Terris M K
Section of Urology, Veterans Affairs Palo Alto Health Care System, California 94304, USA.
Urology. 1999 Sep;54(3):486-9. doi: 10.1016/s0090-4295(99)00148-x.
To determine the true-negative and false-negative rates of sextant prostate biopsies, the most common method of prostate cancer diagnosis.
Forty-three men scheduled for prostatectomy as part of a surgical procedure for bladder pathologic findings agreed to participate in this study. All patients had normal digital rectal examination findings. Immediately before prostatectomy all patients underwent sextant biopsies. The location, amount, and Gleason grade of any cancer identified on the biopsies were recorded. After surgery, the prostate was serially sectioned. The location, grade, and volume of any prostatic adenocarcinoma identified was recorded and compared with the results of the biopsy specimens.
There were 33 patients without prostate cancer in either the biopsies or the prostatectomy specimen. No patients had cancer on the biopsies and no cancer in the prostatectomy specimen. In 6 patients, cancer was found in both the biopsies and the prostatectomy specimens; these cancers were 0.9, 2.1, 2.8, 3. 1, 4.2, and 6.5 cc in volume. In the remaining 4 patients, there was no cancer on the biopsies but the prostatectomy specimen revealed cancers of 0.05, 0.1, 0.3, and 2.5 cc. The overall sensitivity for sextant biopsies was 60.0%, with a specificity of 100%. When only cancers greater than 2 cc or cancers in the peripheral zone were considered, the sensitivity rose to 83.3% and 71.4%, respectively, with a minimal decrease in specificity (97.3% and 97.2%, respectively). In contrast, when transition zone cancers were evaluated, the sensitivity fell to 33.3%.
Sextant biopsies are fairly sensitive for the detection of tumors greater than 2 cc and those in the peripheral zone; however, repeat biopsies should be strongly considered in patients with a high clinical suspicion for prostate cancer and negative initial sextant biopsies.
确定六分区前列腺活检（前列腺癌最常用的诊断方法）的真阴性率和假阴性率。
43名因膀胱病理检查结果而计划接受前列腺切除术的男性同意参与本研究。所有患者直肠指检结果均正常。在前列腺切除术之前，所有患者均接受六分区活检。记录活检中发现的任何癌症的位置、数量和 Gleason 分级。手术后，对前列腺进行连续切片。记录所发现的任何前列腺腺癌的位置、分级和体积，并与活检标本的结果进行比较。
33名患者的活检标本和前列腺切除标本中均无前列腺癌。活检标本中无癌症且前列腺切除标本中也无癌症的患者。6名患者的活检标本和前列腺切除标本中均发现癌症；这些癌症的体积分别为0.9、2.1、2.8、3.1、4.2和6.5立方厘米。其余4名患者的活检标本中无癌症，但前列腺切除标本显示有体积为0.05、0.1、0.3和2.5立方厘米的癌症。六分区活检的总体敏感性为60.0%，特异性为100%。当仅考虑大于2立方厘米的癌症或外周区的癌症时，敏感性分别升至83.3%和71.4%，特异性略有下降（分别为97.3%和97.2%）。相比之下，当评估移行区癌症时，敏感性降至33.3%。
六分区活检对于检测大于2立方厘米的肿瘤和外周区的肿瘤相当敏感；然而，对于临床高度怀疑前列腺癌且初次六分区活检结果为阴性的患者，应强烈考虑重复活检。
