经直肠超声造影靶向前列腺穿刺活检在PSA水平为4~20 ng/ml患者中的作用

目的：探讨前列腺超声造影在经直肠前列腺靶向穿刺活检中的临床应用价值.方法选择96例血清PSA在4~20 ng/ml行前列腺穿刺活检的患者，其中50例行经直肠超声前列腺13针系统性穿刺活检；46例先行经直肠前列腺超声造影，后对超声造影异常增强区靶向穿刺加6点常规穿刺，超声造影无异常者同系统性穿刺.比较两组穿刺活检的效率.结果系统性穿刺组前列腺癌的阳性率为22.0％，造影穿刺组为41.3％，两组间对单纯移行区肿瘤的检出率有统计学差异(P＜0.05).系统穿刺组人均穿刺13.0针，单针阳性率为11％；造影穿刺组人均穿刺10.9针，单针阳性率为20％；两组单针阳性率、人均穿刺针数差异均有统计学意义(P＜0.05).超声造影异常的患者单针阳性率明显高于普通超声检查的患者(31.5％ v s 11.3％)，同时人均穿刺针数低于超声引导下系统性穿刺(9.7 vs 13.0针)，差异具有统计学意义(P＜0.05).系统性穿刺组前列腺癌患者总 Gleason评分为74分，人均6.7分，超声造影穿刺组则分别为133、7.0分，两组比较有统计学差异.两组无严重并发症.结论对于PSA＜20 ng/ml 的患者，超声造影对引导经直肠前列腺靶向穿刺活检具有更高的效率，可减轻患者的痛苦.

Transrectal contrast enhanced ultrasound targeted biopsy for prostate cancer detection in PSA 4-20 ng/ml

Objective To evaluate the effect of transrectal contrast enhanced ultrasound (CE-TRUS)guided targeted biopsy for prostate cancer detection in patients with PSA 4-20 ng/ml. Methods 96 patients with PSA of 4-20 ng/ml were involved in this study. 50 patients were assessed by TRUS and experienced TRUS-guided 13-core systemic biopsy (SB). 46 patients were assessed by CE-TRUS (CE),which was performed with intravenous inj ection of contrast agent before biopsy. Patients with suspicious lesions detected by CE-TRUS were underwent targeted biopsy,and the oth-ers with normal images experienced the same procedure with SB. The prostate cancer detection rates and biopsy-related variables of both groups were compared. Results Prostate cancer detection rates were 22.0% in SB and 41.3% in CE (P<0.05). The mean of 13 cores and 9.3 cores per pa-tient was in both groups,respectively (P<0.05). The positive rate of single core was 11% in SB and 20% in CE,with statistically significance (P<0.05). The mean Gleason score detected in SB was 6.7 whereas the mean Gleason score detected in CE was 7.0 (P<0.05). The positive rate of single core was 12% and 31% in prostate cancer subjects in both groups,respectively (P<0.05). No severe complications happened in both groups. Conclusions CE-TRUS has a value in prostate cancer detection with a targeted biopsy approach in patients with PSA 4-20 ng/ml.