彩色多普勒超声对血清前列腺特异性抗原轻度升高前列腺癌患者的检测价值

目的探讨经直肠彩色多普勒超声在血清前列腺特异性抗原(PSA)轻度升高的早期前列腺癌病灶的检测价值。方法对88例PSA为4.0~20.0ng/ml的患者,穿刺活检术前行经直肠多普勒超声检查,利用彩色直方图软件测定并评价前列腺双侧周缘区血流信号丰富程度,其结果与穿刺活检病理结果比较。利用受试者作业特征曲线(ROC)分析PSA、PSA密度(PSAD)及彩色多普勒超声对周缘区前列腺癌诊断的敏感性、特异性及曲线下面积。结果88例患者经穿刺病理诊断为前列腺癌30例(34.1%),前列腺增生39例(44.3%),前列腺增生伴慢性间质炎症19例(21.6%)。周缘区前列腺癌的彩色血流信号明显高于前列腺增生及前列腺炎症(P=0.0136),ROC曲线分析显示彩色多普勒超声在检测周缘区前列腺癌中的作用优于PSA但不如PSAD,三者曲线下面积分别为0.629,0.542和0.758。经直肠彩色多普勒超声对前列腺癌诊断的敏感性和特异性分别为47.5%和76.5%,PSAD对前列腺癌病灶检测的敏感性和特异性分别为92.3%和24.4%,经直肠彩色多普勒与PSAD相结合在检测周缘区前列腺癌的敏感性和特异性分别为100.0%和80.1%。结论经直肠彩色多普勒超声对提高PSA轻度升高人群中的前列腺癌病灶检出率有一定价值。

Evaluation of color Doppler ultrasonography in detection prostate cancer with intermediate PSA range

Objective To determine the utility of color Doppler transrectal ultrasound in men with prostate specific antigen (PSA)of intermediate range. Methods Grey-scale and color Doppler transrectal ultrasound was performed in 88 consecutive men with serum total PSA levels between 4.0 and 20.0 ng/ml. Vascular accumulation characteristics in the peripheral zone were calculated using BCR (black and white color ratio). Biopsy pathology was used as the standard criteria for receiver operating characteristic (ROC) analysis to compare PSA, PSAD (density) and BCR. Results Biopsy revealed prostate cancer in 30 patients and benign prostate hyperplasia in 39 patients and benign prostate hyperplasia with interstitial inflammation in 19 patients in totally 88 patients. The BCR in the cancer group were markedly increased than those in benign hyperplasia group and prostatitis group (P=0.0136). Areas under the ROC curve for PSAD, BCR and PSA for cancer was 0.758, 0.629 and 0.542, respectively. The sensitivity and specificity of cancer detection on color Doppler transrectal ultrasound was 47.5% ,76.5%, vs 92.3%, 24.4% of PSAD, respectively. High specificity was 80.1% in combination of BCR and PSAD and sensitivity was 100.0% in either positive test alone for cancer detection. Conclusions Color Doppler transrectal ultrasound may be helpful to improve prostate cancer detection rate in patients with PSA of intermediate range.