经直肠超声造影在前列腺癌诊断中的应用

目的探讨经直肠超声造影在前列腺癌诊断的应用价值。方法选择98例血清前列腺特异性抗原(PSA)≥4ng/mL,行经直肠前列腺超声检查及造影检查,最终以病理结果作对照,分析常规超声与超声造影的图像特征。结果超声造影诊断前列腺癌的灵敏度、特异度、准确度分别为87%、92.3%、89.8%;常规超声诊断前列腺癌的灵敏度、特异度、准确度分别为68.3%、75.4%、75%;前列腺结节的超声造影增强模式不同。结论经直肠超声造影对于前列腺癌的敏感度、特异度及准确度均较常规超声检查高,有助于提高前列腺癌的检出率。     

实时超声造影在经直肠前列腺穿刺活检中的应用

目的:探讨实时超声造影技术提高经直肠超声引导下前列腺穿刺活检阳性率的应用价值。方法:PSA异常升高(4~20μg/L)、直肠指检(DRE)异常或前列腺MRI异常的男性患者,经积极肠道准备后进行前列腺穿刺活检,穿刺方案为12+X针(左右侧叶前列腺尖部、中部及基底部腺体各穿刺1针+可疑结节靶向穿刺X针)。穿刺前先对前列腺进行常规超声检查,然后进行超声造影。比较超声造影前后发现前列腺结节内可疑前列腺癌结节数目差异,以及常规超声引导和实时超声造影引导下前列腺穿刺活检前列腺癌检出率的差异。结果:常规经直肠超声发现可疑结节86个,检出前列腺癌57个,阳性率为66.3%。超声造影发现异常结节118个,其中108个检测出前列腺癌,阳性率91.5%。超声造影诊断前列腺异常结节效率明显高于常规经直肠超声(P0.01)。超声造影引导下穿刺检出前列腺癌39例(42.8%),而常规经直肠超声检查仅能检出28例(30.8%),两者差异显著(P=0.033)。结论:实时超声造影可提高前列腺可疑结节的检出率,为前列腺靶向穿刺提供更精确定位。靶向穿刺可有效提高前列腺癌的检出率,有利于早期发现前列腺癌。     

经直肠彩色超声对前列腺癌诊断分析

目的：经直肠彩超检查,对照病理结果,探讨PCa的彩色多普勒超声表现和特征。方法：对经直肠彩超引导下穿刺活检确诊为PCa的30例患者35个恶性结节和BPH的25例患者42个增生结节的回顾,分析在二维声像图和彩色多普勒血流显像中的不同。结果：PCa结节出现在外周带为主,占86％（30／35）,内部以低回声多见,占88％（31／35）;BPH结节多出现在内腺,占81％（22／42）,内部高低回声均可见。BPH结节和PCa结节血供均增加,但PCa结节比BPH结节血流更丰富,动脉收缩期最高流速峰值、舒张末期血流峰速,加速指数、血流阻力指数明显增高,两者差异有统计学意义（P〈0．05）。结论：经直肠彩超有助于前列腺良恶病变的定性诊断,更有利于穿刺活检的准确定位。     

经直肠超声引导前列腺系统穿刺活检术的并发症

1998年 8月～ 2 0 0 0年 6月 ,对 137例拟诊前列腺癌患者行经直肠超声引导13点前列腺系统穿刺活检术 ,对术后并发症及治疗情况进行分析 ,报告如下。资料和方法　本组 137例。年龄5 1～ 86岁 ,平均 70岁。活检指征 :直肠指诊阳性和 (或 )ＰＳＡ >4ｎｇ/ｍｌ。本组直肠指诊阳性者 5 6例 (4 1% )。ＰＳＡ <4ｎｇ/ｍｌ者 12例 (9% ) ,>10ｎｇ/ｍｌ者 82例 (6 0 % ) ,4～ 10ｎｇ/ｍｌ者 43例 (31% )。门诊患者 31例 ,采用电话随访。术前常规清洁肠道。手术前后 2～3ｄ常规口服氟喹诺酮类抗生素。术后观察出血、感染、疼痛及血管迷走神经反应等情…     

