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。     

超声引导下经直肠10针前列腺穿刺活检对前列腺癌诊断的研究

目的 探讨超声引导下经直肠10针前列腺穿刺活检术诊断前列腺癌的临床应用价值。方法 回顾性分析104例经直肠10针穿刺活检的可疑前列腺癌患者。在标准6针系统穿刺法基础上改进确定A组穿刺点后,依据前列腺解剖分区,在经直肠B超显示的前列腺冠状切面的两侧外侧区域（B组）及中央区域（C组）增加4针穿刺点,施行前列腺活检,病例标本分别标注送病理学检查。结果 104例患者中42例确诊为前列腺癌,总阳性率为40.4%。其中所设置的A组穿刺位点阳性25例（占总检出阳性的59.5%）,B组位点阳性9例（21.4%）,C组位点阳性8例（19.0%）。假阴性率为4.7%,术后并发症总发生率为15.4%,未出现严重并发症。结论 超声引导下经直肠10针前列腺穿刺活检术安全、可靠,可以作为临床理想的初次前列腺穿刺活检术式之一。     

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.     

经直肠超声引导13点法前列腺穿刺活检术诊断前列腺癌

目的：评价经直肠超声引导13点法前列腺系统穿刺活检术诊断前列腺癌的临床价值。方法：按照Eskew描述的方法,在标准的经直肠超声引导6点法前列腺系统穿刺活检术的基础上,增加在前列腺的中间部位及前列腺两侧旁正中线远侧的穿刺点数,总共穿刺活检13处。将增加的7处活检部位的病理结果与标准的6点法前列腺系统穿刺活检术进行比较,并对经直肠超声引导13点法前列腺系统穿刺活检术的并发症进行了讨论。结果：总共51例患者中有20例确诊为前列腺癌（20/51）,占39%,此20例前列腺癌患者若仅采用标准的经直肠超声引导6点法前列腺系统穿刺活检术,将有5例患者漏诊,占25%。所有接受经直肠超声引导13点法法前列腺系统穿刺活检术的患者无一例出现严重的并发症。结论：经直肠超声引导13点法前列腺系统穿刺活检术可明显提高前列腺癌的临床检出率,是一种安全、有效的前列腺系统穿刺活检术式,值得在临床推广应用。     

经直肠超声引导前列腺穿刺活检的并发症

前列腺癌的早期诊断是降低其病死率的关键。一般认为经直肠超声引导前列腺穿刺活检（ＴＲＵＰＢ）是诊断前列腺癌的常规安全检查方法,但随着此方法的临床广泛应用发现也有不少并发症,发生率可高达 ６４％～７８％［１］。常见的并发症有感染、出血、疼痛和血管迷走神经症状。１感染 ＴＲＵＰＢ最严重的并发症是菌血症,发生率为１６％～７３％,而菌尿的发生率为２０％～５３％,预防应用抗生素可降低感染的发生率［２］。Ｔｈｏｍｐｓｏｎ等［３］对ＴＲＵＰＢ所用穿刺针针尖及患者血液培养发现,引起感染最常见的细菌为厌氧菌中的杆菌类…     

经会阴和经直肠途径前列腺穿刺活检并发症的比较分析

目的:比较经直肠及经会阴前列腺穿刺活检术并发症的发生率,研究发生原因及处理方法.方法:统计北京医院1998～2007年间前列腺穿刺的患者,检索CNKI中国期刊全文数据库2000～2007年间发表有关前列腺穿刺活检术的文献,对并发症数据进行分析比较.结果:北京医院780例经直肠前列腺穿刺活检并发症发生率:肉眼血尿46.3%、血便8.7%、直肠出血0.5%、泌尿生殖系统感染0.9%、排尿困难0.6%、急性尿潴留0.6%、发热1.9%和血管迷走神经反射0.1%.检索前列腺穿刺相关文献共11篇,经直肠组7篇,经会阴组4篇.总例数分别为:2 244例和1 068例.两种穿刺方法阳性率分别为:32.7%和27.4%,差异无统计学意义(P>0.05).两组并发症发生率经直肠组显著多于经会阴组(P<0.01).结论:经直肠与经会阴两种穿刺方式阳性率相似.经会阴前列腺穿刺的并发症少于经直肠前列腺穿刺.     

