对比增强超声靶向活检与标准系统活检在临床显著前列腺癌检测中的比较：一项前瞻性队列研究的结果，共纳入 1024 例患者。

Comparison of contrast-enhanced ultrasound targeted biopsy versus standard systematic biopsy for clinically significant prostate cancer detection: results of a prospective cohort study with 1024 patients.

机构信息

Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, People's Republic of China.

Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, People's Republic of China.

出版信息

World J Urol. 2019 May;37(5):805-811. doi: 10.1007/s00345-018-2441-1. Epub 2018 Sep 5.

DOI:10.1007/s00345-018-2441-1

PMID:30187133

Abstract

PURPOSE

To assess contrast-enhanced ultrasound (CEUS) targeted biopsy (TB) for clinically significant prostate cancer (PCa) detection compared with systematic biopsy (SB).

METHODS

A total of 1024 consecutive patients scheduled for prostate biopsy were enrolled in this prospective study. CEUS was performed by an experienced radiologist blinded to all clinical data. Suspicious lesions on postcontrast images were sampled in addition to standard 12-core SB. The clinically significant PCa detection rate by CEUS-TB was evaluated in comparison with SB in the total cohort and in different subgroups.

RESULTS

In 378 of 1024 patients (36.9%), the diagnosis of PCa was histologically confirmed. PCa was detected by CEUS-TB in 306 patients (29.9%, 306/1024) and SB in 317 patients (31.0%, 317/1024, P = 0.340). Among 378 PCa patients, 326 (86.2%, 326/378) were diagnosed with significant PCa using Epstein criteria. The significant PCa detection rate of CEUS-TB was 28.7% (294/1024), which was higher than that of SB (25.3%, 259/1024, P = 0.000). CEUS-TB resulted in 67 additional cases of clinically significant PCa, including 51 patients missed by SB and 16 patients under-graded by SB. Conversely, SB detected 32 additional significant PCa missed by TB. In the subgroup analysis, CEUS-TB yielded a higher significant cancer detection rate than SB in patients with a PSA level ≤ 10.0 ng/ml or prostate volume from 30 to 60 ml.

CONCLUSION

The clinically significant PCa detection rate could be improved by the extra sampling of abnormalities on postcontrast images, especially in patients with a PSA level ≤ 10.0 ng/ml or prostate volume from 30 to 60 ml.

摘要

目的

评估对比增强超声（CEUS）靶向活检（TB）在检测临床显著前列腺癌（PCa）方面与系统活检（SB）相比的效果。

方法

本前瞻性研究纳入了 1024 例连续拟行前列腺活检的患者。CEUS 由一位经验丰富的放射科医生进行，该医生对所有临床数据均不知情。在标准的 12 针 SB 之外，对对比后图像上的可疑病变进行取样。在总队列和不同亚组中，评估 CEUS-TB 检测临床显著 PCa 的检出率。

结果

在 1024 例患者中，378 例（36.9%）经组织学证实诊断为 PCa。CEUS-TB 在 306 例患者（29.9%，306/1024）中检测到 PCa，SB 在 317 例患者（31.0%，317/1024，P=0.340）中检测到 PCa。在 378 例 PCa 患者中，326 例（86.2%，326/378）采用 Epstein 标准诊断为显著 PCa。CEUS-TB 的显著 PCa 检出率为 28.7%（294/1024），高于 SB 的 25.3%（259/1024，P=0.000）。CEUS-TB 检出 67 例额外的临床显著 PCa，其中包括 51 例 SB 漏诊和 16 例 SB 低估。相反，SB 检出 32 例 TB 漏诊的显著 PCa。在亚组分析中，CEUS-TB 在 PSA 水平≤10.0ng/ml 或前列腺体积为 30-60ml 的患者中，显著 PCa 的检出率高于 SB。