Narayan P, Jajodia P, Stein R, Tanagho E A
Department of Urology, University of California School of Medicine, San Francisco 94143-0738.
J Urol. 1989 Mar;141(3):560-3. doi: 10.1016/s0022-5347(17)40894-9.
Fine needle aspiration biopsy has been documented to be safe and accurate for the diagnosis of prostate cancer. A study was done based on 3 objectives to determine 1) whether performing core biopsies and fine needle aspiration in each patient with a prostate nodule increases the detection rate of prostate cancer, 2) the accuracy of preoperative grading by fine needle aspiration in predicting the final pathological grade in radical prostatectomy specimens and 3) the usefulness of fine needle aspiration in screening for unsuspected stage A prostate cancer. Of 203 consecutive patients undergoing prostate biopsies core and fine needle aspiration biopsies were performed in 121. An additional 58 patients underwent prostate biopsies just before transurethral resection of the prostate and 24 underwent radical prostatectomy. The diagnostic accuracy of fine needle aspiration was superior to that of core biopsy (82 versus 74 per cent). Performance of both biopsies yielded a higher percentage of positive diagnoses than either biopsy alone (32.2 per cent versus 24 and 28 per cent). Except in poorly differentiated cancers, fine needle aspiration is a poor predictor of final pathological grade. Fine needle aspiration is not useful in detecting stage A1 prostate cancer. Although fine needle aspiration has several distinct advantages over core biopsies, there is a definite learning curve before its use can be fully exploited. It is important to have an experienced pathologist and to perform both biopsies at each center until sufficient experience is accumulated.
细针穿刺活检已被证明对前列腺癌的诊断是安全且准确的。基于三个目标开展了一项研究，以确定：1）对每个有前列腺结节的患者同时进行穿刺活检和细针穿刺是否能提高前列腺癌的检出率；2）细针穿刺术前分级在预测根治性前列腺切除标本最终病理分级方面的准确性；3）细针穿刺在筛查未被怀疑的A期前列腺癌中的作用。在203例连续接受前列腺活检的患者中，121例同时进行了穿刺活检和细针穿刺活检。另外58例患者在经尿道前列腺切除术前接受了前列腺活检，24例接受了根治性前列腺切除术。细针穿刺的诊断准确性优于穿刺活检（82%对74%）。两种活检方法联合使用的阳性诊断率高于单独使用任何一种活检方法（32.2%对24%和28%）。除了低分化癌外，细针穿刺对最终病理分级的预测能力较差。细针穿刺对检测A1期前列腺癌没有用处。尽管细针穿刺相对于穿刺活检有几个明显的优点，但在能够充分利用其优势之前，存在一个明确的学习曲线。拥有一位经验丰富的病理学家并在每个中心同时进行两种活检直到积累足够的经验是很重要的。
