电磁引导经会阴前列腺穿刺联合小标本快脱病理学检查在前列腺癌诊断中的应用价值

杨勇军; 曾一鸣; 贺显雅; 卢强; 李远伟

doi:10.3971/j.issn.1000-8578.2024.24.0111

电磁引导经会阴前列腺穿刺联合小标本快脱病理学检查在前列腺癌诊断中的应用价值

Application Value of Transperineal Biopsy Using Electromagnetic Needle Tracking Combined with Rapid Paraffin-Embedded Section of Small Specimen in Diagnosis of Prostate Cancer

摘要

摘要:
目的探讨电磁引导局麻经会阴前列腺mpMRI-TRUS多模态影像融合穿刺活检联合小标本快脱病理学检查在前列腺癌诊断中的应用价值。
方法回顾性分析138例PI-RADS评分≥3分并行电磁引导局麻经会阴前列腺多模态影像融合穿刺活检患者的临床病历资料。使用AI技术将mpMRI与TRUS多模态影像进行融合，对可疑病灶靶向穿刺2针，然后行前列腺系统穿刺12针。靶向穿刺标本进行小标本快脱病理学检查，比较靶向穿刺、系统穿刺及联合穿刺csPCa检出率的差异。
结果 138例患者csPCa检出率为71.01%。靶向穿刺和系统穿刺csPCa检出率分别为62.32%和70.29%，差异无统计学意义（P=0.20）。联合穿刺csPCa检出率高于靶向穿刺和系统穿刺，但差异均无统计学意义（P>0.05）。前列腺PI-RADS 评分3分患者靶向穿刺、系统穿刺和联合穿刺的csPCa检出率分别为30.95%、38.10%和40.48%；评分4分患者分别为52.94%、61.76%和61.76%；评分5分患者分别为90.32%、96.77%和96.77%，不同PI-RADS评分患者三种穿刺方法在csPCa检出率方面差异均无统计学意义（P>0.05）。前列腺PI-RADS评分3、4、5分患者，靶向穿刺csPCa漏诊率分别为23.53%、14.29%和6.67%。
结论对于PI-RADS v2.1评分≥3分的可疑前列腺癌患者，电磁引导经会阴前列腺穿刺活检联合小标本快脱病理学检查可快速获取病理结果，且有较好的诊断准确性，但联合穿刺仍是目前诊断前列腺癌最合适的方法。

Abstract:
Objective To explore the application value of mpMRI-TRUS multi-modal image fusion transperineal biopsy technique using electromagnetic needle tracking under local anesthesia combined with rapid paraffin-embedded section of small specimen in the diagnosis of prostate cancer.
Methods The clinicopathological data of 138 patients with PI-RADS score≥3 who underwent mpMRI-TRUS image fusion transperineal biopsy using electromagnetic needle tracking under local anesthesia were retrospectively analyzed. AI technology was used to fuse mpMRI and TRUS multi-mode images, and two-core targeted biopsies were performed on suspicious lesions, followed by 12-core systematic biopsies. The specimens obtained from targeted biopsies were sent for rapid paraffin-embedded section pathological examination, and the detection rates of csPCa were compared.
Results The detection rate of csPCa in 138 patients was 71.01%. The detection rates of csPCa in targeted biopsies and systematic biopsies were 62.32% and 70.29%, respectively (P=0.20). The detection rate of combined biopsies was higher than those of targeted biopsies and systematic biopsies, but the difference was not statistically significant (P>0.05). The detection rates of csPCa in targeted biopsies, systematic biopsies, and combined biopsies in patients with PI-RADS score 3 were 30.95%, 38.10%, and 40.48%, respectively; and the percentages were 52.94%, 61.76%, and 61.76% in patients with PI-RADS score 4, respectively; and the percentages were 90.32%, 96.77%, and 96.77% in patients with PI-RADS score 5, respectively, without statistically significant difference (all P>0.05). In the subgroups with PI-RADS scores of 3, 4, and 5, the missed diagnosis rates of csPCa by targeted biopsies were 23.53%, 14.29%, and 6.67%, respectively.
Conclusion For patients with suspected prostate cancer and PI-RADS v2.1 score≥3, transperineal biopsy using electromagnetic needle tracking combined with rapid paraffin-embedded section of small specimen can obtain pathological results rapidly and has good diagnostic accuracy. However, combined biopsy is still the most suitable method for the diagnosis of prostate cancer at present.

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