徒手经会阴活检在诊断价值和安全性方面的初步结果：沙特阿拉伯布赖代法赫德国王专科医院的早期经验

Initial Outcomes of Freehand Transperineal Biopsies Regarding Diagnostic Value and Safety: An Early Experience at King Fahad Specialist Hospital, Buraydah, Saudi Arabia.

作者信息

Alnosayan Hatim, Alharbi Mohannad A, Alharbi Adel H, Aloraini Abdullah S, Alfayyadh Abdulhamid M, Almansour Mohammed

机构信息

Department of Urology, College of Medicine, Qassim University, Qassim, SAU.

Department of Urology, King Fahad Specialist Hospital, Qassim, SAU.

出版信息

Cureus. 2023 May 21;15(5):e39318. doi: 10.7759/cureus.39318. eCollection 2023 May.

DOI:10.7759/cureus.39318

PMID:37351252

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10282500/

Abstract

BACKGROUND

Prostate cancer is a common type of cancer in Saudi Arabia with a high incidence rate. Trans-rectal ultrasound guided prostatic biopsy (TRUSBx) has been the standard diagnostic study for prostate cancer since a landmark study in 1989 which showed that it is better than digitally directed biopsy sampling of the prostate. As an alternative to TRUSBx, transperineal biopsies (TPBx) have gained popularity as they give a higher accuracy rate and avoid many complications. A new study has been conducted in Riyadh, Saudi Arabia to compare TRUSBx and TPBx showed that TPBx has a significantly higher detection rate of prostate cancer cases compared to TRUSBx (45.1% vs. 29.1%, =0.003). The aim of this study is to determine the diagnostic value and safety of freehand transperineal prostate biopsy in patients with an elevated prostatic specific antigen (PSA) and/or abnormal digital rectal exam in King Fahad Specialist Hospital KFSH in Buraydah, Qassim region, Saudi Arabia.

METHODS

This is an observational retrospective study of all patients (n=39) who underwent transperineal biopsies at KFSH to assess the diagnostic value and safety of the procedure.

RESULTS

The mean age of the patients was 70.3 (SD 10.1) years. The most commonly found diagnosis was adenocarcinoma (61.5%), and incidence of complications was detected in (5.1%) of the patients.

CONCLUSION

We concluded that the freehand technique TPBx has a high accuracy rate in detecting prostatic cancer. However, the learning curve could be a limiting factor in implementing it. Increasing the number of biopsies could positively affect diagnostic accuracy, especially with our low complication rate in this procedure. A low number of biopsies in the older age group can give an accurate result with a low risk of complications. Although template-guided TPBx and robot-guided TPBx are better options, the freehand technique represents a cost-effective and time-saving alternative. However, more studies are needed to compare the outcome of such a technique.

摘要

背景

前列腺癌是沙特阿拉伯常见的癌症类型，发病率很高。自1989年一项具有里程碑意义的研究表明经直肠超声引导下前列腺穿刺活检（TRUSBx）优于前列腺指诊引导下活检采样以来，它一直是前列腺癌的标准诊断方法。作为TRUSBx的替代方法，经会阴穿刺活检（TPBx）因其准确率更高且避免了许多并发症而受到欢迎。沙特阿拉伯利雅得进行了一项新研究，比较TRUSBx和TPBx，结果显示TPBx检测前列腺癌病例的比率明显高于TRUSBx（45.1%对29.1%，P=0.003）。本研究的目的是确定沙特阿拉伯卡西姆地区布赖代法赫德国王专科医院中前列腺特异性抗原（PSA）升高和/或直肠指检异常的患者进行徒手经会阴前列腺穿刺活检的诊断价值和安全性。

方法

这是一项对在法赫德国王专科医院接受经会阴穿刺活检的所有患者（n=39）进行的观察性回顾性研究，以评估该操作的诊断价值和安全性。

结果

患者的平均年龄为70.3（标准差10.1）岁。最常见的诊断是腺癌（61.5%），5.1%的患者检测到并发症发生率。

结论

我们得出结论，徒手技术经会阴穿刺活检在检测前列腺癌方面具有较高的准确率。然而，学习曲线可能是实施该技术的一个限制因素。增加穿刺活检的数量可能会对诊断准确性产生积极影响，尤其是在我们这个操作并发症发生率较低的情况下。老年组穿刺活检数量较少也能在低并发症风险下给出准确结果。虽然模板引导下经会阴穿刺活检和机器人引导下经会阴穿刺活检是更好的选择，但徒手技术是一种经济高效且节省时间的替代方法。然而，需要更多研究来比较这种技术的结果。