能量多普勒增强经直肠超声引导下活检能否提高首次及重复前列腺活检时前列腺癌的检出率？

Can Power Doppler enhanced transrectal ultrasound guided biopsy improve prostate cancer detection on first and repeat prostate biopsy?

作者信息

Remzi Mesut, Dobrovits Michael, Reissigl Andreas, Ravery Vincent, Waldert Mattias, Wiunig Christian, Fong Yan Kit, Djavan Bob

机构信息

Department of Urology, University of Vienna, Währinger Gürtel 18-20, Austria.

出版信息

Eur Urol. 2004 Oct;46(4):451-6. doi: 10.1016/j.eururo.2004.06.002.

DOI:10.1016/j.eururo.2004.06.002

PMID:15363559

Abstract

OBJECTIVE

To determine the utility of Power Doppler enhanced transrectal ultrasound (PD-TRUS) and its guided prostate biopsies in men with prostate specific antigen (PSA) levels between 2.5 and 10 ng/ml and to evaluate its impact on prostate cancer (PCa) detection in men undergoing first and repeat biopsies.

METHODS

A total of 136 consecutive referred men with serum total PSA (Abbott Laboratories, Abbott Park, IL, USA) levels between 2.5 and 10 ng/ml (mean age 64 +/- 9 years, range 45-82) and a normal digital rectal examination were included. 101 underwent a first biopsy whereas 35 had repeat biopsy. Gray-scale transrectal ultrasound (TRUS), and PD-TRUS (B&K Medical, Denmark) were performed in lithotomy position before and during the biopsy procedure. Vascularity accumulation and perfusion characteristics were recorded and graded as normal or abnormal in the peripheral zone of the prostate. A Vienna-nomogram based biopsy regime was performed in all patients on first biopsy and a special biopsy regime on repeat biopsy plus additional biopsies from abnormal sites on PD-TRUS.

RESULTS

Overall PCa detection rate was 34.7% and 25.7% and abnormal accumulation on PD-TRUS was identified in 42.3% and 48.6% on first and repeat biopsy, respectively. The PCa detection rate, on first and repeat biopsy in patients with and without PD-TRUS accumulation were 67.4% versus 10.3% (p < 0.001) and 47.05% versus 5.6% (p = 0.0049), respectively. PD-TRUS directed biopsies were positive in 5.7% and 11.1% on first and repeat biopsy whereas PCa detection using the routine prostate biopsy regime was 94.3% and 88.9% on first and repeat biopsy. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PD-TRUS signal alone for PCa detection on first biopsy was 82.8%, 78.8%, 87.9% and 89.7%, respectively, and 88.8%, 68.0%, 47.0% and 94.4% on repeat biopsy, respectively. In comparison, the results PD-TRUS guided biopsies were 53.8%, 59.1%, 16.7%, and 89.5%, on first biopsy, respectively, and 20.0%, 13.3%, 23.5%, 11.1% on repeat biopsy, respectively.

CONCLUSION

Negative PD-TRUS signal is able to exclude most of the patients without PCa in the PSA range of 2.5-10 ng/ml. As an additional tool at TRUS biopsy PD-TRUS has a high negative predictive value and may help to reduce the number of unnecessary biopsies.

摘要

目的

确定能量多普勒增强经直肠超声（PD-TRUS）及其引导下前列腺活检在前列腺特异性抗原（PSA）水平为2.5至10 ng/ml男性中的效用，并评估其对初次活检和重复活检男性前列腺癌（PCa）检测的影响。

方法

纳入136例连续转诊的男性，其血清总PSA（美国伊利诺伊州雅培公园雅培实验室）水平在2.5至10 ng/ml之间（平均年龄64±9岁，范围45 - 82岁）且直肠指检正常。101例接受初次活检，35例接受重复活检。在活检前及活检过程中，患者取截石位，行灰阶经直肠超声（TRUS）和PD-TRUS（丹麦BK医疗公司）检查。记录前列腺外周带的血管聚集和灌注特征，并分为正常或异常。所有患者初次活检采用基于维也纳列线图的活检方案，重复活检采用特殊活检方案，并对PD-TRUS显示异常部位进行额外活检。

结果

总体PCa检测率分别为34.7%和25.7%，初次活检和重复活检时PD-TRUS异常聚集分别为42.3%和48.6%。初次活检和重复活检时，有和无PD-TRUS聚集患者的PCa检测率分别为67.4%对10.3%（p < 0.001）和47.05%对5.6%（p = 0.0049）。初次活检和重复活检时，PD-TRUS引导下活检阳性率分别为5.7%和11.1%，而采用常规前列腺活检方案时PCa检测率初次活检和重复活检分别为94.3%和88.9%。初次活检时，单独PD-TRUS信号检测PCa的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为82.8%、78.8%、87.9%和89.7%，重复活检时分别为88.8%、68.0%、47.0%和94.4%。相比之下，PD-TRUS引导下活检的结果初次活检时分别为53.8%、59.1%、16.7%和89.5%，重复活检时分别为20.0%、13.3%、23.5%和11.1%。