经直肠超声引导前列腺穿刺活检术患者的舒适护理

目的:探讨舒适护理在经直肠超声引导前列腺穿刺活检术患者围手术期的作用。方法:通过实施舒适护理减轻或消除患者的焦虑、恐惧心理,增加患者对手术的了解及信心。结果:66例患者均配合手术顺利完成。术后排尿疼痛15例,尿潴留2例,血尿6例,血便3例,发热10例。患者满意度95.0%。结论:舒适护理应用于前列腺穿刺活检术围手术期可有效提高患者在心理上和生理上的舒适度,对提高护理质量具有重要意义。     

经直肠超声引导10点前列腺穿刺活检诊断前列腺癌临床分析

目的:探讨经直肠彩色多普勒超声引导10点前列腺穿刺活检诊断前列腺癌的临床价值。方法:对71例血清PSA升高和直肠指诊阳性、彩色多普勒出现局部血流增加异常者,行经直肠彩色多普勒超声引导10点前列腺穿刺活检术。结果:71例患者中确诊为前列腺癌者24例(33.8%);前列腺增生28例(39.4%);前列腺炎14例(19.7%);前列腺炎性肉芽肿4例(5.6%);前列腺结核1例。71例患者接受10点前列腺穿刺活检术,有12例(16.9%)术后出现血尿;2例出现血便;1例出现血精,未出现严重的并发症。结论:经直肠彩色多普勒超声引导10点前列腺穿刺活检术是一种安全的方法,有助于提高前列腺癌的早期诊断及前列腺疾病的鉴别诊断。     

Needle aspiration and core biopsy of prostate cancer: comparative evaluation with biplanar transrectal US guidance

Biplanar, transrectal ultrasound (US) guidance of needles was used in the transperineal biopsy of possibly malignant prostatic lesions in 80 patients (83 biopsies). A 22-gauge cytologic needle was used to locate and fixate the lesion, and aspiration specimens for cytologic and histologic evaluation were obtained (with 22- and 14-gauge needles, respectively). Twenty-one 19-gauge needle core biopsies were also performed. Forty-nine patients (61%) had histologically prove adenocarcinoma. The rate of cancer diagnosis was 53% with cytologic evaluation and 54% with histologic evaluation (combined yield, 61%). This included 34% of cancers less than 1.0 cm in diameter and 56% of those 1.0-1.5 cm. Thirteen of 23 (57%) of these lesions were nonpalpable or equivocal on digital rectal examination. These results suggest that transrectal US guidance of thin-needle biopsies is useful in diagnosing early prostate cancer.     

Nonpalpable cancer of the prostate: assessment with transrectal US

Palpable cancer of the prostate is widely believed to be clinically significant. The authors compared the clinical significance of palpable prostate cancer with nonpalpable prostate cancer discovered with transrectal ultrasound (US). A strong association between lesion volume measured with preoperative transrectal US and volumetric measurements in 60 radical prostatectomy specimens permitted the use of tumor size measured with transrectal US as a reasonable estimation of gross tumor volume. In a subsequent clinical series, 147 biopsy-proved cancers were grouped according to size measured at US, the findings at digital rectal examination (DRE), and the Gleason score. For the 147 patients with known prostate cancer, a statistically significant difference between Gleason scores of palpable and nonpalpable cancers could not be demonstrated when the size of the tumor and its location within the prostate were held constant. Assuming that the Gleason score is a reliable indication of malignant potential and clinical significance, the authors conclude that nonpalpable prostatic cancer detected with transrectal US alone may be just as clinically significant as prostatic cancer discovered with DRE.     

Pelvic masses: aspiration biopsy with transrectal US guidance

Biplanar, transrectal ultrasound guidance was used in the transrectal aspiration of two pelvic abscesses, one recurrent tumor, and one sterile, nonmalignant fluid collection. This method provides an alternative path that allows precise localization for aspiration biopsy of pelvic masses.     

