Shapiro A, Lebensart P D, Pode D, Bloom R A
Department of Urology, Hadassah University Hospital, Jerusalem, Israel.
Br J Radiol. 1994 Jul;67(799):668-71. doi: 10.1259/0007-1285-67-799-668.
The development of high definition transrectal ultrasound probes has led to an increased interest in the ability of transrectal ultrasound of the prostate (TRUS) to assist in the diagnosis and management of prostate cancer. The present study was designed to examine the correlation of TRUS with digital rectal examination (DRE). The study group comprised 471 patients in whom the results of (a) DRE, (b) TRUS, and (c) histology of tissue obtained by transrectal biopsy of the prostate (TB), were all available. In those patients where both TRUS and DRE were negative, but prostate specific antigen (PSA) was greater than 10 micrograms ml-1, six random biopsies were performed. In all other cases the biopsies were TRUS directed to the suspicious lesion. There were 142 cases in whom both DRE and TRUS were negative or only mildly suspicious of malignancy. TB in these cases was positive for cancer in 17 cases (12%). In a further 126 cases, TRUS was positive for cancer, while DRE demonstrated no suspicious nodule. TB was positive in only 17 of these cases (13.5%). Similarly, in the 31 cases in which DRE was positive but TRUS was negative, TB was positive in only three cases (10%). In the 172 cases in whom both DRE and TRUS were positive, 99 biopsies were positive (57.5%). It was concluded from this study that DRE remains the most valuable single examination in the diagnosis of prostate cancer. TRUS increases the sensitivity of DRE if both are positive. When there is a discrepancy between the two examinations, the biopsy yield is low. When both are positive, a high cancer yield is obtained, TRUS having added value in directing the biopsy needle to the suspicious site. TRUS is thus a valuable adjunct to DRE in the diagnosis of prostate cancer.
高分辨率经直肠超声探头的发展使得人们对经直肠超声（TRUS）辅助前列腺癌诊断和管理的能力越来越感兴趣。本研究旨在探讨TRUS与直肠指检（DRE）之间的相关性。研究组包括471例患者，这些患者同时具备以下三项检查结果：（a）DRE、（b）TRUS以及（c）经直肠前列腺穿刺活检（TB）的组织学检查结果。对于TRUS和DRE均为阴性，但前列腺特异性抗原（PSA）大于10微克/毫升的患者，进行了6次随机活检。在所有其他情况下，活检均在TRUS引导下针对可疑病变进行。有142例患者DRE和TRUS均为阴性或仅轻度怀疑恶性肿瘤。在这些病例中，TB检查有17例癌症呈阳性（12%）。另有126例患者TRUS检查癌症呈阳性，而DRE未发现可疑结节。其中只有17例TB检查呈阳性（13.5%）。同样，在31例DRE呈阳性但TRUS为阴性的病例中，只有3例TB检查呈阳性（10%）。在DRE和TRUS均为阳性的172例病例中，99例活检呈阳性（57.5%）。本研究得出的结论是，DRE仍然是前列腺癌诊断中最有价值的单项检查。如果DRE和TRUS均为阳性，TRUS可提高DRE的敏感性。当两项检查结果不一致时，活检阳性率较低。当两项检查均为阳性时，癌症阳性率较高，TRUS在将活检针引导至可疑部位方面具有附加价值。因此，在前列腺癌的诊断中，TRUS是DRE的一项有价值的辅助检查。
