Nunez-Nateras Rafael, Andrews Jack R, Martin George L, Andrews Paul E, Humphreys Mitchell R, Ferrigni Robert G, Eversman William G, Castle Erik P
Department of Urology, Mayo Clinic, Phoenix, Arizona, USA.
Can J Urol. 2010 Feb;17(1):4985-8.
Measurements of prostate size are obtained to contribute in the diagnosis and follow up of patients with a variety of diseases. Since its introduction, transrectal ultrasonography (TRUS) of the prostate has become the most common method for assessment of prostate volumes. Ultrasonography, in general, has been associated with concerns of operator dependent variability. Herein, we analyze the accuracy of urologists and radiologists performing TRUS.
The accuracy of preoperative TRUS prostate volume estimation was evaluated by comparing it to gross specimen prostate weight following robot-assisted radical prostatectomy (RARP) performed from August 2004 to March 2008 in Mayo Clinic Arizona. A total of 800 RARPs were evaluated retrospectively with 302 patients having a prostate volume measurement with TRUS at our institution followed by RARP being performed within 30 days. The TRUS measurements were divided into two groups: those TRUS measurements performed by urologists (group 1), and those performed by radiologists (group 2). The accuracy of the two groups were compared using a Pearson correlation analysis.
The estimated weight by TRUS in the total cohort of patients correlated with the pathological specimen weight at 0.802 with a standard error of 0.90. Group 1 performed a total of 114 ultrasounds with a correlation of 0.835 and a standard error of 1.27. Group 2 performed a total of 188 with a correlation of 0.786 and a standard error of 0.88.
Urologists and radiologists are both consistently within 17%-22% of the estimated prostate specimen weight. Urologists appeared to have a slightly higher accuracy in estimation but a higher range of error for the whole group when compared to radiologists. Transrectal ultrasonography is a reliable technique to estimate prostate weight and accuracy to within 20% of the pathological weight. Urologists and radiologists are essentially equally proficient in estimating prostate weight with TRUS. These findings are particularly important with respect to specialty certification and competency/proficiency evaluation, as health care increasingly moves towards outcomes based reimbursement.
获取前列腺大小的测量值有助于多种疾病患者的诊断和随访。自引入以来，经直肠超声检查（TRUS）已成为评估前列腺体积最常用的方法。一般而言，超声检查一直存在依赖操作者的变异性问题。在此，我们分析了泌尿外科医生和放射科医生进行经直肠超声检查的准确性。
通过将2004年8月至2008年3月在亚利桑那州梅奥诊所进行的机器人辅助根治性前列腺切除术（RARP）后前列腺标本的大体重量与术前经直肠超声检查估计的前列腺体积进行比较，评估术前经直肠超声检查估计前列腺体积的准确性。总共对800例RARP进行了回顾性评估，其中302例患者在我们机构进行了经直肠超声检查测量前列腺体积，随后在30天内进行了RARP。经直肠超声检查测量分为两组：一组由泌尿外科医生进行（第1组），另一组由放射科医生进行（第2组）。使用Pearson相关性分析比较两组的准确性。
在整个患者队列中，经直肠超声检查估计的重量与病理标本重量的相关性为0.802，标准误差为0.90。第1组共进行了114次超声检查，相关性为0.835，标准误差为1.27。第2组共进行了188次，相关性为0.786，标准误差为0.88。
泌尿外科医生和放射科医生对前列腺标本估计重量的误差均始终在17%-22%以内。与放射科医生相比，泌尿外科医生在估计方面似乎准确性略高，但整个组的误差范围更大。经直肠超声检查是一种可靠的技术，可将前列腺重量估计准确到病理重量的20%以内。泌尿外科医生和放射科医生在使用经直肠超声检查估计前列腺重量方面基本同样熟练。随着医疗保健越来越朝着基于结果的报销方向发展，这些发现对于专业认证和能力/熟练程度评估尤为重要。
