【摘要】 目的评估经会阴模板磁共振/超声融合成像靶向穿刺技术在首次灰区前列腺特异性抗原(PSA)前列腺穿刺中的价值。方法回顾性分析2020年1月—20201年1月于复旦大学附属华东医院经多参数磁共振(mpMRI)扫描发现可疑病灶、且前列腺影像报告和数据系统PI-RADS分≥3分的132例患者的临床资料,所有患者均为首次行前列腺穿刺。年龄60～85岁,中位年龄69岁。穿刺前血清PSA3.65～9.88 ng/mL,中位PSA8.2 ng/mL,使用实时经直肠超声多影像融合系统对mpMRI提示的可疑病灶行靶向融合穿刺2～3针,随后行10针常规系统穿刺。对照研究比较靶向穿刺和系统穿刺的前列腺癌检出率以及各自的敏感性、特异性及准确性。结果本组132例中,总的前列腺癌检出率为31.1% (41/132)。系统穿刺检出率为23.5% (31/132),靶向穿刺检出率为27.3% (36/132),差异无统计学意义(P> 0.05),PI-RADS评分为5分病例为24例,前列腺癌检出率分别为75% (18/24);PI-RADS分为4分病例为48例,前列腺癌检出率31.3% (15/48);PI-RADS分为3分病例为60例,前列腺癌检出率13.3% (8/60),差异有统计学意义(P<0.001)。132例患者总计穿刺1 616针,其中系统穿刺1 320针,其中穿刺阳性针数201针,敏感性为69.5% (201/289),特异性为15.1% (201/1 327),准确性为25.3% (409/1 616);靶向穿刺296针,其中阳性针数196针,计算其敏感性为73.7% (196/266),特异性为92.6% (1 250/1 350),准确性为89.5% (1 446/1 616)。系统穿刺与靶向穿刺比较,穿刺敏感性差异无统计学意义(χ~2=0 007,P> 0 05),特异性及准确性差异有统计学意义(χ~2=110.246、82.352,均P<0 05)。结论对位于灰区PSA区间且首次行诊断性前列腺穿刺患者,靶向融合穿刺与10针系统穿刺的前列腺癌检出率相似,但靶向穿刺具有更高的特异性及准确性。PI-RADS评分系统对选择合适患者行靶向穿刺有指导作用。更多还原

【Abstract】 Objective To evaluate the value of transperineal template magnetic resonance/ultrasound fusion imaging targeted puncture technology in the first diagnostic prostate puncture for patients with PSA in gray zone.Methods 132 patients with suspicious lesions found on multi-parameter MRI scans,and prostate imaging report and data system PI-RADS score ≥3 in Huadong Hospital Affiliated to Fudan University were analyzed retrospectively.All patients underwent prostate puncture for the first time.Their age ranged from 60 to 85 years old,with a median age of 69 years.The level of serum PSA before puncture was 3.65～9.88 ng/mL,and the median PSA was 8.2 ng/mL.Under the guidance of real-time transrectal ultrasound multi-image fusion system,targeted fusion puncture for suspicious lesions suggested by mpMRI was performed with 2 to 3 needles,and followed by 10-needle conventional system puncture.The detection rate of prostate cancer by targeted puncture and systematic puncture,as well as their sensitivity,specificity and accuracy were compared.Results Among the 132 cases,the total detection rate of prostate cancer was 36.8%(41/132).The detection rate of systematic puncture was 23.5%(31/132),and the detection rate of targeted puncture was 27.3%(36/132).The difference was not statistically significant.There were24 cases with PI-RADS score of 5,and the detection rates of prostate cancer were 75%(18/24).There were 48 ones with PI-RADS score of 4,and the detection rates of prostate cancer were 31.3%(15/48).There were 60 ones with PI-RADS score of 3,and the detection rates of prostate cancer were 13.3%(8/60).The differences were statistically significant(P<0.001).A total of 1 616 needles were punctured in 132 patients.Among them,1 320 needles were systematically punctured,and the number of positive needles was 201.The sensitivity was 69.5%(201/289),the specificity was 15.1%(201/1 327),and the accuracy was 25.3%(409/1 616).There were 296 targeted puncture needles,including 196 positive needles.The sensitivity was 73.7%(196/266),the specificity was 92.6%(1 250/1 350),and the accuracy was 89.5%(1 446/1 616).There was no significant difference in puncture sensitivity between systematic puncture and targeted puncture(χ~2=0.007,P> 0.05),but the differences in specificity and accuracy were statistically significant(χ~2=110.246,82.352,both P<0.05).Conclusion For patients with PSA in gray zone undergo diagnostic prostate puncture for the first time,the detection rate of prostate cancer by targeted fusion puncture is similar to that by 10 needle system puncture,but targeted puncture has higher specificity and accuracy.The PI-RADS scoring system can guide the selection of suitable patients for targeted puncture.更多还原