超声造影在直肠超声前列腺穿刺活检中的应用价值

目的：探讨超声造影（CEUS）下直肠超声前列腺穿刺活检诊断前列腺癌的价值。方法：对70例高危前列腺癌患者行前列腺穿刺活检,其中普通直肠超声（TRUS）组穿刺活检34例,CEUS组36例。结果：CEUS组36例患者共接受穿刺282针,平均7．8针;TRUS组34例接受穿刺279针,平均8．2针。CEUS组发现前列腺癌9例,阳性率为25．0％;TRUS组8例,阳性率为23．5％,两组阳性率比较,差异无统计学意义。而穿刺组织条石蜡病理标本显示,CEUS组282针中,阳性针数37针,阳性率为13．1％;TRUS组279针中,阳性针数25针,阳性率为8．9％;两者阳性率比较,差异有统计学意义（P〈0．05）。两组患者穿刺后无严重并发症发生。结论：CEUS下直肠超声引导前列腺穿刺活检安全可靠,可以提高诊断前列腺癌的敏感性。     

经直肠超声造影和磁共振成像诊断前列腺癌的临床价值比较

目的:探讨经直肠超声造影(CEUS)和磁共振成像(MRI)诊断前列腺癌(PCa)有关问题,评价二者的诊断价值。方法:选取有完整相关临床资料的患者48例,对患者行前列腺超声造影及MRI检查,并与病理检查结果进行比较。结果:48例患者经病理检查证实为PCa 30例。经直肠CEUS诊断符合率为77.08%,敏感性为80.00%,与MRI的符合率(79.16%)、敏感性(76.67%)比较,差异无统计学意义(P>0.05),但其特异性(72.22%)低于MRI的特异性(83.33%),差异有统计学意义(P<0.05)。二者联合诊断的符合率为89.58%,敏感性为90.00%,特异性为88.89%,与单独一种诊断比较,差异均有统计学意义(P<0.05)。结论:经直肠CEUS及MRI对PCa的诊断各有优势,经直肠CEUS联合MRI可提高PCa的检出率。     

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。     

前列腺异常声像特征及位置对经直肠超声穿刺活检诊断前列腺癌的影响

目的 探讨经直肠超声检查中异常声像特征及位置对经直肠超声(TRUS)穿刺活检诊断前列腺癌的影响.方法 前列腺特异性抗原(PSA)4~20 ng/ml、发现异常声像和/或合并直肠指检异常的可疑前列腺癌患者410 例,根据声像特征分为低回声、等回声、高回声组,所有患者均行8+X 针的穿刺方法,详细记录患者临床资料及病理结果,比较两组的穿刺结果.结果 总的前列腺癌检出率为27.07%,低回声组前列腺癌穿刺阳性率(34.27%)明显高于等回声(22.77%)和高回声(13.33%)组(P<0.05),Gleason 评分在低、等回声组前列腺癌中无明显统计学差异(P>0.05).左右侧外周带单独存在低回声病例前列腺癌穿刺阳性率无明显统计差异(P>0.05),双侧外周低回声病例前列腺癌穿刺阳性率(46.97%)明显高于左侧(27.27%)与右侧(28.85%)外周带存在低回声病例(P<0.05).结论 PSA4~20 ng/ml,TRUS 存在低回声声像前列腺穿刺率阳性率明显高于TRUS 中等回声、高回声病例病例,双侧外周带存在低回声病例前列腺穿刺阳性率明显高于单侧外周带存在低回声病例.     

直肠超声引导下经会阴和直肠前列腺穿刺活检术诊断灰区前列腺癌的对比研究

正直肠超声引导下经会阴与经直肠前列腺穿刺活检术均是目前诊断前列腺癌的常用方法,诊断前列腺癌各有其优缺点。我院2009年1月至2015年1月行前列腺穿刺活检术共150例,对两种前列腺穿刺方法的阳性率、并发症发生率进行比较,现报告如下。1资料与方法1.1一般资料选择本院2009年1月至2015年1月就诊的前列腺特异性抗原(prostate specific anti-     

经直肠超声引导下前列腺癌穿刺活检的现状与进展

前列腺特异性抗原(PSA)的检测提高了前列腺癌的检出率和诊治率,配合优秀的成像技术引导下的前列腺活检术提高了对较低危险性的前列腺癌(PCa)的检出率和对其临床分期进行判定。然而,如何选择理想的穿刺活检策略,国内始终有许多未解决的问题及分歧;如何运用前列腺癌相关生物预测因子来实现首次活检以及重复活检的检出率的最优化,不同学者们各自都形成了一定的观点。本文综述经直肠超声引导下前列腺癌穿刺活检的现状与进展。     

