Lepor Herbert, Kaci Ledia
Department of Urology, New York University School of Medicine, New York, New York 10016, USA.
Urology. 2004 Mar;63(3):499-502. doi: 10.1016/j.urology.2003.10.017.
To determine the value of intraoperative biopsy during radical retropubic prostatectomy.
Between October 2000 and August 2002, 500 men with clinically localized prostate cancer underwent radical retropubic prostatectomy by a single surgeon. A 2 to 3-mm circumferential biopsy was routinely obtained from the apical and bladder neck soft-tissue margin and submitted for frozen section examination. In selective cases suspicious for capsular incision, a biopsy was sent from what was believed to be the contiguous neurovascular bundle/lateral pedicle.
Prostate cancer was observed in 4.5%, 0.8%, and 1.6% of the intraoperative biopsies sent from the apical, bladder neck, and neurovascular bundle/lateral pedicle soft-tissue margins, respectively. Patient age, Gleason score, perineural invasion on diagnostic prostate biopsy, and clinical stage were not associated with prostate cancer at the apical soft-tissue margin. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the surgical specimen to predict cancer in the apical soft-tissue margin was 57.7%, 98.2%, 62%, 97.7%, and 96%, respectively. Intraoperative biopsy of the apical soft-tissue margin reduced the positive margin rate by 3.8%.
The yield of intraoperative biopsy of the bladder neck and neurovascular bundle/lateral pedicle is too low to justify it in routine practice. Biopsy of the apical soft tissue should be routinely performed to reduce the positive surgical margin rate.
确定耻骨后根治性前列腺切除术中术中活检的价值。
2000年10月至2002年8月期间，500例临床局限性前列腺癌男性患者由同一外科医生进行耻骨后根治性前列腺切除术。常规从尖部和膀胱颈软组织边缘获取2至3毫米的环形活检组织，并送冰冻切片检查。在怀疑有包膜切开的选择性病例中，从被认为是连续的神经血管束/侧蒂处取活检组织。
分别从尖部、膀胱颈和神经血管束/侧蒂软组织边缘送检的术中活检组织中，前列腺癌的检出率分别为4.5%、0.8%和1.6%。患者年龄、Gleason评分、诊断性前列腺活检时的神经周围侵犯情况以及临床分期与尖部软组织边缘的前列腺癌无关。手术标本预测尖部软组织边缘癌症的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为57.7%、98.2%、62%、97.7%和96%。尖部软组织边缘的术中活检使阳性切缘率降低了3.8%。
膀胱颈和神经血管束/侧蒂术中活检的阳性率过低，在常规实践中无此必要。应常规进行尖部软组织活检以降低手术阳性切缘率。
