Jiang Jimmy, Colli Janet, El-Galley Rizk
Division of Urology, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
J Endourol. 2010 Jan;24(1):143-7. doi: 10.1089/end.2009.0285.
The objective was to provide urologists with a simple basis for optimizing the number of prostate biopsy cores that should be taken.
The records of 1024 patients who had undergone transrectal ultrasound-guided biopsies were reviewed. The prostate volume was divided by the number of biopsies to obtain the volume/biopsy ratio (VBR). Univariate and multivariate analyses were performed to determine the best predictors for positive biopsies.
The analysis included 939 patients who had prostatic-specific antigen <20 ng/mL. The significant independent variables for positive biopsies were age, prostatic-specific antigen, and prostate volume and VBR (p < 0.001). VBR had the strongest correlation coefficient out of all significant variables. Stepwise analysis showed a consistent increase in cancer detection rates as VBR was decreased. The detection rates for VBRs of 2, 3, and 4 were 59%, 53%, and 50%, respectively. The detection rates dropped sharply to 42% and 30% for VBRs of 5 and 6, respectively. Cancers diagnosed with low VBRs were similar to those diagnosed with high VBRs in regard to Gleason scores and percentages of cancer in the prostatectomy specimens.
Using VBR of 4 maintains high cancer detection rates without taking an excessive number of biopsy specimens. This is a simple and easy-to-remember method.
旨在为泌尿外科医生提供一个简单的依据，以优化前列腺穿刺活检的取材条数。
回顾了1024例行经直肠超声引导下活检患者的记录。用前列腺体积除以活检条数得出体积/活检比（VBR）。进行单因素和多因素分析以确定活检阳性的最佳预测因素。
分析纳入了939例前列腺特异性抗原<20 ng/mL的患者。活检阳性的显著独立变量为年龄、前列腺特异性抗原、前列腺体积和VBR（p<0.001）。在所有显著变量中，VBR的相关系数最强。逐步分析显示，随着VBR降低，癌症检出率持续上升。VBR为2、3和4时的检出率分别为59%、53%和50%。VBR为5和6时，检出率分别急剧降至42%和30%。在Gleason评分及前列腺切除标本中的癌症百分比方面，低VBR诊断出的癌症与高VBR诊断出的癌症相似。
采用VBR为4可保持较高的癌症检出率，且无需获取过多的活检标本。这是一种简单且易于记忆的方法。