经直肠超声影像学对前列腺癌病理分级的评估

目的评价经直肠超声引导下前列腺穿刺活检对前列腺癌病理分级的评估作用。方法156例患者,经临床检查及经直肠前列腺穿刺活检病理证实为前列腺癌,由二位有经验超声医师双盲读片,分析前列腺癌的声像图与病理分级之间的关系。结果156例前列腺癌经直肠前列腺穿刺点1014点,阳性穿刺点为660针,阳性率为65．05％,平均每个前列腺癌病人的阳性穿刺点为(4．23±1．73)。不同级别的前列腺癌的声像图具有不同的声像图表现。其中前列腺癌Ⅰ级以非典型性改变为主,夹有低回声结节。前列腺癌Ⅱ级以低回声肿块为主,伴有血流信号浓聚。前列腺癌Ⅲ级以弥漫型低回声病变,可伴有簇状钙化灶及前列腺不对称性肿大。结论经直肠超声引导下前列腺穿刺活检有利于前列腺癌的诊断,超声声像图对判断病理分级有一定作用。     

A prospective randomized trial comparing contrast-enhanced targeted versus systematic ultrasound guided biopsies: impact on prostate cancer detection

BACKGROUND: We performed a prospective randomized trial comparing 5 contrast-enhanced color Doppler (CECD) ultrasound (US) targeted biopsy cores to 10 gray-scale US guided systematic biopsy (SB) cores to determine the impact on the cancer detection rate. METHODS: We prospectively randomized 100 prostate specific antigen (PSA) screening volunteers with an elevated PSA (> or =1.25 ng/ml and free-to-total PSA < 18%) to undergo contrast-enhanced targeted or SB. Contrast-enhanced targeted biopsies with a limited number of five cores were performed into hypervascular areas of the peripheral zone (PZ) during administration of the US contrast agent SonoVue (Bracco, Italy). A subjective grading of the vascularity from 0 to 3 was used: grade 0, no color signal; 1, low density; 2, medium density; and 3, high density of color signals. Ten SBs were obtained in a standard spatial distribution. Cancer detection rates were compared in the groups. RESULTS: Cancer was detected in 16/50 subjects (32%) by targeted biopsy, and in 13/50 patients (26%) with SB. The cancer detection rate was significantly better for the targeted approach (P < 0.04, McNemar). The detection rate for targeted biopsy cores (15.6% or 39/250 cores) was significantly better than for SB cores (6.8% or 34/500 cores, P < 0.001, McNemar). CONCLUSIONS: CECD targeted biopsy detected more cancers than SB with a reduced number of biopsy cores.     

经直肠前列腺穿刺活检中应用不同针径活检针的对比研究

目的:比较不同针径活检针在超声引导下经直肠前列腺穿刺活检中的应用价值。方法:选取2015年1月～2016年10月在我院泌尿外科行超声引导下经直肠前列腺穿刺活检患者100例,采用随机数表法将患者分为观察组与对照组,每组50例,观察组采用16G活检针,对照组采用常规18G活检针,两组均进行相同的系统12针+靶向穿刺方案,由同一名专职医师完成穿刺操作。比较两组间穿刺阳性率以及术后并发症发生率。结果:两组12针系统穿刺阳性率比较差异无统计学意义(36%vs.24%,P=0.190),而靶向穿刺阳性率比较观察组优于对照组(37.5%vs.15.0%,P=0.022)。观察组穿刺阳性率与血清总PSA水平、PSA密度有相关性。两组术后疼痛评分(P=0.629)、术后并发症发生率(P=0.648)比较差异无统计学意义。结论:16G活检针能显著提高前列腺靶向活检阳性率,且术后相关并发症风险并未增加。     

经直肠超声引导前列腺穿刺活检203例临床分析

目的评估经直肠超声引导的前列腺六针穿刺活检在前列腺癌及前列腺其他疾病的诊断和鉴别诊断的价值。方法对指肛检查阳性，血清PSA〉4pg／L及经直肠超声检查前列腺声像图异常怀疑有占位性病变的203人进行经直肠超声引导的前列腺穿刺活检。结果穿刺活检的203例病理结果：良性前列腺增生（BPH）104例占51．24％，前列腺癌（PCa）95例占46．80％，前列腺结核及前列腺平滑肌肉瘤各2例，分别占0．98％。结论经直肠超声引导的前列腺穿刺活检其操作简单，病人痛苦小，并发症少，较安全。在前列腺癌及其他前列腺疾病的诊断与鉴别诊断中有重要的临床价值。     

Direct comparison between transrectal and transperineal extended prostate biopsy for the detection of cancer