弥散加权磁共振联合经直肠超声定位的前列腺穿刺活检诊断前列腺癌的价值

目的 探讨DWI在前列腺穿刺活检中的运用价值.方法 回顾性分析2009年1月至2010年12月在我院行常规经直肠超声(TRUS)定位下经直肠前列腺穿刺(A组)的410例患者和DWI联合TRUS定位下行前列腺穿刺(B组)的141例患者资料,按前列腺特异性抗原(PSA)＜10μg/L、10 μg/L≤PSA ＜20 μg/L、20 μg/L≤PSA ＜50 μg/L和PSA≥50 μg/L将A、B两组各分为4个亚组,分别比较DWI联合TRUS定位与单纯TRUS定位下经直肠前列腺穿刺活检的诊断率.结果 A组PSA＜ 10 μg/L、10μg/L≤PSA ＜20 μg/L、20 μg/L≤PSA＜ 50 μg/L和PSA≥50 μg/L的患者穿刺诊断率分别为12.1％、31.1％、48.0％和91.2％,B组中对应的患者穿刺诊断率分别为23.7％、35.5％、66.7％和96.3％,两种穿刺方法的诊断率在PSA＜ 10 μg/L的患者中有统计学差异(x2=4.405,P＜0.05).结论 对于PSA＜ 10 μg/L的可疑患者,建议行DWI及TRUS联合定位的可疑病灶加系统穿刺法,从而提高前列腺穿刺的诊断率.     

直肠超声引导下经会阴前列腺穿刺活检615例并发症分析

目的探讨经直肠超声引导下经会阴部前列腺穿刺活检并发症发生的相关因素。方法回顾性分析经直肠超声引导下经会阴前列腺穿刺活检患者615例,分析并发症发生率和相关因素。结果本组615例中,213例（213／615,34．63％）出现并发症,其中肉眼血尿117例（117／213,54．93％）,尿路刺激征40例（40／213,18．78％）,尿潴留27例（27／213,12．68％）,血管迷走神经反射11例（11／213,5．16％）,血尿合并血精8例（8／213,3．76％）,发热6例（6／213,2．82％）,会阴部肿胀伴出血4例（4／213,1．88％）。穿刺针数与并发症发生存在相关性（P=0．007）。结论经直肠超声引导下经会阴前列腺穿刺活检是早期前列腺癌诊断的安全有效的方法。使用16G或18G穿刺针合理穿刺可以有效降低并发症发生率。     

超声造影检查在经会阴前列腺穿刺活检中的应用价值

目的 探讨超声造影检查在经直肠超声引导下(CE-TRUS)经会阴前列腺穿刺活检中的临床应用价值.方法 病例选择标准:①直肠指检异常;②PSA>10 ng/ml;③PSA 4～10 ng/ml,f/t PSA异常或PSAD值异常,符合以上之一者即入围此研究.共116例入选者,年龄50～84岁,既往均无前列腺手术病史.行6点系统加异常回声处活检,其中PSA＜10ng/ml者25例,10 ng/ml～者25例,20 ng/ml～者11例,>30 ng/ml者55例.行CF-TRUS经会阴前列腺穿刺活检,彩色多普勒超声检查并记录前列腺局灶性病变部位、回声特征及彩色多普勒血流等情况,其中43例行前列腺超声造影,了解并记录异常血流部位.结果 116例患者穿刺活检证实前列腺癌64例,BPH 52例.43例行超声造影检查后活检者,前列腺癌和BPH分别为25及18例,造影组和非造影组前列腺癌穿刺阳性率比较差异无统计学意义(P=0.622).PSA≤30ng/ml组共61例,其中行超声造影23例,发现前列腺癌8例,未造影组38例中发现前列腺癌5例,造影组穿刺阳性率高于非造影组,2组比较差异有统计学意义(P=0.046);PSA>30 ng/ml患者造影和非造影穿刺阳性率(97.1%与85.0%)比较差异无统计学意义(P=0.095). 结论与B超引导下经直肠前列腺活检相比,CE-TRUS经会阴前列腺穿刺活检并发症少而轻.PSA≤30ng/ml患者结合超声造影检查能提高前列腺癌穿刺阳性率.     

