摘要
目的:探讨前列腺特异性抗原(PSA)异常且首次经直肠前列腺穿刺活检阴性患者的临床特点与转归,评价系统13点穿刺法的临床价值。方法:回顾性分析2010年12月至2013年12月收治的PSA异常且首次经直肠前列腺13点穿刺活检阴性患者204例的临床资料。观察其PSA变化并随访诊疗过程。结果:随访26-42个月,最终确诊前列腺癌(Pca)20例。根据初次活检病理结果分组比较,前列腺上皮内瘤(PIN)组与非PIN组、PIN伴慢性前列腺炎(CP)组与PIN组的Pca确诊率有统计学差异(P<0.05)。以最终是否确诊为Pca分组比较,三种影像技术(TRUS,CT及MRI)的诊断异常率、直肠指检(DRE)异常率及总PSA(TPSA)、PSA密度(PSAD)有统计学差异(P<0.05),95%的Pca患者集中于游离/总PSA(F/T)<0.25范围内。系统13点穿刺法首次检出率为31%,重复穿刺阳性率为18.6%,首次穿刺假阴性率约为7%。结论:对于PSA异常而首次穿刺诊断为阴性的患者,需谨慎排除引起PSA升高的非癌因素。应重视PIN及CP作为独立危险因素对Pca发病的影响,同时需结合影像学表现及PSAD、F/T值判断是否行重复穿刺。系统13点穿刺法假阳性率较低,检出率理想,适于初次活检。
Objective：To report the outcomes of patients of negative prostate biopsy with abnormal serum prostate specific antigen（PSA）,and evaluate the clinical value of systematic 13 cores transrectal prostate biopsy.Methods：A total of 204 patients underwent transrectal prostate biopsy in Zhongnan Hospital from Dec.,2010 to Dec.,2013 were retrospectively analyzed in this study.And the change of PSA and their final clinical diagnosis were followed up.Results：According to the first biopsies,20 cases were confirmed as prostate cancer at last.There were significant differences in positive rate of Pca between PIN group and non-PIN group,PIN combined with CP group and PIN group（P〈0.05）.According to the final diagnose,there were significant differences in abnormality rate of TRUS,CT,MRI,DRE,TPSA and PSAD between Pca group and non-Pca group（P〈0.05）.95% Pca patients exist in the range of F/T0.25.The positive rate of first,second,third time biopsy were 31%,20.7%,14.3%,respectively,and the false nega-tive rate of first biopsy was 7%.Conclusion：Close followed-up and regular PSA testing for patients who have an abnormal PSA level would help to avoid both false negative of prostate cancer and unnecessary biopsy.PIN and CP should be particular valuing as risk factors of Pca.Imaging diagnosis,PSAD,and F/T should be taken into account to estimate the value of repeated biopsy.Systematic 13 cores puncture can be applied to the first biopsy for its ideal positive rate and lower false negative rate.
出处
《武汉大学学报（医学版）》
CAS
2016年第1期141-144,148,共5页
Medical Journal of Wuhan University
