经直肠实时组织弹性成像结合定量参数引导前列腺活检的价值

摘要

目的 评价经直肠实时组织弹性成像(real-time tissue elastography,RTE)结合定量参数峰值应变指数(peak strain index,PSI)引导前列腺活检诊断周围区前列腺癌的价值.方法 回顾性分析2011年2月至2014年2月141例可疑周围区前列腺癌行RTE检查患者的临床资料.年龄49～90岁,平均71.6岁.PSA 0.5～ 190.0 ng/ml,平均30.0 ng/ml.前列腺体积15.8 ～ 178.5 ml,平均50.3ml.141例均行RTE检查,可疑病灶测定PSI.PSI诊断价值评价采用受试者工作特征曲线.每例患者行RTE结合PSI引导靶向性活检2针,系统性活检10针.对靶向性活检和系统性活检结果进行总结.结果 141例中72例为前列腺癌(PSI l.39 ～66.86,平均24.79),69例为良性前列腺病变(PSI 0.46 ～26.31,平均3.02),前列腺癌PSI值显著高于良性病灶PSI值(P＜0.05).根据受试者工作特征曲线分析,取PSI≥ 5.97时诊断前列腺癌的敏感性为87.5％,特异性为88.6％,曲线下面积为0.95,Gleason评分≥7的中、高危前列腺癌患者检出率达95.6％ (43/45).141例患者通过RTE结合PSI,共发现159个可疑癌灶,每个癌灶行靶向性活检2针,穿刺针数阳性率为44％ (140/318),而10针系统性活检的穿刺针数阳性率为30.2％(426/1 410,P＜0.05).诊断的72例前列腺癌患者中,RTE结合PSI引导靶向性活检共检出63例(87.5％),10针系统性活检共检出62例(86.1％,P＞0.05).结论 RTE结合PSI有助于周围区前列腺癌的诊断,RTE联合系统性活检能检出更多中、高危的前列腺癌.%Objective To evaluate the value of transrectal real-time tissue elastography (RTE) targeted prostate biopsy in the peripheral zone combined with peak strain index.Methods One hundred and forty-one patients with suspicious prostate lesions in the peripheral zone were evaluated from February 2011 to February 2014.All the patients underwent RTE with a mean age of 71.6 years,PSA of 30 ng/ml,prostate volume of 50.3 ml and measured peak strain index (PSI).The diagnostic value of PSI was assessed by receiver operating characteristic (ROC) curve.Two-core RTE combined with PSI targeted prostate biopsy was taken and subsequently a 10-core systematic biopsy was taken.The value of RTE was evaluated.The data of targeted biopsy and systematic biopsy in prostate were both reviewed and statistically compared.Results Cancer was detected in 72 of 141 patients (PSI,mean 24.79),and 69 patients had benign prostate disease (PSI,mean 3.02).PSI value of prostate cancer was significantly higher than that of the benign lesions (P ＜ 0.05).Prostate cancer could be predicted with the highest sensitivity (87.5％) and specificity (88.6％) using the cutoff value of PSI ≥ 5.97 with an area under the curve of 0.95.RTE targeted biopsy combined with PSI could detect 95.6％ of moderate or high risk prostate cancer.One hundred and fifty-nine suspicious areas detected by RTE in 141 patients were biopsied with 2 cores for each area.The positive incidence of prostate cancer in RTE-targeted biopsy cores was 44％ and in systematic biopsy was 30.2％ (P ＜ 0.05).Among the 72 prostate cancer patients,63 cases (87.5％) were detected by RTE-targeted biopsy,62 cases (86.1％) by systematic biopsy (P ＞ 0.05).Conclusions RTE combined PSI can improve the detection rate of prostate cancer in the peripheral zone and likewise guide targeted biopsy combined with svstematic biopsy to detect more moderate or high risk prostate cancer.