Evaluation of a prostate biopsy strategy for cancer detection using a computer simulation system with virtual needle biopsy for three-dimensional prostate models

AIM: We evaluated a prostate biopsy strategy for cancer detection using a computer simulation system with virtual needle biopsy for three-dimensional (3D) prostate models. METHODS: Two 3D prostate models with a volume of 25 cc or 50 cc were constructed from computed tomographic images of radical prostatectomy specimens. The peripheral zone (PZ) and transition zone (TZ) were arranged in the prostate models according to the anatomical information. Four thousand patterns of cancer lesions were automatically inserted into each prostate model with a proportion of 75% in PZ and 25% in TZ. Average hit rates (AHR) in prostate models were evaluated both with an increased number of biopsy cores and various angles of virtual needle biopsy. The influence of adding secondary tumors for hit rates was also evaluated. RESULTS: For both sizes, the laterally angled biopsy in 4-8 core biopsy schemes showed higher AHR than the vertical plane biopsy, while the vertical plane biopsy in 10-18 core biopsy schemes showed higher AHR than the laterally angled biopsy. A higher number of biopsy cores increased the AHR of secondary tumors. CONCLUSIONS: Our results suggest that it is important in prostate cancer detection to change the needle placement according to the number of biopsy cores and the size of the prostate.     

Investigating the distribution of prostate cancer using three-dimensional computer simulation

The objective of this work was to investigate the distribution of prostate cancer using three-dimensional (3-D) computer simulation. Two hundred and eighty-one 3-D computer prostate models were constructed from radical prostatectomy specimens. An algorithm was developed which divided each model into 24 symmetrical regions, and it then detected the presence of tumor within an individual region. The distribution rate of prostate cancer was assessed within each region of all 281 prostate models, and the difference between the rates was statistically analyzed using Mantel-Haenszel methodology. There was a statistically significant higher distribution rate of cancer in the posterior half (57.2%) compared to the anterior half ( 40.5%; P=0.001). The base regions (36.8%) had a statistically significant lower distribution rate than either the mid regions (56.3%; P=0.001) or the apical regions (53.5%; P=0.001). The mid regions did have a statistically significant higher distribution rate compared to the apical regions (P=0.032). There was no statistically significant difference between the distribution rate on the left half (48.5%) compared to that on the right half (49.2%; P=0.494). The spatial distribution of prostate cancer can be analyzed using 3-D computer prostate models. The results illustrate that prostate cancer is least commonly located in the anterior half and base regions of the prostate. Through an analysis of the spatial distribution of prostate cancer, we believe that new optimal biopsy strategies and techniques can be developed.     

超声引导下经会阴与经直肠前列腺穿刺活检在前列腺癌诊断中的应用价值

目的 对比分析B超引导下经会阴前列腺穿刺活检(TPBx)与经直肠前列腺穿刺活检(TRBx)在前列腺癌诊断中的应用效果,从而为临床选择合适前列腺穿刺方法提供依据.方法 选择本院2012年11月至2015年12月临床疑似前列腺癌患者171例作为研究对象,根据患者的穿刺方式分为经会阴组(TPBx) 89例和经直肠组(TRBx) 82例,分析肿瘤检出率、并发症发生率、疼痛评分、手术时间.结果 TPBx组和TRBx组在肿瘤检出率、总体并发症发生率方面没有差异,直肠出血TRBX组发生率更高,而TPBx组疼痛发生率高,手术时间长于TRBX组.结论 TPBx和TRBx都能有效地检出前列腺癌,TRBx发生直肠出血较多,而TPBx需要更长的操作时间和增加疼痛.     

经会阴前列腺穿刺与经直肠前列腺穿刺活检在前列腺癌诊断的初探

目的 对比经会阴与经直肠前列腺穿刺活检在前列腺癌诊断中的阳性率及并发症。方法 回顾分析2017年1月到2019年12月行前列腺穿刺活检的病例,经直肠组187例,经会阴组68例。结果 经直肠组阳性穿刺率为34.7%,经会阴组阳性穿刺率为29.4%,两组无统计学差异（P>0.05）。穿刺后经直肠组和经会阴组的血尿发生率分别为40.1%、42.6%,尿潴留发生率分别为6.9%、7.3%,直肠出血发生率分别为1.1%、0%,差别无统计学意义（P>0.05）。穿刺后经直肠组和经会阴组的会阴肿胀的发生率分别为2.6%、13.2%,两组有统计学差异（P<0.05）。结论 超声引导下经直肠、经会阴前列腺穿刺活检均为前列腺癌诊断的有效方法。两者穿刺阳性率无明显差异,但并发症各有特点。     

对比超声引导系统穿刺活检与超声造影靶向活检诊断前列腺癌

目的比较前列腺系统穿刺活检（SB）与CEUS靶向活检对前列腺癌（PCa）的检出率。方法选取可疑PCa患者61例随机分为CEUS靶向活检组和SB组,分别进行CEUS靶向活检及11点系统活检,并进行病理学检查。结果 61例病例中,病理检查证实为PCa共19例（19/61,31.15%）,CEUS组漏诊1例,漏诊率1.64%（1/61）。SB组PCa检出率为26.67%（8/30）,CEUS靶向活检组PCa检出率为35.48%（11/31）;11点穿刺活检获得组织330条,其中癌组织21条;CEUS靶向活检获得组织257条,其中癌组织29条。两组PCa检出率差异无统计学意义（P〉0.05）,但CEUS靶向活检组每个靶点获得癌组织的概率（29/257,11.28%）较11点穿刺活检时每个穿刺点获得癌组织的概率（21/330,6.36%）明显提高（P〈0.05）。结论两组对于PCa的检出率无明显差异;CEUS靶向活检可减少穿刺点数,且每个靶点获得癌组织的概率较SB有所提高。     

