Application of TRUS-guided freehand transperineal biopsy in prostate lesions
-
摘要:
目的探讨在经直肠前列腺超声引导下徒手对前列腺穿刺活检诊断前列腺良恶性病变中的临床价值。 方法选取2019年2月~2020年1月在中国科学技术大学附属第一医院南区就诊的临床疑似前列腺癌并行经会阴前列腺穿刺活检患者62例,依最终病理结果分为2组:前列腺癌组,共25例,男性,年龄55~82岁;前列腺良性病变组,共37例,男性,年龄54~83岁。经直肠超声分别观察记录两组前列腺大小、内部回声及有无异常回声、回声大小范围,并按部位系统穿刺及目标靶向性穿刺,对比分析两组间临床资料以及前列腺病变特征。 结果前列腺癌组病理类型均为前列腺腺癌(包括腺泡癌),良性病变组患者病理提示正常前列腺组织、腺体及间质增生、肌肉以及纤维组织。前列腺癌组穿刺取得组织中共145条病理结果为前列腺癌,108条(75%)位于前列腺周缘区穿刺点,癌组织占比标本组织长度大于50%的有81条(56%)。经直肠超声共发现52个异常回声,均穿刺取得病理,对比分析发现不同大小的低回声其病理成分不同,差异有统计学意义(P < 0.05)。 结论经直肠超声引导下经会阴前列腺穿刺对前列腺周缘区有优势性并可对可疑病变区域直观准确的目标性穿刺,对于前列腺良恶性病变的诊断具有重要意义。 Abstract:ObjectiveTo explore the clinical value of prostate biopsy in diagnosing benign and malignant prostate lesions under the guidance of TRUS. MethodsFrom February 2019 to January 2020, 62 patients with clinically suspected prostate cancer who underwent transperineal prostate biopsy in our Hospital were included. The patients received a freehand transperineal biopsy of the prostate. According to the pathological results, the patients were divided into two groups. The prostate cancer group(25 cases, males, 55-82 years old) and prostatic hyperplasia group (37 cases, males, 54-83 years old). The prostate size, abnormal echoes, systematic biopsy and targeted biopsy were recorded. The ultrasonographic features were compared between two groups. ResultThe pathological types of prostate cancer group were prostate adenocarcinoma (including acinar carcinoma). The prostatic hyperplasia group showed normal prostatic tissue, gland and interstitial hyperplasia, muscle and fibrous tissue. A total of 145 needle malignant tissues were obtained by puncture in prostate cancer group, and 108 needle (75%) were located in the prostatic peripheral zone. There were 81 needle tissues which malignant tissue accounting for more than 50% of the tissue length. A total of 52 abnormal echoes were found by TRUS. The sizes of abnormal echoes and pathological components were significant different between 2 groups. ConclusionTRUS-guided transperineal biopsy has advantages over the prostatic peripheral zone. It can directly and accurately puncture the suspected lesion area, and make it important for the diagnosis of benign and malignant prostatic lesions. -
表 1 62例患者一般资料及实验室检查(Mean±SD)
Table 1. Clinical data and laboratory results of 62 patients
病理类型 年龄(岁) 前列腺总体积(mL) 前列腺周缘区体积(mL) PSA(μg/L) 前列腺癌组(n=25) 70.04±7.72 50.56±36.04 24.65±13.13 53.95±54.64 前列腺良性病变组(n=37) 66.89±8.09 50.94±23.84 25.94±11.67 14.41±16.66 P 0.131 0.959 0.686 0.002 PSA: Prostate specific antigen. 表 2 直肠二维超声检查结果
Table 2. Results of transrectal ultrasonography
病理类型 前列腺低回声结节 前列腺低回声区 阴性 前列腺癌组(n=25) 5 16 4 前列腺良性病变组(n=37) 23 7 16 合计 28 23 20 -
[1] 郑荣寿, 孙可欣, 张思维, 等.2015年中国恶性肿瘤流行情况分析[J].中华肿瘤杂志, 2019, 41(1):19-28. http://d.old.wanfangdata.com.cn/Periodical/zhzl201901008 [2] 郭宏骞.前列腺肿瘤单病种病房的建设与管理[J].现代泌尿外科杂志, 2018, 23(7):485-6. http://d.old.wanfangdata.com.cn/Periodical/xdmnwkzz201807001 [3] 汪涌, 祝广峰, 窦晓亮, 等.2019版EAU前列腺癌指南更新摘要[J].现代泌尿外科杂志, 2020, 25(3):209-13. http://d.old.wanfangdata.com.cn/Periodical/xdmnwkzz202003004 [4] 刘佳, 李扬, 王睿, 等.不同辅助方式在前列腺穿刺活检术中的应用进展[J].智慧健康, 2019, 5(35):61-2. http://d.old.wanfangdata.com.cn/Periodical/zhjk201935025 [5] 何秀利, 蔡涛, 成阳洋, 等.