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目的验证经会阴磁共振超声三维矩阵定位靶向穿刺技术对提高前列腺穿刺活检阳性率的价值。方法选取第二军医大学长海医院泌尿外科2015年2月至6月行经会阴磁共振超声三维定位靶向前列腺穿刺活检+系统性前列腺穿刺活检的患者共15例。15例患者既往有至少1次阴性穿刺的病史,有行再次前列腺穿刺活检的指证,且穿刺前多参数磁共振检查提示有可疑发生前列腺癌的位点,前列腺影像报告和数据系统(PI-RADS)评分4~5分,根据磁共振图像对前列腺腺体中的可疑位点进行三维定位(X、Y、Z轴3个坐标)。全麻后,在经直肠超声引导下行系统性前列腺穿刺活检,后根据三维定位的坐标在经直肠超声图像中进行定位,并根据定位的位置行超声引导下的经会阴前列腺靶向穿刺活检。结果 15例患者中有14例确诊为前列腺癌(93.3%),单纯靶向穿刺活检阳性13例(86.7%),单纯系统性穿刺活检阳性6例(40.0%),系统性穿刺活检阳性而靶向穿刺活检阴性1例(6.7%),靶向穿刺活检阳性而系统性穿刺活检阴性8例(53.3%),系统性穿刺活检和靶向穿刺活检均为阴性1例(6.7%)。两种穿刺方法阳性率差异有统计学意义(P=0.002)。结论经会阴磁共振超声三维定位靶向前列腺穿刺技术可以准确定位并靶向穿刺磁共振显示的可疑位点,对经直肠系统性穿刺活检易漏诊的位置具有较好的诊断效能,但其确切的效果仍需大样本的病例验证。
Objective To verify the value of three-dimensional matrix-based targeted puncture of perineal magnetic resonance ultrasound in improving the positive rate of prostatic biopsy. Methods A total of 15 patients undergoing transrectal biopsy of prostate biopsy and systematic prostatic biopsy undergoing stereotactic stereotactic stereotactic three-dimensional localization were selected from Department of Urology, Changhai Hospital, Second Military Medical University from February to June 2015. Fifteen patients had a history of at least one negative biopsy, a repeat prostate biopsy, and multiple parametric magnetic resonance imaging of the site of suspicious prostate cancer, the Prostate Imaging Report and Data System (PI-RADS ) Scoring 4 to 5 points, according to the magnetic resonance image of the prostate gland suspicious sites in three-dimensional positioning (X, Y, Z axis 3 coordinates). After general anesthesia, systematic prostate biopsy guided by transrectal ultrasound was performed, and then positioned in rectal ultrasound images according to the coordinate of three-dimensional positioning. Ultrasound-guided transperineal needle biopsy was performed under the guidance of the location. Results Of the 15 patients, 14 were diagnosed as prostate cancer (93.3%), 13 were targeted biopsy-positive (86.7%), 6 were systemic biopsy (40.0%), and were biopsy-positive Negative biopsy was negative in 1 case (6.7%), targeted biopsy was positive and systemic biopsy was negative in 8 cases (53.3%). Both biopsy and biopsy were negative in 1 case (6.7%). The positive rate of the two puncture methods was statistically significant (P = 0.002). Conclusion The three-dimensional localization of perineal magnetic resonance ultrasound-guided prostate biopsy can accurately locate and target the suspicious sites displayed by the puncture magnetic resonance. It has good diagnostic performance in the location of missed diagnosis of transrectal systemic biopsy. However, The effect still needs a large sample of case validation.