直肠超声引导下经会阴前列腺穿刺诊断前列腺癌的临床价值及并发症分析

目的 :探讨经直肠超声检查(transrectal ultrasound,TRUS)引导下经会阴前列腺穿刺诊断前列腺癌的临床价值及并发症的发生情况。方法:81例疑诊为前列腺癌的患者行TRUS引导下经会阴前列腺穿刺活检,对穿刺结果进行分析。分析术后1周内肉眼血尿、发热、下尿路刺激症状、会阴血肿等并发症发生情况。结果:患者均活检成功,前列腺癌阳性率为39.5%。术后1周内,并发症发生率34.6%,其中肉眼血尿30.9%,下尿路刺激症状21.0%,尿潴留16.0%,发热3.7%,会阴血肿1.2%。穿刺针数6~8针时并发症发生率24.0%,显著低于穿刺针数≥9针时并发症发生率51.6%(P0.05)。结论:TRUS引导下经会阴前列腺穿刺是前列腺癌早期诊断的重要方法,阳性率高,并发症少,且操作简单,适合在基层医院推广。     

Multiloculated prostate abscess: treatment with transrectal ultrasound guided transrectal needle aspiration and lavage with the saline and antibiotic

Prostatic abscess is a rare but nevertheless serious disease. It should be diagnosed at an early stage by the combination of clinical examination and transrectal ultrasound, and drained. We treated a 79-year-old case with multiple prostate abscesses (PAs) by using lavage of the saline and antibiotic (cefoxitin) after transrectal ultrasound-guided transrectal puncture and aspiration. We are presenting the transrectal ultrasound images of pre- and postmedication, where we achieved complete success and no relapse was seen in follow-up of 1 year.     

Value of random US-guided transrectal prostate biopsy

One hundred sixty-four men underwent ultrasound-guided transrectal biopsy of a hypoechoic prostatic nodule suspicious for malignancy, and random biopsy of normal-appearing areas of the gland. The contribution of random biopsy to diagnosis, staging, and management of prostatic carcinoma was evaluated. A diagnosis of carcinoma was made in 71 patients (43.3%). Carcinoma was diagnosed at biopsy of only the nodule in 56 of these patients (79%), at both the nodule and random biopsy site in 10 (14%), and only at the random biopsy site in five (7%). Random biopsy did not result in significant alteration of clinical staging. However, management was altered in five patients with positive results at random biopsy only, four of whom underwent surgery. The additional yield from random prostatic biopsy was small but distinct and had clinical relevance. The authors conclude that random biopsy is a useful procedure in the evaluation of patients with prostatic nodules.     

The use of transrectal ultrasound in the diagnosis, guided biopsy, staging and screening of prostate cancer

In the authors' experience, transrectal sonography has the ability not only to stage prostatic cancer accurately, but also to detect such lesions before they become palpable.     

Detection of prostate cancer with three-dimensional transrectal ultrasound: correlation with biopsy results

Objectives

The aim of this study was to evaluate the role of three-dimensional transrectal ultrasound in the diagnosis of prostate cancer.

Methods

A total of 112 patients with elevated serum prostate-specific antigen (PSA) or a positive digital rectal examination were evaluated using three-dimensional greyscale transrectal ultrasound (3D-GS TRUS) and three-dimensional power Doppler sonography (3D-PDS). Target biopsies were obtained together with 12 core systematic biopsies. Pathological results were correlated with the imaging data.

Results

Cancers were detected in 269 biopsy sites from 41 patients. 229 sites of cancer were depicted by 3D-GS TRUS and 213 sites were depicted by 3D-PDS. 30 sites were missed by both 3D-GS TRUS and 3D-PDS. Abnormal prostate images depicted by 3D-GS TRUS and 3D-PDS were associated with lesions with a Gleason score of 6.9 or higher.

