Egawa S, Kawakami T, Nishimaki H, Kuwao S, Uchida T, Yokoyama E, Mashimo S, Koshiba K
Department of Urology, Kitasato University School of Medicine.
Nihon Hinyokika Gakkai Zasshi. 1994 May;85(5):792-801. doi: 10.5980/jpnjurol1989.85.792.
The diagnostic usefulness of digital rectal examination (DRE), transrectal ultrasonography (TRUS), magnetic resonance imaging (MRI) and computed tomography (CT) was compared in the differentiation of stage B from stage C prostate cancer. Eighteen patients who had undergone radical retropubic prostatectomy were included in this study. Overall, the positive predictive values (PPV) for detecting extraprostatic disease (extracapsular extension, seminal vesicle invasion) were 100% for DRE, 88.9% for TRUS and 80.0% for MRI, respectively. Corresponding figures for accuracy in detecting extraprostatic spread were 55.6%, 66.7% and 61.1%, respectively. The PPV and accuracy for detecting extraprostatic disease in 13 patients with localized cancer (< stage B) were 75.0%, 53.8% for TRUS and 66.7%, 53.8% for MRI, respectively. Both of these examinations appeared to be superior to DRE alone. The PPV and accuracy increased when findings on TRUS and MRI coincided. Computed tomography was less accurate than MRI in diagnosing nodal involvement because of the higher incidence of false positives. Further efforts should be focused on enhancing preoperative diagnostic precision in staging prostate cancer because of the limited usefulness of the current imaging techniques. Development of more reliable diagnostic modalities or designing ideal combination of these studies are desperately needed.
比较了直肠指检（DRE）、经直肠超声检查（TRUS）、磁共振成像（MRI）和计算机断层扫描（CT）在鉴别B期和C期前列腺癌方面的诊断效用。本研究纳入了18例接受根治性耻骨后前列腺切除术的患者。总体而言，DRE、TRUS和MRI检测前列腺外疾病（包膜外浸润、精囊侵犯）的阳性预测值（PPV）分别为100%、88.9%和80.0%。检测前列腺外扩散的相应准确率分别为55.6%、66.7%和61.1%。13例局限性癌症（<B期）患者中，TRUS和MRI检测前列腺外疾病的PPV和准确率分别为75.0%、53.8%以及66.7%、53.8%。这两项检查似乎均优于单独的直肠指检。当TRUS和MRI结果一致时，PPV和准确率会提高。由于假阳性发生率较高，CT在诊断淋巴结受累方面不如MRI准确。鉴于目前成像技术的效用有限，应进一步致力于提高前列腺癌分期的术前诊断准确性。迫切需要开发更可靠的诊断方法或设计这些检查的理想组合。
