【摘要】 目的探讨多参数核磁共振(mp MRI)与经直肠超声(TRUS)融合成像引导下前列腺靶向穿刺MRFTB活检对Gleason评分≥7分前列腺癌检出的临床意义。方法本组88例,均因可疑前列腺癌且mp MRI提示可疑前列腺癌病灶于我院行mp MRI与TRUS融合成像引导下前列腺靶向穿刺联合系统穿刺。入组患者年龄43~85岁,平均(69.74±8.46)岁;血清PSA 0.44~87.07ng/m L,平均(12.57±12.62)ng/m L;前列腺体积14.56~128.80m L,平均(43.89±20.81)m L。使用彩超仪及容积导航仪进行mp MRI与TRUS图像融合,对mp MRI显示的可疑前列腺癌病灶行靶向穿刺1~4针,然后在TRUS引导下对前列腺左右两叶行12针系统穿刺。根据前列腺穿刺活检引导方式不同,分为靶向穿刺组(MRF-TB)、系统穿刺组(SB)和联合穿刺组(MRF-TB+SB),分别比较3种前列腺穿刺活检方法对前列腺癌的检出率和Gleason评分≥7分的前列腺癌的检出率。结果 88例患者穿刺过程顺利,术后无相关并发症。所有患者均行核磁超声融合靶向穿刺联合系统穿刺(MRF-TB+SB),共检出46例前列腺癌,肿瘤检出率为52.3%。MRF-TB检出前列腺癌41例(46.6%);SB检出前列腺癌40例(45.5%)。MRF-TB+SB对前列腺癌的总检出率明显高于SB,差异有统计学意义(P=0.031);但MRF-TB与SB相比和MRF-TB+SB与MRF-TB相比差异均无统计学意义(P>0.05)。88例患者中共检出Gleason评分≥7分前列腺癌38例(43.2%),MRF-TB和SB分别检出Gleason评分≥7分前列腺癌35例(39.8%)和30例(34.1%)。MRF-TB漏诊的3例Gleason评分≥7分前列腺癌中,2例患者MRF-TB穿刺结果为前列腺癌Gleason评分=6分,1例患者MRF-TB结果为阴性。SB漏诊的8例患者中,5例患者SB穿刺结果为前列腺癌Gleason评分=6分,3例患者SB结果为阴性。MRF-TB+SB对Gleason评分≥7分前列腺癌的检出率明显高于SB,差异有统计学意义(P<0.05),但MRF-TB与SB相比、MRF-TB+SB与MRF-TB相比,差异均无统计学意义(P>0.05)。结论对于mp MRI发现可疑前列腺癌病灶的患者,MRF-TB对前列腺癌的总检出率不低于SB,MRF-TB+SB可以提高Gleason评分≥7分前列腺癌的检出率,此结论需要更大样本量的前瞻性临床研究证实。更多还原

【Abstract】 Objective To investigate the value of multiparametric magnetic resonance imaging/transrectal ultrasound(mp MRI/TRUS) fusion targeted biopsy for the detection of prostate cancerwith Gleason Score≥7. Methods Total of 88 cases who were suspected to have prostate cancer with lesions in multiparametric magnetic resonance imaging examinations(mp MRI), received mp MRI/TRUS fusion targeted biopsy(MRF-TB) combine with systematic biopsy(SB). The average age was(69.74±8.46) years(range 43~82 years). The average serum PSA before biopsy was(12.57±12.62) ng/m L(range 0.44~87.07 ng/m L). The average prostate volume was(43.89±20.81)m L(range 14.56~128.80 m L). After importing MRI imagings to the ultrasound system, one to four-core MRF-TB was performed with real-time fusion of TRUS and mp MRI imaging, followed by a 12-core SB guided by TRUS. We compared the detection rates for all prostate cancer and Gleason Score≥7 grade prostate cancer between MRF-TB group, SB group and MRF-TB+SB group respectively. Results All 88 patients complete biopsy with no complications. 46 of 88 cases(52.3%) were diagnosed as prostate cancer, in which 41 cases(46.6%) were diagnosed by MRF-TB, 40 cases(45.5%) were diagnosed by SB. Detected ration of prostate cancer using MRF-TB combine with SB(MRF-TB+SB) was more than that using SB(52.3% vs. 45.5%, P =0.031), whereas there was no significant difference between MRF-TB and SB(46.6% vs. 45.5%, P=1.000), MRF-TB and MRF-TB+SB(46.6% vs. 52.3%, P =0.063). 38 patients(43.2%) were diagnosed as prostate cancer with Gleason Score≥7, in which 35 patients(39.8%) were diagnosed by MRF-TB, 30 patients(34.1%) were diagnosed by SB. Detection rate of prostate cancer with Gleason Score≥7 MRF-TB+SB was more than that using SB(43.2% vs. 34.1%, P =0.008), whereas there was no significant difference between MRF-TB and SB(39.8% vs. 34.1%, P =0.227), MRF-TB and MRF-TB+SB(39.8% vs. 43.2%, P =0.250). Conclusion For patients suspected as prostate cancer by mp MRI, MRF-TB can detect as more prostate cancer as SB. Combination of MRF-TB and SB can increase detection rates of prostate cancer with Gleason Score≥7. This conclusion needs to be further confirmed by perspective clinical research results.更多还原