Conclusion

The detection rates of prostate cancer were significantly improved with 3D-GS TRUS and 3D-PDS on serum PSA levels >10 ng ml^–1 or 20 ng ml^–1. 3D-GS TRUS and 3D-PDS may improve the biopsy yield by determining appropriate sites for target and systematic biopsies. The abnormalities detected by 3D ultrasound were associated with moderate- and high-grade prostate cancers. However, based on the number of false-negative TRUS results, the use of systematic prostate biopsies should not be eliminated.Prostate cancer is a common malignancy in older males. Previous autopsy studies have shown that one-third of males over 50 years old have latent cancer, yet only 10% develop clinically significant carcinomas during their lifetime [1]. The exact mechanism mediating the progression of microfocal cancers into symptomatic forms of the disease has not been elucidated. Since prostate cancers demonstrate remarkably heterogeneous behaviours ranging from slow-growing lesions to aggressive tumours that metastasise rapidly [2], the diagnosis and treatment of prostate cancers is very challenging. The current methods of screening for prostate cancer include measuring serum prostate-specific antigen (PSA) levels, digital rectal examination and transrectal ultrasound (TRUS) scanning and biopsy. However, controversy surrounds which screening method is the most clinically significant for detecting lesions.Since approximately 20–50% of prostate cancers are invisible by greyscale (GS) TRUS [3], GS TRUS has limited value for detection of prostate cancer [4,5]. In addition, 35% of lesions missed by GS TRUS are moderate- or high-grade tumours [6]. Colour Doppler ultrasound, as an important adjunct to GS TRUS, could improve detection of prostate cancer, although in one study 16% of cases with clinically significant cancer were still missed by this method [7].Three-dimensional (3D) TRUS is a relatively new imaging modality. Preliminary studies have shown improved cancer detection with 3D TRUS when compared with two-dimensional TRUS [8,9]. However, it is still unknown which malignant lesions may be detected by 3D TRUS. Furthermore, 3D TRUS has not been analysed in correlation with the site-specific biopsy pathological results.The purpose of this study was to assess the role of 3D-GS TRUS and 3D power Doppler sonography (3D-PDS) in the diagnosis of prostate carcinoma. This study correlated 3D-GS TRUS and 3D-PDS data with biopsy pathological results using a site-by-site analysis that included target and systematic biopsies.     

碘伏纱布块在预防经直肠前列腺穿刺活检术后感染中的应用

目的：研究降低经直肠前列腺穿刺活检术后感染的方法。方法2010年5月-2013年3月收我院108例行经直肠前列腺穿刺活检术的患者,随机分成3组,A 组行常规经直肠前列腺穿刺活检术,B 组在经直肠前列腺穿刺活检术前用碘伏纱布块填塞直肠至术后6 h,C 组方法与 B 组相同但碘伏纱布块填塞直肠至术后12 h,比较3组术后感染率。结果 B 组（8.3％）和 C 组（5.6％）术后感染率无显著差异,但较 A 组（19.4％）明显降低（P ﹤0.05）。结论经直肠前列腺穿刺活检术前,用碘伏纱布块填塞直肠至术后6 h,可明显减少术后感染的发生率。     

Stage A adenocarcinoma of the prostate: transrectal US and sonographic-pathologic correlation

Results of transrectal ultrasound (TRUS) of the prostate and pathologic examination of specimens obtained at transurethral resection of the prostate (TURP) were compared in 29 patients with clinical stage A adenocarcinoma. Ten specimens contained no residual tumors larger than 5 mm in diameter; in the remaining 19 glands, 20 discrete cancers were found. At TRUS, 30 peripheral hypoechoic lesions were demonstrated, of which 11 corresponded to carcinoma at pathologic examination. Other hypoechoic peripheral zone lesions included a focal area of dilated acinar glands in 10 cases, post-TURP scarring with fingerlike projections of fibrosis in seven, dysplasia in one, and no correlation in one. Of nine tumors that were not detected prospectively at TRUS, eight were predominantly in the anterior zone and one was in the posterior peripheral zone but was isoechoic. Overall, the sensitivity of TRUS in the evaluation of clinical stage A lesions was 55% and the specificity was 37%. Clinical stage A carcinomas may be difficult to detect at US, and findings are often nonspecific. Any suspicious peripheral zone lesion should undergo biopsy with TRUS guidance before being diagnosed as malignant.     

