Fujimoto H, Tobisu K, Niwakawa M, Kume H, Tomita K, Mizutani T, Tsutsumi M, Kakizoe T
Division of Urology, National Cancer Center Hospital.
Nihon Hinyokika Gakkai Zasshi. 1997 Apr;88(4):479-87. doi: 10.5980/jpnjurol1989.88.479.
To estimate the usefulness of sextant systematic core biopsy or transrectal ultrasonography (TURS) for performing radical prostatectomy.
The findings of sextant biopsy and TRUS were compared with 52 step-sectioned specimens obtained from radical prostatectomy.
In 34 cases with no influence of hormonal therapy at the time of TRUS and biopsy, sextant systematic core biopsy provided tumor distribution rather precisely. In 33% of the cases who had received hormonal therapy, tumor cells were not detected by this sextant biopsy series. In these cases, majority of residual cancer existed in transition zone, paraurethral or fibromuscular stroma. Six cases showed small adenocarcinoma in only one biopsy tip obtained from sextant biopsy, while 4 cases were revealed well differentiated adenocarcinoma (Gleason score less than 4) by these core biopsies. Comparing with tumor mapping, Gleason score, PSA level and pT stage of the radical prostatectomy specimens, these tumors presented as, not clinically insignificant, but clinically significant prostate cancer. Playing special attention to distraction of normal ultrasound zonal configuration, TRUS detected neurovascular invasion with 94.7% sensitivity, 78.3% positive predictive value and 90. 9% negative predictive value, while seminal vesicle invasion with 75% sensitivity, 50% positive predictive value, 90.9% negative value.
Sextant biopsy tended to underestimate the tumors located in the transition zone, paraurethral and fibromuscular lesion. Additional or direct biopsies in transition zone are indispensable for accurate diagnosis. Findings of TRUS and distribution of positive core biopsy from sextant biopsy enable to extract stage C prostate cancer providing negative surgical margin.
评估六分区系统穿刺活检或经直肠超声检查（TRUS）在根治性前列腺切除术中的应用价值。
将六分区活检和TRUS的结果与52例根治性前列腺切除术后的连续切片标本进行比较。
在34例TRUS和活检时未受激素治疗影响的病例中，六分区系统穿刺活检能较准确地提供肿瘤分布情况。在33%接受过激素治疗的病例中，该六分区活检系列未检测到肿瘤细胞。在这些病例中，大部分残留癌存在于移行区、尿道旁或纤维肌基质中。6例在六分区活检的仅一个穿刺针芯中显示有小腺癌，而4例通过这些穿刺活检显示为高分化腺癌（Gleason评分小于4）。与根治性前列腺切除标本的肿瘤定位、Gleason评分、前列腺特异性抗原（PSA）水平和pT分期相比，这些肿瘤表现为具有临床意义而非临床无意义的前列腺癌。特别注意正常超声分区结构的破坏，TRUS检测神经血管侵犯的敏感性为94.7%，阳性预测值为78.3%，阴性预测值为90.9%；检测精囊侵犯的敏感性为75%，阳性预测值为50%，阴性预测值为90.9%。
六分区活检往往会低估位于移行区、尿道旁和纤维肌病变中的肿瘤。对于准确诊断，在移行区进行额外或直接活检是必不可少的。TRUS的结果以及六分区活检阳性穿刺针芯的分布有助于识别能够实现阴性手术切缘的C期前列腺癌。