AIM: To establish whether extended transrectal (TR) and extended transperineal (TP) biopsies are equivalent in detecting prostate cancer. METHODS: Due to an elevated prostate-specific antigen (PSA) greater than 2.5 ng/mL or abnormal digital rectal examination findings, 783 men underwent a transrectal ultrasound-guided three-dimensional 26-core biopsy, a combination of TR 12-core and TP 14-core biopsies. Using recursive partitioning, the best combination of sampling sites that gave the highest cancer detection rate at a given number of biopsy cores was selected either with a TR or a TP approach. The cancer detection rate and characteristics of detected cancers were compared between the TP 14-core and the TR 12-core biopsies and between selected subset biopsy schemes. RESULTS: Prostate cancer was detected in 283 of the 783 men (36%). There was no statistical difference in cancer detection rate or in the characteristics of detected cancers between TP 14-core and TR 12-core biopsies. As far as the best combination of sampling sites was selected, there was no statistical difference in cancer detection rates or in the characteristics of detected cancers between the TP and the TR subset biopsy schemes up to 12 cores. TP and TR biopsies performed equally, regardless of a history of negative biopsy, a digital rectal examination finding, the PSA level or the prostate volume. CONCLUSIONS: We demonstrated for the first time that extended TP biopsy is as effective as its TR counterpart in detecting cancer and the characteristics of detected cancers, as far as sampling sites are selected to maximize the cancer detection rate.     

经直肠多模态超声与多模态MRI检查对前列腺癌诊断价值的对照研究

目的比较经直肠多模态超声与多模态MRI检查对前列腺癌的诊断价值。方法回顾性分析2016年4月至2018年5月解放军总医院第一医学中心收治的102例可疑前列腺癌患者的临床资料。平均年龄66.1(38.0~85.0)岁,PSA平均值30.1(0.4~227.0)ng/ml,PSA密度(PSAD)平均值0.67(0.02~4.27)ng/ml^2。102例均行经直肠多模态超声(经直肠常规超声、剪切波弹性成像和超声造影)、多模态MRI(T2加权成像、弥散加权成像和动态增强)以及实验室检查。以经直肠超声引导穿刺活检或手术病理结果作为金标准,对比经直肠多模态超声与多模态MRI检查诊断前列腺癌的敏感性、特异性、阳性预测值、阴性预测值、准确性和受试者工作特征(receiver operating characteristic,ROC)曲线的曲线下面积。结果102例中,病理诊断为前列腺癌62例,良性前列腺增生(BPH)40例。并联多模态经直肠超声(即经直肠常规超声、剪切波弹性成像和超声造影检查中任一项结果阳性诊断为前列腺癌)诊断前列腺癌63例,BPH 39例;诊断前列腺癌的敏感性、特异性和准确性分别为98.4%、70.0%和87.3%。多模态MRI检查诊断前列腺癌75例,BPH 27例;诊断前列腺癌的敏感性、特异性和准确性分别为95.2%、60.0%和81.4%。并联多模态经直肠超声和多模态MRI检查诊断前列腺癌ROC曲线的曲线下面积分别为0.842和0.776,差异无统计学意义(P=0.208)。结论并联多模态经直肠超声检查诊断前列腺癌的效能不亚于多模态MRI检查。     

Predictors of prostate cancer on repeat transrectal ultrasound-guided systematic prostate biopsy

BACKGROUND: We analyzed the outcome of repeated transrectal ultrasound (TRUS)-guided systematic prostate biopsy in Japanese men whose clinical findings were suspected of prostate cancer after previous negative biopsies. METHODS: Between January 1993 and March 2002, 1045 patients underwent TRUS-guided prostate biopsy. Among them, 104 patients underwent repeat biopsy due to indications of persistent elevated serum prostate-specific antigen (PSA), abnormal digital rectal examination (DRE) or TRUS, increased PSA velocity, and/or previous suspicious biopsy findings. Several clinicopathological factors were evaluated for their ability to predict the detection of prostate cancer on repeat biopsy. RESULTS: Prostate cancer was detected in 22 of 104 patients (21.2%) who underwent repeat biopsies. PSA concentration and PSA density at both the initial and repeat biopsies, and PSA velocity in men with positive repeat biopsy were significantly greater than those in men with negative repeat biopsy. The incidence of abnormal findings in DRE and TRUS at initial biopsy in men with positive repeat biopsy was also significantly higher than that in men with negative repeat biopsy. However, neither the presence of prostatic intraepithelial neoplasia nor number of biopsy cores at initial biopsy had a significant association with the results of the repeat biopsy. Furthermore, multivariate analysis revealed that PSA and PSA density at both the initial and repeat biopsies, PSA velocity, and DRE and TRUS findings at initial biopsy were independent predictors of malignant disease on repeat biopsy. CONCLUSION: Despite an initial negative biopsy, repeat TRUS-guided biopsy should be carried out to exclude prostate cancer in cases of suspicious clinical findings, such as elevated PSA or PSA-related parameters, or abnormal findings of DRE or TRUS.