摘要
目的:评估PI⁃RADS评分系统中3分病灶的临床有意义前列腺癌(CSPCa)分区检出率,分析其临床参数取值区间,并分析MRI/TRUS影像融合靶向穿刺能否提高CSPCa检出率,为进一步前列腺穿刺抉择提供参考。方法:回顾性分析南京鼓楼医院2019年1月至2019年12月所有行经会阴前列腺穿刺活检患者的临床资料,选取其中PI⁃RADS V23分的297例前列腺疾病患者,分析前列腺组织学四分区中CSPCa的检出率,同时分析CSPCa患者临床参数的取值区间。结果:外周带、移行带、中央带及前纤维基质区的CSPCa检出率分别为23.8%、11.2%、40.0%及50.0%。附加MRI/TRUS影像融合靶向穿刺提高了CSPCa检出率但并未具有显著差异。CSPCa与非CSPCa患者分组比较时,两组患者的临床资料如fPSA/tPSA及PSAD差异显著,而tPSA具有差异性。CSPCa组fPSA/tPSA数值更低,PSAD更高,tPSA数值更高。CSPCa组fPSA/tPSA、PSAD及tPSA、PV的均数分别为0.12、0.35μg/L^(2)、13.06μg/L及47.31 ml。结论:PI⁃RADS 3分的前列腺病灶,外周带比移行带具有更高的CSPCa检出率,中央带及前纤维基质区域虽然病例偏少但是CSPCa检出率更高。当患者合并以下临床参数:fPSA/tPSA<0.12及PSAD>0.35μg/L^(2)时,强烈建议穿刺活检,对于移行带及中央带附加MRI/TRUS影像融合靶向穿刺获益更大。
Objective: To investigate the detection rate of clinically significant PCa(CSPCa) in lesions of prostate imaging-reporting and data system(version 2)(PI-RADS v2) score 3 in different histological zones of the prostate, the value range of clinical parameters, and the possibility of improving the detection rate by MRI/TRUS fusion prostate biopsy. Methods: This retrospective study included 297 patients with prostatic lesions of PI-RADS v2 score 3 undergoing transperineal prostate biopsy in Nanjing Drum Tower Hospital from January to December 2019. We analyzed their clinical data, the detection rate of CSPCa in the four histological zones of the prostate and the value range of the clinical parameters. Results: The detection rates of CSPCa in the peripheral zone, transitional zone, central zone and anterior fibromuscular stroma were 23.8%, 11.2%, 40.0% and 50.0%, respectively. In comparison with conventional biopsy, additional MRI/TRUS image fusion biopsy improved the detection rate of CSPCa in the four zones, though with no statistically significant difference. The patients with CSPCa, compared with those in the non-CSPCa group, showed a lower value of free PSA/total PSA(fPSA/tPSA)(0.12 ± 0.05 vs 0.18 ± 0.07) but a higher tPSA level([13.06 ± 10.07] vs [8.61 ± 5.86] μg/L) and PSA density(PSAD)([0.35 ± 0.34] vs [0.16 ± 0.11] μg/L^(2)). Conclusion: In prostate lesions of PI-RADS v2 score 3, the detection rate of CSPCa was higher in the peripheral zone, even higher in the central zone and anterior fibromuscular stroma, than in the transitional zone. Prostatic biopsy is strongly recommended for patients with fPSA/tPSA < 0.12 or PSAD > 0.35 μg/L^(2), and additional MRI/TRUS image fusion biopsy is preferable for the lesions in the transitional or central zone.
作者
徐向军
董翔
马文亮
朱逸琪
黄海峰
汪维
张青
邱雪峰
庄君龙
郭宏骞
甘卫东
XU Xiang-jun;DONG Xiang;MA Wen-liang;ZHU Yi-qi;HUANG Hai-feng;WANG Wei;ZHANG Qing;QIU Xue-feng;ZHUANG Jun-long;GUO Hong-qian;GAN Wei-dong(Department of Urology,Gulou Clinical School of Integrated Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210000,China;Department of Urology,Lianyungang Hospital Affiliated to Nanjing University of Chinese Medicine,Lianyungang,Jiangsu 222004,China;Department of Urology,Gulou School of Clinical Medicine,Nanjing University School of Medicine,Nanjing,Jiangsu 210000,China;Depart-ment of Urology,Drum Tower Hospital Affiliated to Nanjing University School of Medicine,Nanjing,Jiangsu 210000,China)
出处
《中华男科学杂志》
CAS
CSCD
北大核心
2022年第1期32-36,共5页
National Journal of Andrology