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。     

经直肠和经会阴活检对前列腺癌诊断价值的Meta分析

 目的 系统性比较了经直肠(transrectal, TR)和经会阴(transperineal, TP)前列腺活检对于前列腺癌的诊断价值。方法 通过检索Pubmed、Embase、Web of science、知网和百度学术等数据库,筛选出直到2018-10的可用研究,并对纳入本研究的5篇文献进行Meta分析,计算95%的置信区间内合并的比值比,用来评估TR和TP在前列腺癌检出率方面的差异。本文共纳入了1561例患者,随机分为TR和TP组。结果 Meta分析显示,接受TP前列腺活检的患者与TR组比较,前列腺癌检出率没有显著改善 (OR=1.09, 95% CI 0.95~1.25)。对于血清前列腺特异性抗原(PSA)水平,两组之间也没有统计学差异 (OR=-0.13, 95% CI -0.71~0.45)。对于前列腺体积,两组之间存在统计学差异(OR=-3.28, 95% CI -6.40~-0.6)。结论 meta分析显示TR和经TP活检对前列腺癌的检出率没有统计学差异。     

Comparison of sonoelastography guided biopsy with systematic biopsy: impact on prostate cancer detection

A prospective study was performed to determine the value of sonoelastography (SE) targeted biopsy for prostate cancer (PCa) detection. A series of 230 male screening volunteers was examined. Two independent examiners evaluated each subject. One single investigator performed ≤5 SE targeted biopsies into suspicious regions in the peripheral zone only. The stiffness of the lesion was displayed by SE and color-coded from red (soft) to blue (hard). Hard lesions were considered as malignant and targeted by biopsy. Subsequently, another examiner performed ten systematic biopsies. Cancer detection rates of the two techniques were compared. Cancer was detected in 81 of the 230 patients (35%), including 68 (30%) by SE targeted biopsy and in 58 (25%) by systematic biopsy. Cancer was detected by targeted biopsy alone in 23 patients (10%) and by systematic biopsy alone in 13 patients (6%). The detection rate for SE targeted biopsy cores (12.7% or 135 of 1,109 cores) was significantly better than for systematic biopsy cores (5.6% or 130 of 2,300 cores, P < 0.001). SE targeted biopsy in a patient with cancer was 2.9-fold more likely to detect PCa than systematic biopsy. SE targeted biopsy detected more cases of PCa than systematic biopsy, with fewer than half the number of biopsy cores in this prostate-specific antigen screening population.     

Current status of transrectal ultrasound-guided prostate biopsy in the diagnosis of prostate cancer

In contemporary practice, most prostate cancers are either invisible on ultrasound or indistinguishable from concurrent benign prostatic hyperplasia. Diagnosis therefore rests on prostate biopsy. Biopsies are not simply directed at ultrasonically visible lesions, as these would miss many cancers; rather the whole gland is sampled. The sampling itself is systematic, using patterns based on prostate zonal anatomy and the geographical distribution and frequency of cancer. This review explains the evolution of the prostate biopsy technique, from the classical sextant biopsy method to the more recent extended biopsy protocols (8, 10, 12, >12 and saturation biopsy protocols). Extended protocols are increasingly being used to improve diagnostic accuracy, especially in those patients who require repeat biopsy. This trend has been facilitated by the ongoing improvement in safety and acceptability of the procedure, particularly with the use of antibiotic prophylaxis and local anaesthesia. The technical details of these extended protocols are discussed, as are the current data regarding procedure-related morbidity and how this may be minimized.