Halpern Ethan J, Frauscher Ferdinand, Strup Stephen E, Nazarian Levon N, O'Kane Patrick, Gomella Leonard G
Department of Radiology, Jefferson Prostate Diagnostic Center, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107-5244, USA.
Radiology. 2002 Oct;225(1):71-7. doi: 10.1148/radiol.2251011938.
To evaluate cancer detection with targeted biopsy of the prostate performed on the basis of high-frequency Doppler ultrasonographic (US) imaging findings versus cancer detection with a modified sextant biopsy approach with laterally directed cores.
Sixty-two patients were prospectively evaluated with gray-scale, color, and power Doppler transrectal US performed with patients in the lithotomy position. Gray-scale and Doppler findings within each sextant were rated on a five-point scale. Up to four targeted biopsy specimens were obtained from each patient on the basis of Doppler findings; this was followed by a modified sextant biopsy. Conditional logistic regression analysis was performed to compare the positive yields for targeted and sextant biopsy specimens. Clustered receiver operating characteristic analysis was performed to compare gray-scale, color, and power Doppler detection of cancer at sextant biopsy sites.
Cancer was detected in 18 (29%) of 62 patients, including 11 patients in whom cancer was detected with both sextant and targeted biopsy, six in whom cancer was detected only with sextant biopsy, and one in whom cancer was detected only with targeted biopsy. The positive biopsy rate for targeted biopsy (24 [13%] of 185 cores) was slightly higher than that for sextant biopsy (36 [9.7%] of 372 cores; P =.1). The odds ratio for cancer detection with targeted versus sextant cores was 1.8 (95% CI: 0.9, 3.7). Receiver operating characteristic analysis demonstrated that overall identification of positive sextant biopsy sites was close to random chance for gray-scale (area under the curve, 0.53), color Doppler (area under the curve, 0.50), and power Doppler (area under the curve, 0.47) imaging.
Targeted biopsy performed on the basis of high-frequency color or power Doppler findings will miss a substantial number of cancers detected with sextant biopsy.
评估基于高频多普勒超声（US）成像结果进行前列腺靶向活检与采用改良六分区活检方法（增加侧向活检组织）进行癌症检测的效果。
前瞻性评估62例患者，患者取截石位，行经直肠灰阶、彩色及能量多普勒超声检查。对每个六分区内的灰阶和多普勒检查结果进行五分制评分。根据多普勒检查结果，每位患者最多获取4个靶向活检标本；随后进行改良六分区活检。采用条件逻辑回归分析比较靶向活检和六分区活检标本的阳性率。进行聚类受试者操作特征分析，比较六分区活检部位灰阶、彩色和能量多普勒对癌症的检测情况。
62例患者中有18例（29%）检测出癌症，其中11例患者六分区活检和靶向活检均检测出癌症，6例仅六分区活检检测出癌症，1例仅靶向活检检测出癌症。靶向活检的阳性活检率（185个组织芯中有24个[13%]）略高于六分区活检（372个组织芯中有36个[9.7%]；P = 0.1）。靶向活检组织芯与六分区活检组织芯检测癌症的比值比为1.8（95%CI：0.9，3.7）。受试者操作特征分析表明，对于六分区活检阳性部位的总体识别，灰阶成像（曲线下面积，0.53）、彩色多普勒成像（曲线下面积，0.50）和能量多普勒成像（曲线下面积，0.47）接近随机概率。
基于高频彩色或能量多普勒检查结果进行的靶向活检会遗漏大量六分区活检检测出的癌症。
