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目的探讨对于临床高度怀疑恶性的前列腺肿物6针穿刺法的必要性以及如何提高其阳性诊断率。方法总结我院自2001至2015年345例临床高度怀疑恶性前列腺肿物行6针穿刺病例。所有病例在穿刺前通过直肠指诊或影像学检查均提示前列腺结节。记录患者穿刺病理结果。应用ROC曲线分析前列腺特异性抗原(PSA)、前列腺体积以及PSA/前列腺体积,对此类患者在6针穿刺中出现阳性结果的判断价值。结果病理确诊为前列腺恶性肿物(阳性)309例(89.6%),其中前列腺癌300例,特殊病理类型9例;阴性穿刺36例(10.4%)。阳性组病例的血清PSA水平明显高于阴性组(P<0.001)。通过ROC曲线分析显示,PSA对于6针穿刺阳性结果的判断价值最高,以PSA 22.89ng/mL作为临界值时,其曲线下面积(AUC)达到0.866,敏感性和特异性分别为90.6%和82.6%。结论临床高度怀疑恶性前列腺肿物的患者行6针法穿刺存在合理性。在此类患者人群中,对PSA≥22.89ng/mL的患者进行6针穿刺,整体临床获益可能最高。
Objective To investigate the necessity of 6-needle aspiration for clinically highly suspected prostate tumor and how to improve its positive diagnostic rate. Methods From March 2001 to December 2015, 345 cases of clinically suspected malignant prostatic tumor were treated with 6-needle aspiration. All cases through the digital rectal examination or imaging prior to puncture are prompted prostate nodules. Record the patient’s biopsy results. ROC curve analysis of prostate-specific antigen (PSA), prostate volume and PSA / prostate volume, such patients in 6-pin puncture the positive results of the judgment. Results 309 cases (89.6%) had benign prostatic hyperplasia (positive), including 300 cases of prostate cancer, 9 cases of special pathological types and 36 cases of negative puncture (10.4%). Serum PSA levels in the positive group were significantly higher than those in the negative group (P <0.001). The ROC curve analysis showed that PSA was the most valuable for 6-needle biopsy, and the area under the curve (AUC) was 0.866 when the PSA was 22.89ng / mL as the cutoff value. The sensitivity and specificity were 90.6% and 82.6 %. Conclusion The patients with highly suspected malignant prostatic tumor in clinical practice have the reasonableness of 6-needle puncture. In these patient populations, a 6-pole needle aspiration for patients with PSA ≥ 22.89 ng / mL may have the highest overall clinical benefit.