摘要
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χ^(2)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�
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 usingχ^(2) 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
作者
刘禹
高杰
汪维
张青
赵晓智
黄海锋
李丹燕
付尧
郭宏骞
Liu Yu;Gao Jie;Wang Wei;Zhang Qing;Zhao Xiaozhi;Huang Haifeng;Li Danyan;Fu Yao;Guo Hongqian(Department of Urology,Nanjing University Research Institute of Urology,Nanjing Drum Tower Hospital,Nanjing University Medical School,Nanjing 210008,China;Department of Pathology,Nanjing Drum Tower Hospital,Nanjing University Medical School,Nanjing 210008,China;Department of Radiology,Nanjing Drum Tower Hospital,Nanjing University Medical School,Nanjing 210008,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2021年第3期192-196,共5页
Chinese Journal of Urology
关键词
前列腺肿瘤
多参数磁共振
前列腺影像报告与数据系统
靶向穿刺
系统穿刺
Prostatic neoplasms
Multi-parametric magnetic resonance imaging
Prostate Imaging-Reporting and Data System
Targeted biopsy
Systematic biopsy
