经直肠超声鉴别前列腺外周区低回声良、恶性病变的价值

摘要

Objective To evaluate transrectal ultrasound ( TRUS) in the identification of benign and malignant hypoechoic lesions in the prostate peripheral zone .Methods The data of 74 cases of hypoechoic lesions in the prostate peripheral zone confirmed by TRUS were analyzed retrospectively .All patients underwent ‘6 +X ’ prostate biopsy guided by TRUS .The analysis on the distribution differences between benign and malignant lesions in the different morphological characteristics as well as the morphological characteristics of hypoechoic lesions was conducted .The positive rates of different hypoechoic lesions biopsies were calculated .Results ①Of the 74 lesions,30 benign lesions and 44 malignant lesions,the detection rate of prostate cancer was 59.5%(44/74).②The malignant lesions were dominated by mass(38.64%) and girdle-shaped ( 45.45%) lesions.The benign lesions were dominated by small-nodositied lesions (57.15%).There were significant differences (P<0.05).③The positive rates of targeted biopsy for mass ,girdle-shaped lesions were 89.5%(17/19),69.0%(20/29),respectively,which were significantly higher than that (26.9%,7/26) of small-nodositied lesions(P<0.05).④The specificity of combining mass with girdle-shaped lesions as a sonographic characteristic for the diagnosis of prostate cancer was 70 .8%,the positive predictive value was 84 .1%.Conclusion The mass and girdle-shaped hypoechoic lesions in the prostate peripheral zone could be regarded as ‘hot spot ’ of targeted biopsy .The combination of above two forms applied to the diagnosis of prostate cancer could improve the specificity of TRUS.%目的：探讨经直肠超声（ TRUS）鉴别前列腺外周区低回声良恶性病变的价值。方法回顾性分析74例在TRUS检查发现前列腺外周区低回声并在超声引导下行“6＋X”前列腺穿刺活检的病例资料，分析低回声病变的形态特点，良恶性病变在不同形态特征的分布特点，计算不同形态低回声病变的穿刺活检阳性率。结果①74例患者中，良性30例，恶性44例，前列腺癌检出率为59．5％（44／74）。②恶性病变以肿块状（38．64％）、带状多见（45．45％），良性病变以小结节状多见（57．15％），差异有统计学意义（P＜0．05）。③靶向穿刺活检阳性率肿块状为89．5％（17／19）、带状为69．0％（20／29），显著高于小结节状的[26．9％（7／26），（P＜0．05）]。④将“肿块＋带状”两种形态结合作为诊断前列腺癌特异度70．8％、阳性预测值84．1％。结论 TRUS表现为外周区肿块及带状的低回声病变可作为靶向性穿刺活检的“热点”；将“肿块＋带状”两种形态结合作为诊断前列腺癌声像图特征可提高TRUS的特异性。