Del Rosso Alessandro, Di Pierro Ezio Domenico, Masciovecchio Stefano, Galatioto Giuseppe Paradiso, Vicentini Carlo
Department of Urology, University of L'Aquila, G. Mazzini Hospital, Teramo, Italy.
Arch Ital Urol Androl. 2012 Mar;84(1):22-5.
To prospectively evaluate whether TRUS guided biopsy associated with Color Doppler (CD) imaging improves the detection of PCa.
From January 2008 to December 2010, 144 subjects, with an increased PSA value or with a suspect digital rectal examination, were enrolled. Transrectal grey-scale Ultrasound (US) and CD examination were performed in all patients. CD US was considered positive or negative on the basis of the presence or absence of vascular abnormality. Prostate biopsy was performed immediately after grey-scale and Doppler evaluation, with a mean of 10 core-biopsy for each patient as well as a selective biopsy of all US abnormal areas (hypoechoic lesion or CD abnormality areas).
PCa has been detected in 71 (49.3%) patients. 58 of the 71 patients had a hypoechoic area at US scan and 27 had a CD abnormality. The PSA value was < 4 ng/ml in 11 patients (Group 1), in 63 patients PSA ranged between 4 and 10 ng/ml (Group 2) and in 70 patients PSA was greater than 10 ng/ml (Group 3). The detection rate was 36.7, 36.5 and 62.8% respectively. In Group 1 we detected 5 hypoechoic areas and 4 CD abnormal areas. Moreover 6 of 11 patients had a positive DRE. In the Group 2, 20 patients were positive to DRE; we visualized 21 hypoechoic areas and 7 CD abnormality. In the Group 3, 38 patients had a positive DRE, with 32 hypoechoic areas and 16 CD abnormalities found. We obtained 1537 total bioptic cores, 1440 randomly from peripheral gland, 70 from hypoechoic areas and 27 from abnormal CD flow areas. The detection rate was 17.1, 65.7 and 22.2% respectively.
CD US showed to be a complement to grey-scale imaging of prostate unless insufficiently sensitive to replace the standard systematic 8-12 core random peripherally biopsy. Furthermore it should be associated routinely to TRUS to easily focus suspect areas.
前瞻性评估经直肠超声（TRUS）引导下联合彩色多普勒（CD）成像的活检是否能提高前列腺癌（PCa）的检出率。
纳入2008年1月至2010年12月期间144例前列腺特异性抗原（PSA）值升高或直肠指检可疑的患者。所有患者均接受经直肠灰阶超声（US）及CD检查。根据有无血管异常，CD US分为阳性或阴性。在灰阶和多普勒评估后立即进行前列腺活检，每位患者平均取10个核心活检样本，并对所有超声异常区域（低回声病变或CD异常区域）进行选择性活检。
71例（49.3%）患者检测到PCa。71例患者中，58例超声扫描时有低回声区，27例有CD异常。11例患者（第1组）PSA值<4 ng/ml，63例患者PSA值在4至10 ng/ml之间（第2组），70例患者PSA值大于10 ng/ml（第3组）。检测率分别为36.7%、36.5%和62.8%。在第1组中，我们检测到5个低回声区和4个CD异常区。此外，11例患者中有6例直肠指检阳性。在第2组中，20例患者直肠指检阳性；我们观察到21个低回声区和7个CD异常。在第3组中，38例患者直肠指检阳性，发现32个低回声区和16个CD异常。我们共获取1537个活检样本，其中1440个随机取自外周腺组织，70个取自低回声区，27个取自CD血流异常区。检测率分别为17.1%、65.7%和22.2%。
CD US是前列腺灰阶成像的一种补充手段，除非其敏感性不足而无法取代标准的系统8 - 12针外周随机活检。此外，应常规将其与TRUS联合使用，以便轻松聚焦可疑区域。
