经直肠超声造影诊断前列腺癌的临床分析

目的：探讨经直肠超声造影（CE-TRUS）在前列腺癌（PCa）早期诊断方面的特点及其局限性。方法：对128例前列腺特异性抗原（PSA）和/或直肠指检（DRE）异常的患者,分别进行经直肠超声（TRUS）和CE-TRUS检查,其结果再与穿刺活检或根治手术后病理结果进行对比,同时对CE-TRUS异常区域进行靶向穿刺活检的阳性率与系统穿刺活检进行比较。结果：128例可疑患者中有56例被确诊为PCa,CE-TRUS异常的有54例,其中有46例为PCa,敏感性为82.1%,而TURS的敏感性仅为64.3%,CE-TRUS检查仅出现8例假阳性和10例假阴性,其假阳性主要是由于良性前列腺增生和急、慢性前列腺炎引起的,而假阴性则主要是由于原发灶位于外周带和移行带的较低PSA水平患者、小体积癌灶、中高分化肿瘤而导致的。对于CE-TRUS异常的54个病例进行靶向穿刺活检的阳性率为77.4%,远高于系统随机的穿刺活检。CE-TRUS的诊断阳性率与PSA水平有明显相关。结论：对于可疑PCa患者,临床上可以利用CE-TRUS靶向穿刺活检来提高其诊断能力,但也需要充分考虑系统穿刺活检在诊断PCa方面的优势。

Clinical analysis of contrast-enhanced transrectal ultrasonography for the diagnosis of prostate cancer

Objective： To evaluate the role of contrast-enhanced transrectal uhrasonography （CE-TRUS） for diagnosing prostate cancer. Methods： A hundred and twenty-eight cases with abnormal prostate-specific antigen （PSA） and/or digital rectal examination （DRE） were examined by TRUS and CRTRUS respectively, and the results were compared with those by pathology of biopsy or radical retro-public prostectomy. The targeted biopsy in abnormal CE-TRUS areas was also compared to systematic biopsy. Results： Among 128 subjects diagnosed with PCa, 54 cases had abnormal CE-TRUS performance, including 46 cases of PCa with 82.1% sensitivity. And the sensitivity of TURS was only 64.3%. Eight false-positive and ten false-negative findings from CE-TRUS were observed. The false-positive was mainly due to BPH, urgent/chronic prostatitis, while the false-negative was mainly due to the original site located in the peripheral zone or transitional zone with low PSA levels, small volume and high differentiation. In furthermore, the positive rate of targeted biopsy was much higher than that in the system random biopsy in those cases. Significant correlation between the cancer detection rate with CE-TRUS and serum PSA levels were also found. Conclusion： CE-TRUS with targeted biopsy can be used to improve the clinical detection rate of prostate cancer. And systematic biopsy should not be excluded due to the unsatisfied false-positive and false-negative compared to targeted biopsy.