MRI定位联合经直肠超声引导下经会阴穿刺诊断前列腺癌

目的观察MRI引导目标穿刺活检(TB)诊断前列腺癌(PCa)的临床应用价值。方法对120例临床疑诊PCa患者行MRI,而后在经直肠超声(TRUS)引导下,分别采用系统穿刺(SB)与MRI定位行经会阴前列腺目标穿刺术(MRI-TB)。根据穿刺病理结果统计SB、MRI-TB及SB+MRI-TB对PCa检出率和穿刺阳性针率。结果病理诊断78例PCa,42例良性病变。SB、MRI-TB对PCa的漏诊率分别为23.08%(18/78)、8.97%(7/78),差异有统计学意义(P=0.048)。SB、MRI-TB及SB+MRI-TB对PCa的检出率分别为50.00%(60/120)、59.17%(71/120)和65.00%(78/120),SB+MRI-TB高于SB和MRI-TB(P均0.05)。SB、MRI-TB及SB+MRI-TB的阳性针率分别为31.17%(374/1 200)、59.58%(286/480)及35.14%(538/1 531),MRI-TB高于SB和SB+MRI-TB(P均0.001)。结论采用MRI-TB方案可提高穿刺阳性针率,减少穿刺点数,降低重复穿刺和并发症风险;联合应用SB+MRI-TB可提高PCa检出率。     

经直肠超声造影引导前列腺穿刺活检诊断前列腺癌

目的探讨经直肠超声造影(CETRUS)引导前列腺穿刺活检对前列腺癌的诊断价值。方法对79例可疑前列腺癌患者分别行常规经直肠超声(TRUS)、CETRUS及经直肠前列腺穿刺活检。以病理结果为标准,对比TRUS、CETRUS和TRUS联合CETRUS引导经直肠前列腺穿刺活检对前列腺癌的诊断效能。结果 79例中,病理诊断为前列腺腺癌36例,前列腺良性增生43例。35例CETRUS见异常征象,其中30例病理诊断恶性,诊断敏感度83.33%(30/36),特异性88.37%(38/43),准确率86.08%(68/79)。39例TRUS见异常征象,其中24例病理诊断为恶性病变,诊断敏感度66.67%(24/36),特异度65.12%(28/43),准确率65.82%(52/79)。TRUS联合CETRUS诊断前列腺癌30例,敏感度83.33%(30/36),特异度72.09%(31/43),准确率77.22%(61/79)。ROC曲线结果显示,TRUS、CETRUS、TRUS联合CETRUS引导前列腺穿刺活检对诊断前列腺癌的AUC分别为0.740、0.859及0.777,CETRUS的诊断效能高于TRUS及TRUS联合CETRUS(Z=2.371、2.858,P=0.018、0.004)。结论 CETRUS引导前列腺穿刺活检对前列腺癌的诊断效能较高。     

Extensive biopsy using a combined transperineal and transrectal approach to improve prostate cancer detection

