单纯靶向活检与系统联合靶向活检在高PI-RADS评分患者中的对比性研究
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南京医科大学第一附属医院泌尿外科

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国家自然科学基金项目(面上项目,重点项目,重大项目)(No.82002718 and No.81672532);江苏省自然科学基金 (No.BK20191077)


A comparative study of targeted biopsy alone and systematic combined targeted biopsy in patients with high PI-RADS scores
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The National Natural Science Foundation of China (General Program, Key Program, Major Research Plan)(No.82002718 and No.81672532);Natural Science Foundation of Jiangsu Province (No.BK20191077)

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    摘要:

    目的: 比较前列腺单纯靶向活检与系统联合靶向活检对高PI-RADS评分4~5分患者的诊断效能。 方法: 回顾性分析2019年7月1日至2022年6月1日南京医科大学第一附属医院439例前列腺PI-RADS评分为4~5分且接受前列腺单纯靶向活检与系统联合靶向活检患者的临床资料。中位年龄70(42,90)岁,中位前列腺特异性抗原11.7(1.4,49.5)ng/ml,中位前列腺体积37.6(14.0,201.1)ml,中位前列腺特异性抗密度0.3(0.04,3.0)ng/ml2。PI-RADS评分4分患者283例,5分患者156例。分别由2名泌尿外科医生独立对每例患者行bp-MRI-TRUS认知融合靶向活检和系统联合靶向活检。通过χ2检验或Fisher精确检验比较不同活检方式对有意义前列腺癌(CsPCa-A)的检出情况。 结果:439例中341例(77.7%)阳性,98例(22.3%)阴性,其中单纯靶向活检诊断前列腺癌的阳性率为73.0%(189/259),靶向联合系统活检阳性率为84.4%(152/180)。439例中294例(67.0%)诊断为CsPCa-A,单纯靶向活检与靶向联合系统活检对CsPCa-A的检出率差异无统计学意义[63.3%(164/259)与72.2%(127/180),P=0.05]。如仅仅行单纯靶向活检,会有15.6%(28/180)的CsPCa-A被遗漏。在PI-RADS评分4分患者中,单纯靶向活检与靶向联合系统活检对CsPCa-A的检出率差异有统计学意义[58.9%(86/146)与70.8%(97/137), P=0.04],在PI-RADS评分5分患者中,单纯靶向活检与靶向联合系统活检对CsPCa-A的检出率差异无统计学意义[69.0%(78/113)与76.7%(33/43),P=0.3]。 当0<PSA≤20时,单纯靶向活检与靶向联合系统活检对CsPCa-A的检出率差异有统计学意义[60.9%(117/192)与71.4%(105/147),P=0.04];当20<PSA≤50时,单纯靶向活检与靶向联合系统活检对CsPCa-A的检出率差异无统计学意义[70.1%(47/67)与75.8%(25/33),P=0.6]。当PI-RADS评分4分且0<PSA ≤20ng/ml时,单纯靶向活检与靶向联合系统活检对CsPCa-A的检出率差异有统计学意义[58.1%(72/124)与70.7%(82/116),P=0.04];当PI-RADS评分4分且20<PSA ≤50ng/ml时, 单纯靶向活检与靶向联合系统活检对CsPCa-A的检出率差异无统计学意义[63.6%(14/22)与76.2%(16/21),P=0.4];当PI-RADS评分5分,0<PSA ≤20ng/ml和20<PSA ≤50ng/ml时,单纯靶向活检与靶向联合系统活检对CsPCa-A的检出率差异均无统计学意义[66.2%(45/68)与74.2%(23/31),P=0.4]和[73.3%(33/45)与83.3%(10/12),P=0.7]。 结论:对于PI-RADS评分为4~5分疑似高危前列腺癌的患者,当PI-RADS评分4分且PSA>20ng/m或PI-RADS评分5分时,靶向活检可取代系统联合靶向活检。

    Abstract:

    Objective:To compare the diagnostic efficacy of prostate targeted biopsy alone and systematic targeted biopsy in patients with high PI-RADS score of 4~5. Methods:From1 July 2019 to 1 June 2022, 439 patients with prostate PI-RADS score of 4-5 who received prostate targeted biopsy alone and combined system targeted biopsy in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The patient’s median age was 70(42,90) yeas. median prostate specific antigen was 11.7(1.4,49.5)ng/ml,median prostate volume was 37.6(14.0,201.1)ml, Median prostate-specific anti-density was 0.3(0.04,3.0)ng/ml2. There were 283 patients with PI-RADS score of 4 and 156 patients with PI-RADS score of 5. Two urologists independently performed bp-MRI-TRUS cognitive fusion targeting and targeting combined system biopsy in each patient. The detection of CsPCa-A by different biopsy methods were compared by χ2 test or Fisher's exact test. Outcome:341out of 439 cases (77.7%) were positive, 98 cases (22.3%) were negative, Among of them, the positive rate of single targeted biopsy in the diagnosis of prostate cancer was 73.0% (189/259), and the positive rate of targeted combined systematic biopsy was 84.4% (152/180). Of the 439 cases,294 (67.0%) were diagnosed with CsPCa-A, and there was no significant difference in the detection rate of CsPCa-A between single targeted biopsy and targeted combined systematic biopsy [63.3% (164/259) and 77.2%(127/180), P=0.05]. If only targeted biopsy was performed, 15.6% (28/180) of CsPCa-A would be missed. In patients with a PI-RADS score of 4, there was significant difference in the detection rate of CsPCa-A between targeted biopsy alone and targeted combined systematic biopsy [58.9% (86/146) and 70.8% (97/137), P=0.04]. In patients with a PI-RADS score of 5, there was no significant difference in the detection rate of CsPCa-A between single targeted biopsy and targeted combined systematic biopsy [69.0%(78/113)与76.7%(33/43),P=0.3]。 When 0<PSA ≤20ng/ml, the difference in the detection rate of CsPCa-A between pure targeted biopsy and targeted combined systematic biopsy was statistically significant[60.9%(117/192)与71.4%(105/147),P=0.04]。When 20<PSA≤50, there was no significant difference in the detection rate of CsPCa-A between single targeted biopsy and targeted combined systematic biopsy[70.1%(47/67)与75.8%(25/33),P=0.6]。When the PI-RADS score was 4 and 0<PSA ≤20ng/ml, the difference in the detection rate of CsPCa-A between single targeted puncture and targeted combined systematic puncture was statistically significant [58.1%(72/124)与70.7%(82/116),P=0.04];When the PI-RADS score was 4 and 20<PSA ≤50ng/ml, there was no significant difference in the detection rate of CsPCa-A between single targeted puncture and targeted combined systematic puncture [63.6%(14/22)与76.2%(16/21),P=0.4];When the PI-RADS score was 5 points, 0 20ng/m or PI-RADS score is 5, a single targeted biopsy can replace the system combined with targeted biopsy.

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  • 收稿日期:2022-11-07
  • 最后修改日期:2023-01-05
  • 录用日期:2023-05-23
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