Moran Brian J, Braccioforte Michelle H, Conterato Dean J
Chicago Prostate Cancer Center, Westmont, Illinois 60559, USA.
J Urol. 2006 Oct;176(4 Pt 1):1376-81; discussion 1381. doi: 10.1016/j.juro.2006.06.030.
In this study we investigated the detection rate and morbidity of stereotactic transperineal prostate re-biopsy with 3-dimensional mapping for diagnosis of nonpalpable isoechoic occult prostate malignancy.
A total of 180 consecutive patients with continued increasing total prostate specific antigen and at least 1 prior benign transrectal prostate biopsy underwent stereotactic transperineal prostate biopsy at a single outpatient institution between April 2004 and March 2006. Similar to a prostate brachytherapy procedure, patients were placed in the dorsal lithotomy position. With the patient under general anesthesia, and using transrectal ultrasound, a perineal brachytherapy template and stabilizing device, the prostate was positioned on the implant grid. It was equally divided into 8 sections (octants) according to x and y coordinates on the mid gland axial image. The midplanes of axial and sagittal prostate gland images for each patient determined the x, y and z coordinates that would occupy each octant. Tissue cores were initially obtained from the apical octants, followed by identical x and y coordinates of the basilar octants. Specimens from each specific octant were placed in 1 of 8 specimen jars and pathological review was reported accordingly.
Stereotactic transperineal prostate biopsy yielded positive biopsies identifying adenocarcinoma in 68 of 180 (38%) patients. Acute urinary retention developed in 18 of 180 (10%) patients requiring an indwelling urinary catheter upon discharge home. In all patients estimated blood loss was less than 5 cc and median pain score was 1 of 10.
Stereotactic transperineal prostate biopsy is extremely well tolerated and useful for diagnosis of nonpalpable isoechoic occult prostate malignancy. Additionally, stereotactic transperineal prostate biopsy provides comprehensive tissue sampling with accurate 3-dimensional mapping of malignancy in this select group of patients.
在本研究中，我们调查了采用三维定位的立体定向经会阴前列腺再次活检对不可触及的等回声隐匿性前列腺癌的诊断检出率及发病率。
2004年4月至2006年3月期间，共有180例连续的患者，其总前列腺特异性抗原持续升高且至少有1次先前的经直肠前列腺良性活检，在一家门诊机构接受了立体定向经会阴前列腺活检。与前列腺近距离放射治疗程序类似，患者置于膀胱截石位。在患者全身麻醉下，使用经直肠超声、会阴近距离放射治疗模板和稳定装置，将前列腺置于植入网格上。根据中叶轴向图像上的x和y坐标，将其平均分为8个部分（卦限）。每个患者的前列腺轴向和矢状面图像的中间平面确定了每个卦限所占据的x、y和z坐标。最初从尖部卦限获取组织芯，随后从基部卦限相同的x和y坐标处获取。来自每个特定卦限的标本置于8个标本瓶中的1个，并据此报告病理检查结果。
立体定向经会阴前列腺活检在180例患者中的68例（38%）中发现腺癌阳性活检结果。180例患者中有18例（10%）发生急性尿潴留，出院回家时需要留置导尿管。所有患者估计失血量均小于5 cc，中位疼痛评分为10分中的1分。
立体定向经会阴前列腺活检耐受性极佳，对不可触及的等回声隐匿性前列腺癌的诊断很有用。此外，立体定向经会阴前列腺活检在这一特定患者群体中提供了全面的组织采样以及对恶性肿瘤准确的三维定位。