PURPOSE: Previous studies have indicated that 6-core transrectal prostate biopsy misses a considerable number of cancers. We performed an extensive biopsy protocol of 12-core sampling using both transperineal and transrectal approaches to determine the impact on the cancer detection rate. MATERIALS AND METHODS: We prospectively evaluated 402 men who underwent 6-core transperineal and 6-core transrectal biopsies simultaneously due to abnormal digital rectal examination (DRE) and/or elevated prostate-specific antigen (PSA) levels of 4.0 ng/mL or greater. Using the transperineal approach we obtained four cores from the bilateral peripheral zone targeting the lateral and parasagittal areas and two cores from the bilateral transition zone. The following transrectal biopsy was performed traditionally. We compared cancer detection rate between the extended 12-core procedure and conventional 6-core transperineal and transrectal groups in terms of total PSA and DRE findings. RESULTS: Using the extensive combined method, prostate cancer was detected in 195 cases (48.5%) and the detection rate significantly increased 7.2% and 8.5% compared to the transperineal and transrectal groups, respectively. According to PSA levels and DRE findings, the cancer detection rate by the combined method was significantly improved in patients with PSA levels of 4-10 ng/mL and negative DRE: 10.3% and 11.6% compared to the transperineal and transrectal groups, respectively. CONCLUSIONS: The extensive 12-core method significantly improved the overall cancer detection rate and was especially efficient for men with PSA levels of 4-10 ng/mL accompanied by a negative DRE finding.     

B超引导10点前列腺穿刺法诊断前列腺癌的结果分析

目的探讨经直肠超声引导下10点法前列腺穿刺活检中前列腺癌阳性结果的分布情况。方法本组473例均因PSA>4ng/ml而进行经直肠超声引导下10点法宝前列腺穿刺活检,穿刺点为在标准的系统6点(前列腺旁正中线矢状切面尖部、中部、底部)的基础上,两外侧各增加2针(外侧周缘中部、底部)。本组患者年龄为41～85岁,平均65岁;PSA水平4.1～444ng/ml,平均15.05ng/ml;前列腺体积8.0～160.0ml,平均42.17ml。对穿刺各针的阳性率及各区域独立出现的阳性率进行分析。结果穿刺总阳性率为26.6%(126/473)。前列腺各穿刺部位的阳性率为:外侧底部23.7%(112/473)、外侧中部20.7%(98/473)、底部19.5%(92/473)、中部18.4%(87/473)、尖部23.9%(113/473)。只有该区域出现阳性的分布情况:外侧底部8.7%(11/126)、外侧中部5.6%(7/126)、底部2.4%(3/126)、中部3.2%(4/126)、尖部7.1%(9/126)。各穿刺部位的阳性率具有统计学差异(P<0.01)。结论经直肠超声引导下经直肠前列腺10点法穿刺活检术可明显提高前列腺癌的临床检出率。其前列腺的尖部、外侧底部和外侧中部的穿刺阳性率要比其他部位高。     

The incidence of prostate cancer in men with prostate specific antigen greater than 4.0 ng/ml: a randomized study of 6 versus 12 core transperineal prostate biopsy

PURPOSE: The prostate cancer detection rate in patients with elevated prostate specific antigen (PSA) increases with extended needle biopsy protocols. Transperineal biopsy under transrectal ultrasound guidance is rarely reported, although notable cancer diagnoses are obtained with this technique. We describe the results of 6 and 12 core transperineal biopsy. MATERIALS AND METHODS: A total of 214 patients with PSA greater than 4.0 ng/ml were prospectively randomized to undergo 6 or 12 core transperineal biopsy. Each group of 107 patients was comparable in terms of clinical characteristics. The procedure was performed on an outpatient basis using local anesthesia. Specimens were obtained with a fan technique with 2 puncture sites slightly above the rectum (1 per lobe) under transrectal ultrasound guidance. Cores were taken from all peripheral areas, including the far lateral aspect of the prostate. RESULTS: The overall cancer detection rate was 38% and 51% for 6 and 12 core biopsy, respectively. In patients with PSA between 4.1 and 10 ng/ml the cancer detection rate was 30% and 49% for 6 and 12 core biopsy, respectively. CONCLUSIONS: The 12 core transperineal prostate biopsy is superior to 6 core biopsy. The technique provides optimal prostate cancer diagnosis. About half of the patients with PSA greater than 4.0 ng/ml and a slightly lower percent with PSA between 4.1 and 10 ng/ml have prostate cancer.     

