目的 比较多指数磁共振成像(mp-MRI)与经直肠超声(TRUS)影像融合引导靶向穿刺与常规系统穿刺对前列腺癌的阳性检出率.方法 从Medline、Embase和中国期刊全文数据库中检索比较影像融合靶向穿刺和常规系统穿刺对前列腺癌阳性检出率的前瞻性研究,检索时限截至2015年7月21日.对各项研究中两种穿刺方法阳性检出率的相对危险度(RR)进行荟萃分析,经异质性检验后采用固定效应模型或随机效应模型进行统计分析,并根据可能产生异质性的原因进行分层分析和敏感性分析.结果 共有21项研究入选(n=3415).荟萃分析结果显示,影像融合引导靶向穿刺对前列腺癌的阳性检出率明显优于常规系统穿刺(RR=1.09,95%CI 1.00~1.18,P=0.047),在临床有意义前列腺癌的检出率方面,影像融合引导靶向穿刺也具有明显优势(RR=1.22,95%CI 1.06~1.40,P=0.005).结论 影像融合引导靶向穿刺可以提高前列腺癌,尤其是临床有意义的前列腺癌检出率.%Objective To compare the positive detection rate of transrectal ultrasound ( TRUS) and multi-parameter MRI( mp-MRI) image fusion guided biopsy with conventional biopsy for diagnosing prostate cancer .Methods Medline, Embase and China National Knowledge Infrastructure ( CNKI) were searched for the studies comparing the positive detec-tion rate of prostate cancer by image fusion guided biopsy and conventional biopsy .The retrieval time span was till July 21 , 2015.Outcome measure was relative risk ( RR) of the yield .Fixed or random model method was used for data analysis ,and stratified analysis and sensitivity analysis were performed according to the possible heterogeneity .Results 21 studies ( n=3415 ) were collected .The results of meta-analysis indicated that image fusion guided biopsy outperforms conventional biopsy in detecting prostate cancer (RR=1.09,95%CI 1.00-1.18,P=0.047), especially clinically significant prostate cancer(RR=1.22,95%CI 1.06-1.40,P=0.005).Conclusion Image fusion guided biopsy should be performed to opti-mize the detection of clinically significant prostate cancer .
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