Hamper U M, Sheth S, Walsh P C, Holtz P M, Epstein J I
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
AJR Am J Roentgenol. 1990 Nov;155(5):1015-9. doi: 10.2214/ajr.155.5.2120928.
Detection of involvement of the neurovascular bundles (NVB) by tumor is important in deciding whether sexual function can be preserved in patients undergoing radical prostatectomy for prostatic cancer. The nerve branches innervating the corpora cavernosa have a rather constant association with the capsular arteries and veins of the prostate, forming the periprostatic neurovascular bundle, which can be identified intraoperatively and spared during radical surgery, thus preserving potency. We examined 160 patients with biopsy-proved clinical stage A or B adenocarcinoma with transrectal sonography before radical prostatectomy to determine how useful the procedure is for predicting tumor extension into the NVB. Correlation with pathologic serial sections was obtained in each patient. The sonograms depicted the NVB on both sides in 77 patients (50%), on the right side only in 13 (8%), and on the left side only in 36 patients (23%). In 29 patients (19%) neither neurovascular bundle could be identified on the sonograms. Ninety-one tumors in this series showed evidence of extraglandular spread pathologically, which was posterolateral or into the NVB in 70 tumors involving 82 hemispheres. Using transrectal sonography, we correctly identified invasion of the NVB in 54 cases and missed it in 28 cases. NVB invasion was predicted incorrectly with transrectal sonography in 51 cases; absence of involvement of the NVB was correctly predicted in 177 hemispheres. The sensitivity of sonography for predicting invasion of the NVB was 66%, with a specificity of 78% and an accuracy of 75%. Positive predictive values and negative predictive values were 51% and 86%, respectively. We conclude that transrectal sonography currently suffers from lack of sufficient spatial resolution to detect accurately invasion of the NVB.
检测肿瘤是否累及神经血管束（NVB）对于决定接受前列腺癌根治术的患者能否保留性功能至关重要。支配海绵体的神经分支与前列腺的包膜动脉和静脉有着相当恒定的联系，形成前列腺周围神经血管束，术中可识别该神经血管束并在根治性手术中予以保留，从而保留性功能。我们在前列腺癌根治术前对160例经活检证实为临床A期或B期腺癌的患者进行经直肠超声检查，以确定该检查对预测肿瘤向NVB扩展的有效性。对每位患者均获取了与病理连续切片的相关性。超声检查显示，77例患者（50%）双侧均可见NVB，仅右侧可见的有13例（8%），仅左侧可见的有36例（23%）。29例患者（19%）的超声检查均未发现神经血管束。本系列中有91个肿瘤在病理上显示有腺外扩散，其中70个肿瘤（涉及82个半球）表现为后外侧扩散或侵犯NVB。通过经直肠超声检查，我们正确识别出54例NVB侵犯，漏诊28例。经直肠超声检查错误预测NVB侵犯51例；正确预测177个半球未累及NVB。超声检查预测NVB侵犯的敏感性为66%，特异性为78%，准确性为75%。阳性预测值和阴性预测值分别为51%和86%。我们得出结论，目前经直肠超声检查缺乏足够的空间分辨率，无法准确检测NVB侵犯。
