摘要
目的:回顾性分析靶向穿刺漏诊有临床意义前列腺癌(csPCa)的原因。方法:纳入我院2018年6月至2020年12月因PSA升高同时伴有磁共振异常信号652例患者,进一步行经会阴前列腺靶向穿刺联合系统穿刺,分析靶向或系统穿刺对前列腺癌及csPCa的检出率,通过鱼骨图法探讨靶向穿刺漏诊csPCa的原因。结果:靶向穿刺联合系统穿刺对前列腺癌的总检出率为45.7%(298/652),对于csPCa的检出率为37.4%(244/652)。靶向穿刺漏诊csPCa患者共38例,其中23例为靶向穿刺阴性,15例为靶向穿刺ISUP病理分级偏低。MRI图像质量低、PSAD≤0.15 ng/(ml·m^(3))、靶区位于尖部、靶区<10 mm、PI-RADS 2评分≤3分是单纯靶向穿刺漏诊csPCa的主要原因,其检出率为31.6%,联合系统穿刺活检将提高检出率5.8%(P=0.027)。结论:联合穿刺较单纯靶向穿刺或系统穿刺对csPCa有较高的检出率,靶向穿刺漏诊csPCa与肿瘤自身特性及靶区图像密切相关。
Objective:To retrospectively analyze the causes of missed diagnosis of clinically significant PCa(csPCa)by targe⁃ted biopsy(TB).Methods:This retrospective study included 652 males aged(71.32±16.53)years with elevated PSA and ab⁃normal MRI signals detected in our hospital from June 2018 to December 2020.We further examined the patients by transperineal pros⁃tatic TB and systematic biopsy(SB),analyzed the detection rates of PCa and csPCa by TB and SB,and investigated the causes of missed diagnosis of csPCa in TB using the fishbone diagram.Results:The total detection rate of PCa and csPCa by TB combined with SB was 45.7%(298/652),and that of csPCa was 37.4%(244/652),with 38 cases of csPCa missed in TB,including 23 cases of negative TB and 15 cases of low ISUP grade.The causes of missed diagnosis of csPCa by TB included low MRI image quality,PSA density≤0.15 ng/ml/cm^(3),target area<10 mm,and PI⁃RADS 2 score≤3.The detection rate of csPCa by TB alone was 31.6%,which was increased by 5.8%(P=0.027)when TB combined with SB.Conclusion:TB combined with SB yields a higher de⁃tection rate of csPCa than either used alone.Missed diagnosis of csPCa by TB is closely related to the characteristics of tumor and MR image of the target area.
作者
蒋鹤松
周闪
牛晓兵
冀鲁
JIANG He-song;ZHOU Shan;NIU Xiao-bing;JI Lu(Department of Urology,Huai'an First Hospital Affiliated to Nanjing Medical University,Huai'an,Jiangsu 223300,China)
出处
《中华男科学杂志》
CAS
CSCD
2024年第4期315-320,共6页
National Journal of Andrology
关键词
靶向穿刺
有临床意义前列腺癌
系统穿刺
漏诊
targeted biopsy
clinically significant prostate cancer
systematic biopsy
missed diagnosis
