Spencer J A, Alexander A A, Gomella L, Matteucci T, Goldberg B B
Division of Diagnostic Ultrasound, Thomas Jefferson University Hospital, Philadelphia.
Clin Radiol. 1994 Oct;49(10):711-4. doi: 10.1016/s0009-9260(05)82667-4.
Five hundred and eighty men underwent transrectal ultrasound-guided biopsy of the prostate using the four quadrant biopsy (4QB) technique. Four hundred and three men had focal hypoechoic lesions of the peripheral gland but the other 177 men referred because of concern for the presence of cancer had no discrete sonographic lesion. Cancer was found from 4QB in only 32 of these 177 men (18.1%) compared to 158 of the 403 men (39.2%) with focal hypoechoic lesions (P < 0.001). Additional biopsy evidence of cancer was found in contralateral isoechoic (sonographically normal) quadrants in 41 men with focal hypoechoic cancerous lesions. In 17 men with hypoechoic lesions that were biopsy-benign, cancer was found in other isoechoic quadrants. There was no difference between the average Gleason scores of hypoechoic cancers and isoechoic cancers, other than when cancers were incidentally found in men with benign focal hypoechoic lesions. These had significantly lower scores (P = 0.02). Cancer yield in the 177 men without hypoechoic lesions increased as a function of prostate-specific antigen (PSA) level; 11% if PSA < 10ng/ml, 32% if > 20ng/ml. Prostatitis was the most common abnormal biopsy finding in these men. 4QB increases the yield of prostate cancer compared to simple biopsy of hypoechoic lesions and improves knowledge of local disease extent. 4QB is recommended for men with elevated PSA levels but no peripheral gland sonographic abnormality.
580名男性采用四象限活检（4QB）技术接受了经直肠超声引导下的前列腺穿刺活检。403名男性外周腺存在局灶性低回声病变，但另外177名因担心患癌前来就诊的男性未发现明显的超声病变。在这177名男性中，4QB仅发现32例癌症（18.1%），而在403名有局灶性低回声病变的男性中有158例癌症（39.2%）（P<0.001）。在41名有局灶性低回声癌性病变的男性对侧等回声（超声检查正常）象限中发现了更多癌症活检证据。在17名活检为良性的低回声病变男性中，在其他等回声象限发现了癌症。除了在有良性局灶性低回声病变的男性中偶然发现的癌症外，低回声癌和等回声癌的平均Gleason评分没有差异。这些癌症的评分明显较低（P = 0.02）。在177名无低回声病变的男性中，癌症检出率随前列腺特异性抗原（PSA）水平升高而增加；PSA<10ng/ml时为11%，>20ng/ml时为32%。前列腺炎是这些男性最常见的异常活检结果。与单纯对低回声病变进行活检相比，4QB提高了前列腺癌的检出率，并改善了对局部疾病范围的了解。对于PSA水平升高但外周腺超声检查无异常的男性，建议采用4QB。
