评估超声在前列腺癌试验中的作用——1期：英国微超声的早期经验。
Evaluating the Role of Ultrasound in Prostate Cancer trial - phase 1: Early experience of micro-ultrasound in the United Kingdom.
作者信息
Parker Pamela, Twiddy Maureen, Rigby Alan, Whybrow Paul, Simms Matthew
机构信息
University of Hull and Hull University Teaching Hospitals NHS Trust, Kingston upon Hull, UK.
Institute of Clinical and Applied Health Research, Hull York Medical School, Kingston upon Hull, UK.
出版信息
Ultrasound. 2024 Nov;32(4):244-252. doi: 10.1177/1742271X231226302. Epub 2024 Feb 14.
PURPOSE
The purpose of this study was to evaluate if the use of micro-ultrasound can detect clinically significant prostate pathology when compared to histology obtained during a transperineal prostate biopsy.
METHODS
Patients suspected of having prostate cancer, who had a pre-biopsy magnetic resonance imaging and could tolerate a transrectal examination, were prospectively recruited. All patients had a micro-ultrasound scan prior to their biopsy. The findings of magnetic resonance imaging, micro-ultrasound and histology were risk stratified in accordance with local pathways. Comparison of assigned risk scores was made using histology as the reference standard.
RESULTS
Data from 101 patients were evaluated. Histology showed that clinically significant prostate cancer was detected in 48.5% ( = 49/101) of patients. Moderate inter-rater agreement was found in both magnetic resonance imaging and micro-ultrasound with К of 0.31 in both modalities. High-risk findings were identified in 81% ( = 82/101) patients at magnetic resonance imaging and in 66% ( = 67/101) patients at micro-ultrasound. Sensitivity and specificity of magnetic resonance imaging were found to be 87% and 34.6% and for micro-ultrasound 73.3% and 53.8%, respectively.
CONCLUSION
A limitation of this study was that the biopsy was not performed with micro-ultrasound which may have resulted in unidentified cancers and lowered the apparent accuracy of the technique. However, we conclude that while micro-ultrasound was diagnostic, magnetic resonance imaging demonstrated higher sensitivity in our local population and remains the pre-biopsy imaging modality of choice. However, the higher specificity of micro-ultrasound identified does indicate that it may be of value when magnetic resonance imaging is contraindicated. The role of micro-ultrasound, within an active surveillance pathway for prostate cancer, warrants further investigation.
目的
本研究的目的是评估与经会阴前列腺活检时获取的组织学结果相比，使用微型超声能否检测出具有临床意义的前列腺病变。
方法
前瞻性招募疑似患有前列腺癌、活检前进行过磁共振成像且能耐受经直肠检查的患者。所有患者在活检前均进行了微型超声扫描。根据当地路径对磁共振成像、微型超声和组织学检查结果进行风险分层。以组织学检查结果作为参考标准，对分配的风险评分进行比较。
结果
对101例患者的数据进行了评估。组织学检查显示，48.5%（n = 49/101）的患者检测出具有临床意义的前列腺癌。磁共振成像和微型超声检查的评分者间一致性中等，两种检查方式的K值均为0.31。磁共振成像检查发现81%（n = 82/101）的患者有高危结果，微型超声检查发现66%（n = 67/101）的患者有高危结果。磁共振成像的敏感性和特异性分别为87%和34.6%，微型超声的敏感性和特异性分别为73.3%和53.8%。
结论
本研究的一个局限性是活检未使用微型超声进行，这可能导致未识别出癌症，并降低了该技术的表观准确性。然而，我们得出的结论是，虽然微型超声具有诊断价值，但磁共振成像在我们当地人群中显示出更高的敏感性，仍然是活检前首选的成像方式。然而，所确定的微型超声较高的特异性确实表明，当磁共振成像检查禁忌时，它可能具有价值。微型超声在前列腺癌主动监测路径中的作用值得进一步研究。
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