCa in 2 patients where lesion-directed biopsies were negative. None (0/19) of the lesions smaller than 0.2 ml on TRUS had PCa whereas, 33% (4/1 2) of patients with lesions greater than 0.2 ml had PCa. When the subgroup of patients with negative TRUS and PSA levels between 4 and 10ng/mL were considered, 25% (1/4) of cases with PCa would have been missed if 0.15 was used as the cut-off point for PSAD, however, this would save 61% (30/49) of unnecessary biopsies. The positive predictive value of PSA (cut-off level lOng/mL), PSAD (cut-off level 0.15), and hypoechoic lesions on TRUS were found to be 11.5%, 33%, and 13%, respectively. When hypoechoic lesions greater than 0.2 mL were taken as the positive finding, the positive predictive value and specificity rates of TRUS increased to 33% and 91 %, respectively, without any change in the sensitivity. Conclusions : In patients with a negative DRE and intermediate PSA levels, the application of PSAD would have saved 49% of study patients with BPH from a biopsy, but would have missed 27% of PCa cases. By ignoring lesions smaller than 0.2 mL on TRUS, a very high specificity of 91% was achieved with a sensitivity of 36%. Thus, further investigations aimed at defining a better mode of diagnosis of PCa are warranted.