MRI-spectroscopy-guided prostate biopsy

Prostate cancer is currently one of the main causes of urological practice workload. Patients with negative prostate biopsies may pose serious problems to the urologist in the decision making process for follow-up due to the lack of definitive data in the follow-up algorithm. MRI spectroscopy seems to open a diagnostic window evaluating prostatic metabolic changes. The performance of perineal prostatic biopsy with stabilizer and template enables selective biopsy of the suspect voxels following the spectroscopic study, simulating the Rubick's cube.     

Aspiration biopsy of prostate

Needle biopsy of the prostate has been widely practiced for more than twenty-five years, whereas transrectal aspiration biopsy, first described fifty years ago, has not. We describe our experience using the transrectal aspiration biopsy and correlate the results with histologic studies of the prostate obtained by conventional needle biopsy and surgical specimens. Aspiration needle biopsy of the prostate has a high degree of diagnostic accuracy, it causes minimal inconvenience and discomfort, the results are rapidly available, the ease of entering the suspected area in the prostate is more precise than with conventional needle biopsy, and sampling of prostate can be greater. The disadvantages of aspiration biopsy are that the technique, being unfamiliar to most urologists, must be learned and requires an experienced cytologist for interpretation. Cytologic evaluation by aspiration biopsy and the histologic diagnosis by conventional needle biopsy are complementary.     

Comparison of lidocaine suppositories and periprostatic nerve block during transrectal prostate biopsy

The aim of this randomized prospective and partially double-blind study was to evaluate the efficacy of transrectal lidocaine applied as suppositories in comparison to periprostatic infiltration as methods of reducing pain during transrectal prostate biopsy. 100 patients were randomized to four groups and received either a suppository containing 60 mg of lidocaine 2 h before biopsy, a 120-mg lidocaine suppository 1 h before biopsy, a 120-mg lidocaine suppository 2 h before biopsy, or they were anaesthetized with a periprostatic infiltration of 5 ml 2% lidocaine. In all patients the same 10-core transrectal biopsy technique was performed. Pain was evaluated using a visual pain scale ranging from 0 to 10 points. The mean pain score in the 60-mg (2 h), 120-mg (1 h), and 120-mg (2 h) lidocaine suppository groups was 3.63, 3.56, and 3.58 respectively. The mean pain score of patients receiving periprostatic infiltration was 1.80. No patient showed vegetative symptoms like sweating or hypotonia. No patient had severe pain. Eight of the 9 patients with no pain were in the periprostatic injection group. Thus, all lidocaine suppositories showed a good analgesic effect although a significantly better pain reduction was achieved by periprostatic lidocaine infiltration.     

对比MRI-经直肠超声软件融合导航穿刺与认知融合导航穿刺检出前列腺癌效果

目的 对比MRI-经直肠超声（TRUS）软件融合导航穿刺与认知融合导航穿刺检出前列腺癌（PC）效果。方法 回顾性分析120例疑诊PC患者、共127个病灶,均接受2～3针靶向穿刺（TB）+10针系统穿刺方案经会阴前列腺穿刺活检,并根据TB引导方法将其中73例（78个结节）接受MRI-TRUS软件融合导航穿刺归为A组,47例（49个结节）接受认知融合穿刺归为B组;比较2组经TB检出PC及临床显著性PC（csPC）阳性率、不同大小病灶PC阳性率,以及穿刺2针与3针PC阳性率。结果 A组经TB检出PC阳性率及csPC阳性率分别为55.13%（43/78）及39.74%（31/78）,B组分别为53.06%（26/49）及34.69%（17/49）;组间差异均无统计学意义（P均＞0.05）。对于最大径≤10 mm病灶,A组TB检出PC阳性率高于B组（P＜0.05）;而对于最大径＞10 mm且＜15 mm、≥15 mm病灶,组间TB检出PC阳性率差异均无统计学意义（P均＞0.05）。A组2针与3针TB检出PC阳性率差异无统计学意义（P＞0.05）,而B组3针TB检出PC阳性率高于2针（P＜0.05）。结论 MRI-TRUS软件融合导航穿刺检出PC及csPC阳性率与认知融合导航穿刺相当,但有助于减少TB次数、提高最大径≤10 mm小病灶检出率。     

超声引导的经直肠前列腺穿刺活检术（附121例报告）

为提高前列腺癌的诊断水平，应用端扫式双平面高频（７．５ＭＨｚ）探头的腔内Ｂ超为指引，配以自动弹射式组织芯活检装置，对１２１例可疑前列腺癌患者行经直肠前列腺穿刺活检术。结果：前列腺增生７８例，前列腺癌３３例，前列腺炎１０例。该技术简单、准确、取材满意、并发症少，但必须掌握其适应证，避免不必要的活检，提高对前列腺癌的活检阳性率。