超声造影及其引导穿刺在前列腺癌新分级分组中的应用

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摘要目的探讨经直肠超声造影（CETRUS）及其引导穿刺在前列腺癌（PCa）Gleason分级分组中的应用价值。方法前瞻性选取2016年1月~2020年1月广州市番禺区中心医院收治的疑似PCa患者并行前列腺超声造影及其引导穿刺患者118例，根据病例结果将其分为PCa组（46例）和良性组（72例）；根据Gleason分级分组将其分为Gleason≤3+4组（13例）和Gleason≥4+3组（33例）。分析超声造影诊断PCa敏感度、特异性和诊断率；通过时间-强度曲线获取造影参数并进行比较，根据病理结果对良恶性组织的造影参数和PCa的新分级分组进行分析。结果 46例确诊为PCa患者。超声造影诊断PCa的敏感度、特异度和诊断率分别为74%、83%和80%。PCa分级分组结果为1组5例(11%)，2组8例(17%)，3组9例(20%)，4组12例（26%），5组12例（26%）。PCa组与良性组初始强度（B）、曲线下面积（AUC）比较，差异无统计学意义（P > 0.05）；PCa组达峰时间（TIP）、峰值减半时间（IHT）短于良性组，峰值强度（PI）高于良性组，差异均有统计学意义（均P < 0.05）。PCa患者癌区B、PI和AUC高于周围组织，TIP和IHT低于周围组织，差异均有统计学差异（均P < 0.05）。Gleason≥4+3组（3~5组）B、PI和AUC高于Gleason≤3+4组（1~2组），差异均有统计学意义（均P < 0.05）；两组TIP、IHT比较，差异无统计学意义（P > 0.05）。结论超声造影及引导下穿刺有较高的诊断率，能够很好地反映PCa新分级分组的差异性，二者可协同评价PCa的预后，也有助于靶向引导前列腺穿刺确诊。

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	何杰灵1 陈少敏2 于倩3 刘大伟4 李文辉3 何金花5 梁展鹏1▲ 杨锐林6▲

关键词 ：经直肠超声造影, 穿刺活检, 前列腺癌, Gleason分级分组

Abstract：Objective To investigate the application value of contrast enhanced transrectal ultrasound (CETRUS) and its guided prostate biopsy in the new Gleason grading groups of prostate cancer (PCa). Methods From January 2016 to January 2020, 118 cases with suspected PCa who underwent prostate biopsy in Guangzhou Panyu Central Hospital were selected. The patients were divided into the PCa group (46 cases) and the benign group (72 cases), according to the pathological result. According to Gleason Grading groups, PCa patients were divided into Gleason ≤ 3+4 group (13 cases) and Gleason ≥ 4+3 group (33 cases). The sensitivity, specificity and diagnosis rate of CETRUS in diagnosis of PCa were analyzed. The contrast parameters were obtained and compared by time-intensity curve, and the parameters of benign and malignant tissues and the gleason grading groups of PCa were analyzed according to the pathological results. Results Forty-six cases were diagnosed with PCa. The sensitivity, specificity and diagnostic rate of CETRUS in diagnosis of PCa were 74%, 83% and 80%, respectively. The PCa classification grouping result showed that 5 cases (11%) in Group 1, 8 cases (17%) in Group 2, 9 cases (20%) in Group 3, 12 cases (26%) in Group 4 and 12 cases (26%) in Group 5, respectively. There were no significant differences in base intensity (B) and area under curve (AUC) between the PCa group and the benign group (P > 0.05). Time to peak (TIP) and peak in half time (IHT) of the PCa Group were shorter than those of the benign group, peak intensity (PI) of the PCa Group was higher than that of the benign Group, and the differences were statistically significant (all P < 0.05). B, PI and AUC of cancer tissues in PCa patients were higher than those of surrounding tissues, TIP and IHT of cancer tissues were shorter than those of surrounding tissues, and the differences were statistically significant (all P < 0.05). B, PI and AUC in Gleason ≥ 4+3 group (Group 3-5) were higher than Gleason ≤ 3+4 group (Group 1-2), and the differences were statistically significant (all P < 0.05); there were no significant differences in TIP, IHT between two Groups (P > 0.05). Conclusion CETRUS with its guided prostate biopsy has a high diagnostic rate, and can reflect the difference of new Gleason grading groups of PCa. The combination of both can evaluate the prognosis of PCa and also help to targeted biopsy for PCa.

Key words： Contrast enhanced transrectal ultrasound Prostate biopsy Prostate cancer Gleason grading groups

基金资助:广东省广州市卫生健康科技一般引导项目（2019 1A010083）；
广东省中医药局中医药科研项目（20192073）；
广东省广州市番禺区科技计划医疗卫生项目（2019-Z04-37）。

通讯作者: ▲共同通讯作者

引用本文:

何杰灵1 陈少敏2 于倩3 刘大伟4 李文辉3 何金花5 梁展鹏1▲ 杨锐林6▲. 超声造影及其引导穿刺在前列腺癌新分级分组中的应用[J]. 中国医药导报, 2020, 17(13): 152-156.
HE Jieling1 CHEN Shaomin2 YU Qian3 LIU Dawei4 LI Wenhui3 HE Jinhua5 LIANG Zhanpeng1▲ YANG Ruilin6▲. Application of contrast enhanced transrectal ultrasound and its guided prostate biopsy in new Gleason grading groups of prostate cancer. 中国医药导报, 2020, 17(13): 152-156.

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