经直肠B超引导个体化前列腺穿刺活检方案的探讨

背景与目的:经直肠B超(transrectal uhrasonography,TRUS)引导前列腺6针穿刺活检术(sextant)曾被认为是诊断前列腺癌的"金标准".近年来,许多报道其检出率不高,应该增加穿刺针数来提高前列腺癌的检出率,但至今仍无一种理想的方案.本研究旨在探讨一种合适的前列腺穿刺活检方案,以提高前列腺癌的初次检出率.方法:回顾性分析325例疑为前列腺癌患者初次活检的临床资料.全部采用系统12针组合穿刺方案,对可疑病灶处补充1～2针.根据穿刺结果,分析穿刺阳性率与针数、体积的关系.结果:325例患者确诊前列腺癌126例(38.8%).12针中的6、8、10针组合最高阳性率与12针穿刺组合阳性率比较,差异均有统计学意义(38.8%vs.27.7%,29.8%and 35.4%,P＜0.05).比较体积不同3个组,发现＜40 ml组8针组合与10针、12针组合无统计学差异(38.4%vs.40.4%,42.4%,P＞0.05),而40～60 ml组8针组合与10针组合(36.2%vs.26.9%,P=0.046)、＞60 ml组10针组合与12针组合差异均有显著性(37.9%vs.25.8%,P=0.049).结论:并非每位患者都需行系统12针穿刺,而应该个体化对待.建议＜40 ml的前列腺采用8针、40～60 ml的10针和＞60ml的12针组合方案,并根据B超所见增加针数(1或2针)或者进行重点穿刺.

Individualization of transrectal ultrasonography-guided prostate biopsy for prostate cancer detection

BACKGROUND & OBJECTIVE: Transrectal ultrasonography (TRUS)-guided sextant biopsy technique was regarded as golden standard method for the diagnosis of prostate cancer. Recently, many reports show that the detection rate of prostate cancer by sextant biopsy is not high, and suggest to take more cores to improve the detection rate. But there is no ideal protocol now. This study was to explore an appropriate prostate biopsy protocol for the detection of prostate cancer. METHODS: Clinical data of 325 consecutive men with suspected prostate cancer were analyzed. All patients underwent 12-core biopsy protocol (first biopsy) with additional 1 or 2 cores at each suspicious area detected by TRUS. The sensitivity of different combinations of biopsy cores was analyzed. RESULTS: Of the 325 patients, 126 (38.8%) were positive for prostate cancer. The detection rate by 12-core protocol was significantly higher than maximal detection rate by 6-, 8-, and 10-core protocols (38.8% vs. 27.7%, 29.8%, and 35.4%, P<0.05). In the patients with prostate volume of <40 ml, there was no significant difference in detection rate of prostate cancer between 8-, 10-, and 12-core protocols. In the patients with prostate volume of 40-60 ml, the detection rate by 10-core protocol was significantly higher than that by 8-core protocol (36.2% vs. 26.9%, P=0.046). In the patients with prostate volume of >60 ml, the detection rate by 12-core protocol was significantly higher than that by 10-core protocol (37.9% vs. 25.8%, P=0.049). CONCLUSIONS: Individual prostate biopsy protocol should be taken for the detection of prostate cancer. We recommend 8-core protocol for the patients with small prostate (<40 ml), 10-core protocol for the patients with the prostate of 40-60 ml, and 12-core protocol for the patients with the prostate of >60 ml, and add 1 or 2 cores or take focus biopsy protocol at suspicious areas detected by TRUS.