针对经腹会阴直肠癌根治术（Miles手术）后前列腺特异性抗原（PSA）升高男性患者的新型经会阴超声引导活检术

New transperineal ultrasound-guided biopsy for men in whom PSA is increasing after Miles' operation.

作者信息

Park Byung Kwan, Chung Jae Hoon, Song Wan, Kang Minyong, Sung Hyun Hwan, Jeon Hwang Gyun, Jeong Byong Chang, Seo Seong Il, Jeon Seong Soo, Lee Hyun Moo, Kwon Ghee Young

机构信息

Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Dong, Gangnam-Ku, Seoul, 06351, Republic of Korea.

Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

出版信息

Insights Imaging. 2023 Mar 16;14(1):42. doi: 10.1186/s13244-023-01384-y.

DOI:10.1186/s13244-023-01384-y

PMID:36929129

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10020382/

Abstract

OBJECTIVES

Currently, a prostate biopsy is guided by transrectal ultrasound (US) alone. However, this biopsy cannot be performed in men without an anus. The aim of this study was to show the outcomes of a new transperineal US (TPUS)-guided biopsy technique in patients who underwent Miles' operation.

METHODS

Between April 2009 and March 2022, TPUS-guided biopsy was consecutively conducted in 9 patients (median, 71 years; range, 61-78 years) with high prostate-specific antigen values (22.60 ng/mL; 6.19-69.7 ng/mL). Their anuses were all removed due to rectal cancer. TPUS-guided biopsy was performed according to information on prostate magnetic resonance imaging. The technical success rate, cancer detection rate, and complication rate were recorded. Tumor sizes were compared between benign and cancer groups using an unpaired t-test with Welch's correction.

RESULTS

The new TPUS-guided biopsy was successfully performed in all patients. Cancer was detected in 77.8% (7/9) of the patients. These were all categorized as PI-RADS 5. Among them, the detection rate of significant cancer (Gleason score 7 or higher) was 66.7% (6/9). The median tumor size was 2.4 cm (1.7-3.1 cm). However, two patients were diagnosed with benign tissue with PI-RADS 3 or PI-RADS 4. Their median tumor size was 1.0 cm (0.8-1.2 cm). There was significant difference between the cancer and benign groups (p = 0.037) in terms of tumor size. Neither post-biopsy bleeding nor infections occurred.

CONCLUSIONS

New TPUS-guided biopsy technique may contribute to detecting large PI-RADS 5 prostate cancer in men after Miles' operation.

摘要

目的

目前，前列腺活检仅由经直肠超声（US）引导。然而，这种活检无法在没有肛门的男性中进行。本研究的目的是展示一种新的经会阴超声（TPUS）引导活检技术在接受迈尔斯手术患者中的结果。

方法

2009年4月至2022年3月期间，对9例前列腺特异性抗原值较高（22.60 ng/mL；范围6.19 - 69.7 ng/mL）的患者（中位年龄71岁；范围61 - 78岁）连续进行TPUS引导活检。他们均因直肠癌切除了肛门。根据前列腺磁共振成像信息进行TPUS引导活检。记录技术成功率、癌症检出率和并发症发生率。使用带有韦尔奇校正的非配对t检验比较良性和癌症组之间的肿瘤大小。

结果

所有患者均成功进行了新的TPUS引导活检。77.8%（7/9）的患者检测到癌症。这些均被归类为PI-RADS 5。其中，显著癌症（ Gleason评分7或更高）的检出率为66.7%（6/9）。中位肿瘤大小为2.4 cm（1.7 - 3.1 cm）。然而，两名患者被诊断为PI-RADS 3或PI-RADS 4的良性组织。他们的中位肿瘤大小为1.0 cm（0.8 - 1.2 cm）。癌症组和良性组之间在肿瘤大小方面存在显著差异（p = 0.037）。活检后既未发生出血也未发生感染。