两种经直肠超声引导下穿刺方法对可疑前列腺癌的诊断效能比较

Comparison of the diagnostic efficacy of two transrectal ultrasound-guided puncture methods for suspected prostate cancer

    摘要
  • 摘要:
    目的 探究经直肠常规超声引导下系统穿刺和经直肠超声造影成像（contrast-enhanced ultrasonography，CEUS）引导下靶向穿刺诊断可疑前列腺癌（prostate cancer，PCa）的诊断效能。
    方法 选择2021年2月至2024年2月在上海市奉贤区中心医院疑诊为PCa的239例患者，有139例接受直肠CEUS引导下经直肠穿刺活检，采用靶向穿刺法，纳入造影组，有100例接受常规超声引导下直肠穿刺活检，采用12点穿刺法，纳入常规组。比较两组PCa检出率、有临床意义前列腺癌（clinically significant prostate cancer，CsPCa）检出率，并分析不同亚组间的PCa检出率；比较两组穿刺针数、单针阳性针数和穿刺相关并发症。
    结果 经手术病理结果证实，造影组经穿刺确诊PCa 75例（53.96%），良性病变64例（46.04%）；常规组经穿刺确诊PCa 38例（38.00%），良性病变62例（62.00%）。造影组PCa检出率显著高于常规组（P<0.05）。造影组不同年龄、前列腺特异抗原（prostate specific antigen，PSA）水平之间的PCa检出率差异均有统计学意义（P<0.05），常规组不同PSA水平之间的PCa检出率差异有统计学意义（P<0.05），当年龄>70岁时，造影组PCa检出率显著高于常规组（P<0.05），当PSA水平>20 ng/mL时，造影组PCa检出率显著高于常规组（P<0.05），当前列腺体积在31～60 cm3之间时，造影组PCa检出率显著高于常规组（P<0.05）。造影组靶向穿刺共计283针，常规组系统穿刺共计1200针，造影组单针阳性率显著高于常规组（P<0.001）。两组穿刺相关并发症差异均无统计学意义（P>0.05）。
    结论 经直肠CEUS引导下靶向穿刺在PCa的诊断中具有较高的检出率和单针阳性率，尤其在高龄和高PSA水平患者中优势明显，且安全性良好。

     

    Abstract:
    Objective To investigate the diagnostic efficacy of transrectal conventional ultrasound-guided systematic biopsy and transrectal contrast-enhanced ultrasonography (CEUS)-guided targeted biopsy for suspected prostate cancer (PCa).
    Methods A total of 239 patients with suspected PCa who were admitted to Shanghai Fengxian District Central Hospital between February 2021 and February 2024 were selected. Among them, 139 patients who underwent transrectal CEUS-guided targeted biopsy were included in the CEUS group. The conventional group included 100 patients who underwent transrectal conventional ultrasound-guided biopsy (12-core biopsy). The detection rates of PCa and clinically significant prostate cancer (CsPCa) in the two groups were compared. The detection rates of PCa in different subgroups were also analyzed. Core number, positive single-core count, and biopsy-related complications were compared between the two groups.
    Results Biopsy confirmed PCa in 75 (53.96%) patients and benign lesions in 64 (46.04%) patients in the CEUS group. In the conventional group, 38 (38.00 %) patients had PCa, and 62 (62.00 %) had benign lesions. The detection rate of PCa in the CEUS group was significantly higher than that in the conventional group (P<0.05). There were statistically significant differences in the detection rate of PCa between the different age groups and patients with different prostate specific antigen (PSA) levels in the CEUS group (P<0.05). Moreover, there were statistically significant differences in the detection rate of PCa between patients with different PSA levels in the conventional group (P<0.05). For patients aged >70 years, the PCa detection rate in the CEUS group was significantly higher than that in the conventional group (P<0.05). When the PSA level was >20 ng/mL, the PCa detection rate in the CEUS group was significantly higher than that in the conventional group (P<0.05). When the prostate volume was 31–60 cm3, the detection rate of PCa in the CEUS group was significantly higher than that in the conventional group (P<0.05). The CEUS group received a total of 283 targeted punctures, whereas the conventional group received 1,200 systematic punctures. The positivity rate for a single core was significantly higher in the CEUS group than that in the conventional group (P<0.001). Biopsy-related complications were comparable between the two groups (P>0.05).
    Conclusions Transrectal CEUS-guided targeted biopsy can achieve a high detection and single-core positive rate in the diagnosis of PCa, particularly in older patients with high PSA levels. Moreover, it is safe.

     

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