周围神经阻滞与单纯尖部浸润麻醉在前列腺穿刺中的镇痛效果比较[J].临床超声医学杂志, 2020, 22(1):79-81. http://d.old.wanfangdata.com.cn/Periodical/lccsyxzz202001031 [6] 彭毓璐.超声引导下经会阴与经直肠前列腺穿刺活检并发症比较分析[D].北京: 军事科学院, 2018. [7] 邵亚军, 雷霆宇, 邵林海.直肠B超会阴前列腺12点穿刺术对前列腺特异性抗原水平为4~10 ng/mL患者前列腺癌诊断价值[J].陕西医学杂志, 2020, 49(4):450-2, 513. [8] 丁雪飞, 栾阳, 王飞, 等.改良经会阴模板定位下前列腺系统穿刺在前列腺癌诊断中的应用[J].中华泌尿外科杂志, 2019, 40(10):763-7. http://d.old.wanfangdata.com.cn/Periodical/zhmnwk201910009 [9] 劳明, 潘忠勉, 黄文成, 等.血清T-PSA及F-PSA检测对乳腺癌的诊断价值[J].肿瘤防治研究, 2007, 34(1):81-2. http://d.old.wanfangdata.com.cn/Periodical/zlfzyj200701027 [10] 王仕海.不同PSA评价方式对前列腺癌的诊断价值分析[J].临床研究, 2019, 21(3):151-2. http://d.old.wanfangdata.com.cn/Periodical/yyybj201903085 [11] 李盈.PSA、f/tPSA在前列腺癌患者血清中的表达及临床意义[J].中外医学研究, 2020, 18(1):61-2. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zwyxyj202001027 [12] 黄考平, 温世和, 杨天.血清PSA与良性前列腺增生临床病理的相关性研究[J].中国实用医药, 2019, 14(34):66-7. http://d.old.wanfangdata.com.cn/Periodical/zhmnwk200606018 [13] Fine SW, Reuter VE.Anatomy of the prostate revisited:implications for prostate biopsy and zonal origins of prostate cancer[J].Histopathology, 2012, 60(1):142-52. http://cn.bing.com/academic/profile?id=7ba72eef39693068a3ebb4187644f91c&encoded=0&v=paper_preview&mkt=zh-cn [14] Rozet F, Hennequin C, Beauval JB, et al.CCAFU Guidelines on prostate cancer[J].Prog Urol, 2016, 27(Suppl 1):S95-143. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=ab6d2aa5410d36c3e34fddcb7e2954a9 [15] 史点顺, 洪建军, 徐静, 等.前列腺外腺体积及PSA外腺体积密度鉴别诊断灰区前列腺癌的价值探讨[J].临床超声医学杂志, 2019, 21(10):789-91. http://d.old.wanfangdata.com.cn/Periodical/lccsyxzz201910025 [16] Porcaro AB, Tafuri A, Sebben M, et al.Prostate volume index is able to differentiate between prostatic chronic inflammation and prostate cancer in patients with normal digital rectal examination and prostate-specific antigen values < 10 ng/mL:results of 564 biopsy naïve cases[J].Urol Int, 2019, 103(4):415-22. [17] Guo G, Xu Y, Zhang X.TRUS-guided transperineal prostate 12+X core biopsy with template for the diagnosis of prostate cancer[J].Oncol Lett, 2017, 13(6):4863-7. http://cn.bing.com/academic/profile?id=dd33f0b801309fb5475c159602c50823&encoded=0&v=paper_preview&mkt=zh-cn [18] 朱云海, 孟军, 邹政.直肠超声引导下经会阴前列腺穿刺诊断前列腺癌的临床价值及并发症分析[J].中国中西医结合影像学杂志, 2015, 13(6):611-2, 616. http://d.old.wanfangdata.com.cn/Periodical/zgzxyjhyxxzz201506007 [19] 凌冰, 王小燕, 蓝春勇, 等.经直肠超声鉴别前列腺外周区低回声良、恶性病变的价值[J].广西医学, 2014, 36(11):1542-5. http://d.old.wanfangdata.com.cn/Periodical/gxyx201411012 [20] 张林华, 吴蓉, 徐光, 等.前列腺癌经直肠超声图像特征与其危险度的关系研究[J].中国全科医学, 2016, 19(24):2884-8. http://d.old.wanfangdata.com.cn/Periodical/zgqkyx201624004 [21] Gosselaar C, Roobol MJ, Roemeling S, et al.The value of an additional hypoechoic lesion-directed biopsy core for detecting prostate cancer[J].BJU Int, 2008, 101(6):685-90. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=1ff87e47e8e8d2ca42e8a628dfee546c [22] 张丽君, 邢伟, 邢士军.3.0 T磁共振扩散峰度成像联合扩散加权成像评估侵袭性前列腺癌J].分子影像学杂志, 2020, 43(1):76-81. doi: 10.12122/j.issn.1674-4500.2020.01.16 [23] 李丹丹, 高振森, 寇光玲.经直肠前列腺超声造影靶向活检诊断前列腺癌的可行性研究[J].中国超声医学杂志, 2020, 36(1):63-6. http://d.old.wanfangdata.com.cn/Periodical/zgcsyxzz202001020 [24] 陈辽, 黄鑫, 邓倾, 等.经直肠超声造影联合肿瘤标志物检查对前列腺良、恶性病灶的诊断效果分析[J].中国医学前沿杂志:电子版, 2020, 12(2):92-5. http://d.old.wanfangdata.com.cn/Periodical/zgyxqyzz202002021