214例前列腺穿刺结果的前列腺癌病灶分布情况分析

目的探讨经直肠超声引导下经直肠前列腺穿刺活检结果的前列腺癌病灶分布情况。方法本组214例,其中214例前列腺特异抗原＞4．0ng/ml 203例,直肠指诊可疑前列腺癌41例；均行13针前列腺穿刺活检术。入选病例的年龄为50～90岁,平均69．8岁；PSA水平0．8～112．3ng/ml,平均18．7 ng/ml；前列腺体积12．3～182．5ml,平均61．3 ml；直肠指诊阴性者173例,阳性者41例。分析各穿刺部位的阳性率。结果5区13针法的阳性率为36．0%(77/214)。前列腺各穿刺部位的阳性率为：底部48/214(22．4%)、中部57/214(26．6%)、尖部57/214(26．6%)、外侧底部47/214(22．0%)、外侧中部61/214(28．5%)。各穿刺部位的阳性率的差异具有显著性(P＜0．001)。结论前列腺穿刺活检发现的前列腺癌病灶分布不均匀。前列腺的尖部、中部和外侧中部的穿刺阳性率较其它部位高。     

Comparison of contrast enhanced color Doppler targeted biopsy with conventional systematic biopsy: impact on prostate cancer detection

PURPOSE: We performed a prospective study to determine whether a limited biopsy approach with contrast enhanced color Doppler ultrasound targeted biopsy of the prostate would detect cancer as well as gray scale US guided systematic biopsy with a larger number of biopsy cores. MATERIALS AND METHODS: We examined 230 male screening volunteers with a total prostate specific antigen of 1.25 ng./ml. or greater and free-to-total prostate specific antigen less than 18%. Two independent examiners evaluated each subject and a single investigator performed 5 or fewer contrast enhanced targeted biopsies into hypervascular regions in the peripheral zone during intravenous infusion of the US contrast agent Levovist (Schering, Berlin, Germany). Subsequently another examiner performed 10 systematic prostate biopsies. The cancer detection rates of the 2 techniques were compared. RESULTS: Cancer was detected in 69 of the 230 patients (30%), including 56 (24.4%) by contrast enhanced targeted biopsy and in 52 (22.6%) by systematic biopsy. Cancer was detected by targeted biopsy alone in 17 patients (7.4%) and by systematic biopsy alone in 13 (5.6%). The overall cancer detection rate by patient was not significantly different for targeted and systematic biopsy (p = 0.58). The detection rate for targeted biopsy cores (10.4% or 118 of 1,139 cores) was significantly better than for systematic biopsy cores (5.3% or 123 of 2,300 cores, p <0.001). Contrast enhanced targeted biopsy in a patient with cancer was 2.6-fold more likely to detect prostate cancer than systematic US guided biopsy. CONCLUSIONS: Contrast enhanced color Doppler targeted biopsy detected as many cancers as systematic biopsy with fewer than half the number of biopsy cores. Although an increase in cancer detection was achieved by combining targeted and systematic techniques in this screening population, contrast enhanced targeted biopsy alone is a reasonable approach for decreasing the number of biopsy cores.     

6针法和13针法前列腺穿刺活检术诊断前列腺癌的分析比较

目的探讨5区13针法和6针法前列腺穿刺活检诊断前列腺癌的差异。方法本组214例,因前列腺特异性抗原>4.0ng/ml或直肠指诊前列腺癌阳性可疑而行13针前列腺穿刺活检术,其中前列腺特异性抗原>4.0ng/ml者203例,直肠指诊前列腺癌阳性可疑者41例。入选病例的年龄为50￣90岁,平均69.8岁;PSA水平0.8￣112.3ng/ml,平均18.7ng/ml;前列腺体积12.3￣182.5ml,平均61.3ml;直肠指诊阴性者173例,阳性者41例。结果6针法和13针法的阳性率分别为30.8(f/214)和36.0(w/214),后者的阳性率提高14.3(/77()P<0.001)。两者的差异在前列腺特异性抗原≤20ng/ml,指诊阴性,体积>40ml,前列腺特异性抗原密度≤0.30,年龄<70岁的患者中更显著。结论5区13针前列腺穿刺活检术比系统6针发现前列腺癌的阳性率更高。