Gohji K, Morisue K, Kizaki T, Fujii A
Department of Urology, Hyogo Medical Center for Adults, Japan.
Br J Urol. 1995 Jun;75(6):758-65. doi: 10.1111/j.1464-410x.1995.tb07387.x.
To determine the usefulness of transrectal ultrasound (TRUS) and systematic biopsy by correlating these results with pathological findings after radical prostatectomy.
Pre-operative TRUS examination combined with the findings on systematic biopsy in 15 patients (mean age 70.6 years, range 57-87) who underwent radical prostatectomy between October 1992 and February 1994 were compared retrospectively to the histological features of whole mount sections of the surgical specimens.
In all cases, the tumour was visualized as a hypoechoic area on the sonogram. In addition, in six of 15 cases the tumour was localized in an isoechoic area which was examined before the operation by systematic biopsy. In this series, a systematic biopsy before operating detected tumour grade and localization of the tumour in 14 and 15 patients, respectively. The positive predictive value of capsular penetration and seminal vesicle invasion on the sonogram was 0.71 and 1.00, respectively, while sensitivity was 1.00 and 0.33, respectively. Five of seven patients with findings of capsular penetration on the sonogram revealed capsular penetration in the resected prostate, whereas, of three patients with pathologically detected seminal vesical invasion, only one had findings of seminal vesicle invasion by ultrasonography. The serum prostate specific antigen level of all three patients was more than 30 ng/mL. Moreover, in this series of 15 patients TRUS detected the precise stage in 11 patients. In the remaining four patients, two were overstaged and two were understaged. Tumours with hypoechogenicity were of higher grade and larger than tumours with isoechogenicity. All tumours with hypoechogenicity were palpable and all with isoechogenicity were not.
TRUS combined with a systematic biopsy was useful in predicting tumour grade, exact location and capsular penetration. However, it was not useful for determining tumour stage or predicting seminal vesicle invasion of prostate cancer. TRUS-guided seminal vesicle biopsy must be performed in patients with a serum prostate specific antigen of more than 30 ng/mL.
通过将经直肠超声（TRUS）及系统活检结果与根治性前列腺切除术后的病理结果相关联，来确定其有用性。
回顾性比较1992年10月至1994年2月期间接受根治性前列腺切除术的15例患者（平均年龄70.6岁，范围57 - 87岁）术前TRUS检查及系统活检结果与手术标本全层切片的组织学特征。
所有病例中，肿瘤在超声图像上均表现为低回声区。此外，15例中有6例肿瘤位于等回声区内，术前已通过系统活检对该区域进行了检查。在本系列中，术前系统活检分别在14例和15例患者中检测到肿瘤分级及肿瘤位置。超声图像上包膜侵犯和精囊侵犯的阳性预测值分别为0.71和1.00，而敏感性分别为1.00和0.33。超声图像上有包膜侵犯表现的7例患者中，5例在切除的前列腺中显示有包膜侵犯；而病理检测有精囊侵犯的3例患者中，超声检查仅1例有精囊侵犯表现。这3例患者的血清前列腺特异性抗原水平均超过30 ng/mL。此外，在这15例患者系列中，TRUS在11例患者中检测到了准确分期。其余4例患者中，2例分期过高，2例分期过低。低回声肿瘤的分级高于等回声肿瘤，且体积更大。所有低回声肿瘤均可触及，而等回声肿瘤均不可触及。
TRUS联合系统活检有助于预测肿瘤分级、准确位置及包膜侵犯。然而，它对确定肿瘤分期或预测前列腺癌精囊侵犯无用。血清前列腺特异性抗原超过30 ng/mL的患者必须进行TRUS引导下的精囊活检。
