靶向穿刺与靶向联合系统穿刺对前列腺PI-RADS评分4~5分患者的诊断效能比较

目的比较靶向穿刺与靶向联合系统穿刺对多参数磁共振(mpMRI)前列腺影像报告与数据系统(PI-RADS)评分4~5分患者的诊断效能。方法回顾性分析2018年1月至2020年2月南京大学医学院附属鼓楼医院378例前列腺PI-RADS评分为4~5分且接受前列腺靶向穿刺联合系统穿刺患者的临床资料。中位年龄69(64,75)岁,中位前列腺特异性抗原9.5(6.7,16.3)ng/ml,中位前列腺体积34.1(23.5,48.4)ml。PI-RADS评分4分240例,5分138例。所有患者均行经会阴前列腺穿刺,在mpMRI/经直肠超声融合图像引导下,先行2针靶向穿刺,再行12针系统穿刺。评估穿刺病理及穿刺阳性的Gleason评分,通过χ²检验或Fisher精确检验比较不同穿刺方式前列腺癌和有临床意义前列腺癌(CsPCa)的检出情况。结果378例中290例阳性,88例阴性。靶向穿刺平均2.4针/例,系统穿刺平均12.0针/例,靶向穿刺与系统穿刺对前列腺癌的检出率差异无统计学意义73.3%(277/378)与68.3%(258/378),P=0.129],对CsPCa的检出率差异无统计学意义55.8%(211/378)与49.7%(188/378),P=0.094],准确率差异无统计学意义79.1%(299/378)与77.8%(294/378),P=0.658],穿刺针数阳性率差异有统计学意义64.2%(580/904)与23.1%(1049/4536),P<0.001]。靶向穿刺与靶向穿刺联合系统穿刺的病理符合率为92.3%(349/378),对前列腺癌的检出率差异无统计学意义73.3%(277/378)与76.7%(290/378),P=0.275],对CsPCa的检出率差异无统计学意义55.8%(211/378)与62.2%(235/378),P=0.076]。靶向穿刺对前列腺癌的漏诊率为4.5%(13/290),对CsPCa的漏诊率为10.2%(24/235)。在PI-RADS评分4分的患者中,靶向穿刺与靶向穿刺联合系统穿刺对前列腺癌的检出率差异无统计学意义65.4%(157/240)与69.2%(166/240),P=0.381],对CsPCa的检出率差异无统计学意义46.7%(112/240)与52.9%(127/240),P=0.171];靶向穿刺的准确率为82.1%(197/240),对前列腺癌的漏诊率为5.4%(9/166),对CsPCa的漏诊率为11.8%(15/127)。在PI-RADS评分5分的患者中,靶向穿刺与靶向穿刺联合系统穿刺对前列腺癌的检出率差异无统计学意义87.0%(120/138)与89.9%(124/138),P=0.452],对CsPCa的检出率差异无统计学意义71.7%(99/138)与78.3%(108/138),P=0.211];靶向穿刺的准确率为73.9%(102/138),对前列腺癌的漏诊率为3.2%(4/124),对CsPCa的漏诊率为8.3%(9/108)。结论对于PI-RADS评分为4~5分的高危前列腺癌患者,靶向穿刺以更少的穿刺针数可获得与靶向穿刺联合系统穿刺相近的检出效果,但仍存在诊断不准确及漏诊的可能。

Analysis of diagnostic efficacy of targeted biopsy versus targeted biopsy combined with systematic biopsy for patients with PI-RADS score of 4-5

Objective To analyze the diagnostic efficacy of targeted biopsy(TB)versus targeted biopsy combined with systematic biopsy(TB+SB)for patients with multi-parametric magnetic resonance imaging(mpMRI)prostate imaging-reporting and data system(PI-RADS)score of 4-5.Methods The clinical data of 378 patients with mpMRI PI-RADS score of 4-5 in Nanjing Drum Tower Hospital from January 2018 to February 2020 who received prostate TB+SB were retrospectively analyzed.Median age was 69(64,75)years old,median prostate specific antigen was 9.5(6.7,16.3)ng/ml,and median prostate volume was 34.1(23.5,48.4)ml.There were 240 cases with PI-RADS score of 4 and 138 cases with PI-RADS score of 5.Evaluating Gleason score of positive biopsy pathology and usingχ² test or Fisher exact test to analyze the detection of prostate cancer(PCa)and clinically significant prostate cancer(CsPCa)by TB versus TB+SB.Results Of the all 378 cases,88 cases(23.3%)were negative and 290 cases(76.7%)were positive.The average number of needle for TB was 2.4 per person,while SB was 12 per person.TB and SB had no statistically significant difference in the detection rate of PCa(73.3%vs.68.3%,P=0.129)and CsPCa(55.8%vs.49.7%,P=0.094)and in the accuracy(79.1%vs.77.8%,P=0.658),but had a statistically significant difference in the positive rate(64.2%vs.23.1%,P<0.001).The pathological coincidence rate of TB and TB+SB was 92.3%.There was no statistical difference in the detection rate of PCa(73.3%vs.76.7%,P=0.275)and CsPCa(55.8%vs.62.2%,P=0.076)between TB and TB+SB.The missed diagnosis rate of TB for PCa was 4.5%,for CsPCa was 10.2%.For patients with PI-RADS score of 4,TB had no significant difference in the detection rate of PCa(65.4%vs.69.2%,P=0.381)and CsPCa(46.7%vs.52.9%,P=0.171)from TB+SB.The accuracy of TB was 82.1%.The missed diagnosis rate of TB for PCa was 5.4%,for CsPCa was 11.8%.For patients with PI-RADS score of 5,TB had no significant difference in the detection rate of PCa(87.0%vs.89.9%,P=0.452)and CsPCa(71.7%vs.78.3%,P=0.211)from TB+SB.The accuracy of TB was 73.9%.The missed diagnosis rate of TB for PCa was 3.2%,for CsPCa was 8.3%.Conclusions For high-risk prostate cancer patients with PI-RADS score of 4-5,TB can obtain a detection effect similar to that of TB+SB with fewer needles,but there is still the possibility of inaccurate diagnosis and missed diagnosis.