摘要
目的探讨超声引导下经会阴前列腺系统穿刺(transperineal prostate systematic biopsy,SPB)与认知融合多参数磁共振成像(multi-parameter magnetic resonance imaging,mpMRI)经会阴靶向穿刺(cognitive fusion mpMRI targeted biopsy,CFTB)对不同血清前列腺特异抗原(prostate-specific antigen,PSA)水平前列腺癌的诊断价值。方法回顾性分析2018年1月至2019年12月上海交通大学附属第六人民医院行超声引导下SPB的患者527例,按PSA水平分为A组(PSA 4~10μg/L)和B组(PSA>10μg/L)。患者均行SPB,其中376例mpMRI检查时发现可疑病灶而行CFTB。采用χ^(2)检验比较两组内SPB与CFTB对前列腺癌检出率的差异;以穿刺病理诊断结果作为金标准,计算两组SPB及CFTB诊断前列腺癌的敏感性、特异性及准确性,并采用χ^(2)检验进行比较。结果527例患者中,最终经病理诊断为前列腺癌患者共319例(60.5%)。A组198例患者检出前列腺癌103例,总检出率为52.0%。其中SPB检出前列腺癌72例,检出率为36.4%,敏感性为67.9%,特异性为17.7%,准确性为26.5%;CFTB检出前列腺癌79例,检出率为39.9%,敏感性为75.6%,特异性为91.6%,准确性为88.8%。A组中两种方法诊断前列腺癌的检出率及敏感性差异无统计学意义(χ^(2)=0.525、0.005,均P>0.05),特异性及准确性差异有统计学意义(χ^(2)=108.340、79.829,均P<0.05)。B组329例患者共检出前列腺癌216例,总检出率为65.7%。其中SPB检出前列腺癌160例,检出率为48.6%,敏感性为78.2%,特异性为37.6%,准确性为49.5%;CFTB检出前列腺癌例189例,检出率为57.4%,敏感性为89.3%,特异性为90.6%,准确性为90.2%。B组中两种方法诊断前列腺癌的检出率、敏感性、特异性、准确性差异有统计学意义(χ^(2)=5.131、4.391、61.339、38.982,均P<0.05)。结论当PSA>10μg/L时,CFTB对前列腺癌的诊断效能高于SPB;当PSA 4~10μg/L时,两种方法对于前列腺癌的检出率及敏感性差异无统计学意义.
Objective To evaluate the value of ultrasound-guided transperineal systematic prostate biopsy(SPB)and cognitive fusion multi-parameter magnetic resonance imaging(mpMRI)suspicious transperineal targeted biopsy(CFTB)in the prostate cancer with different serum prostate specific antigen(PSA)levels.Methods A retrospective analyses were performed in 527 patients with suspected prostate cancer who underwent ultrasound-guided SPB from January 2018 to December 2019 in Shanghai Jiaotong University Affiliated 6th People′s Hospital.According to the PSA levels,they were divided into group A(PSA 4-10μg/L)and group B(PSA>10μg/L).All the patients underwent ultrasound-guided SPB,376 patients with suspicious mpMRI had two additional targeted biopsies.The detection rates of ultrasound-guided SPB and CFTB in prostate cancer were tested byχ^(2) test.Compared with pathological results,the sensitivity,specificity,accuracy of two methods were calculated and tested byχ^(2) test,and a P<0.05 was defined as statistically significant difference.Results Prostate cancer was detected in 319 of 527 patients(60.5%).One hundred and three cases of 198 patients in group A were diagnosed as prostate cancer,with an overall detection rate was 52.0%.Among them,ultrasound-guided SPB detected 72 cases of prostate cancer,the detection rate was 36.4%,sensitivity was 67.9%,specificity was 17.7%,accuracy was 26.5%,the detection rate,sensitivity,specificity and accuracy of CFTB were 39.9%,75.6%,91.6%and 88.8%,respectively.In this group,there were no statistically significant differences in the detection rate and sensitivity of the two methods in the diagnosis of prostate cancer(χ^(2)=0.525,0.005,both P>0.05),and the differences in specificity and accuracy were statistically significant(χ^(2)=108.340,79.829,respectively,both P<0.05).Two hundred and sixteen cases of 329 patients in group B were diagnosed as prostate cancer,with an overall detection rate was 65.7%.Among them,160 cases of perineal prostate cancer were detected by ultrasound-guided SPB,with the detection rate was 48.6%,sensitivity was 78.2%,specificity was 37.6%and accuracy was 49.5%.A total of 189 cases of prostate cancer detected by CFTB,the detection rate was 57.4%,the sensitivity was 89.3%,the specificity was 90.6%,and the accuracy was 90.2%.All the differences were statistically significant in group B(χ^(2)=5.131,4.391,61.339,38.982,all P<0.05).Conclusions When PSA is greater than 10μg/L,CFTB has a higher diagnostic efficiency than SPB.When PSA is 4-10μg/L,there are no significant differences between the two methods in the detection rate and sensitivity of prostate cancer.
作者
陈文颖
陈磊
郭倩
徐燕军
胡兵
Chen Wenying;Chen Lei;Guo Qian;Xu Yanjun;Hu Bing(Department of Ultrasound in Medicine,Shanghai Jiaotong University Affiliated 6th People′s Hospital,Shanghai 200233,China;Department of Ultrasound in Medicine,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou 215001,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2021年第3期243-248,共6页
Chinese Journal of Ultrasonography
基金
国家重点研发计划数字诊疗装备研发重点专项[国家重点基础研究发展计划(973计划)](2017YFC0113800)
上海重中之重医学影像重点学科(上海市医学领先专业重点学科基金)(2017ZZ02005)
上海重点临床专科(上海市重点学科建设基金)(shslczdzk03203)
苏州市"科教兴卫"青年科技项目(KJXW2017034)。
关键词
超声引导下穿刺活检
前列腺癌
磁共振成像
前列腺特异抗原
Ultrasound-guided biopsy
Prostate cancer
Magnetic resonance imaging
Prostate specific antigen
