多参数磁共振成像-经直肠超声认知融合靶向穿刺活检在前列腺癌诊断中的应用效果

Efficacy of multiparametric magnetic resonance imaging-transrectal ultrasound cognitive fusion-targeted biopsy in the diagnosis of prostate cancer

摘要

目的 探讨多参数磁共振成像（mpMRI）-经直肠超声认知融合靶向穿刺活检在前列腺癌（PCa）诊断中的应用价值，以期优化基层医院PCa诊断流程、提升PCa的检出率与准确性。方法 回顾性分析2018年11月-2025年9月于宝鸡市中心医院接受mpMRI检查并行经直肠前列腺穿刺活检的896例可疑PCa患者的临床及病理资料。其中352例（39.29%）患者接受mpMRI-经直肠超声认知融合靶向穿刺活检（mpMRI-靶向穿刺活检组），544例（60.71%）患者接受传统的经直肠前列腺系统穿刺活检（传统穿刺活检组）。对比两组患者的整体PCa例数、临床有意义PCa（csPCa）的检出率及穿刺后并发症发生情况。亚组分析不同血清总前列腺特异性抗原（tPSA）水平、前列腺影像报告与数据系统（PI-RADS）评分及前列腺前纤维肌质区中两种穿刺方式对PCa、csPCa的检出率差异。结果 896例患者穿刺术后病理为PCa者562例（62.72%），csPCa者486例（54.24%）。mpMRI-靶向穿刺活检组的PCa及csPCa检出率明显高于传统穿刺活检组[73.01%（257/352）对比56.07%（305/544），P=0.01；67.61%（238/352）对比45.59%（248/544），P=0.01]。亚组分析显示，mpMRI-靶向穿刺活检组可以显著提高tPSA＜10 ng/mL，PI-RADS 1～2分及PI-RADS 3分患者中PCa及csPCa的检出率（P＜0.05）。在前列腺前纤维肌质区可疑占位患者中，mpMRI-靶向穿刺活检组的PCa及csPCa检出率显著高于传统穿刺活检组[42.86%（24/56）对比19.12%（13/68），P=0.003；33.93%（19/56）对比11.76%（8/68），P=0.002]。两组间穿刺后并发症发生率差异无统计学意义（P＞0.05）。结论 mpMRI-经直肠超声认知融合靶向穿刺活检可以显著提高PCa及csPCa检出率，特别是位于前列腺前纤维肌质区特殊位置的病灶，是一种安全、有效的诊断方法，值得在基层地区级医院开展和推广。

Abstract

Objective To explore the value of multiparametric magnetic resonance imaging (mpMRI)-transrectal ultrasound (TRUS) cognitive fusion-targeted biopsy in the diagnosis of prostate cancer (PCa) in primary regional hospitals, aiming to optimize the diagnostic workflow and improve the detection rate and accuracy of PCa. Methods A retrospective analysis was conducted on the clinicopathological data of 896 patients with suspected PCa who underwent mpMRI and transrectal prostate biopsy at Baoji Central Hospital during Nov.2018 and Sep.2025. Among them, 352 (39.29%) underwent mpMRI-TRUS cognitive fusion-targeted biopsy, while 544 (60.71%) underwent conventional transrectal prostate systematic biopsy. The overall detection rate of PCa, clinically significant prostate cancer (csPCa), and post-biopsy complication rates were compared between the two groups. Subgroup analyses were performed to explore the detection rates of PCa and csPCa between two biopsy approaches across different serum total prostate-specific antigen (tPSA) levels, PI-RADS scores, and lesions located in the anterior fibromuscular stroma of the prostate. Results Among the 896 patients, 562 (62.72%) were pathologically diagnosed with PCa, and 486 (54.24%) with csPCa. The mpMRI-TRUS cognitive fusion-targeted biopsy group showed significantly higher detection rates of both PCa and csPCa compared to the conventional biopsy group [73.01% (257/352) vs. 56.07% (305/544), P=0.01; 67.61% (238/352) vs. 45.59% (248/544), P=0.01]. Subgroup analyses revealed that mpMRI-TRUS cognitive fusion-targeted biopsy significantly improved the detection rates of PCa and csPCa in patients with tPSA < 10 ng/mL, PI-RADS score 1-2, and PI-RADS score 3 (P<0.05). Among patients with suspicious lesions in the anterior fibromuscular stroma, those who underwent mpMRI-TRUS cognitive fusion-targeted biopsy had significantly higher PCa and csPCa detection rates compared to the conventional biopsy group [42.86% (24/56) vs. 19.12% (13/68), P=0.003; 33.93% (19/56) vs. 11.76% (8/68), P=0.002]. There was no statistically significant difference in post-biopsy complication rates between the two groups (P>0.05). Conclusion mpMRI-TRUS cognitive fusion-targeted biopsy can significantly improve the detection rates of PCa and csPCa, particularly for lesions located in the anatomically challenging anterior fibromuscular stroma. It is a safe and effective diagnostic method, worthy of implementation and promotion in primary hospitals.

关键词

多参数核磁共振 / 前列腺癌 / 经直肠前列腺穿刺活检 / 认知融合靶向穿刺活检

Key words

multiparametric magnetic resonance imaging / prostate cancer / transrectal prostate biopsy / cognitive fusion-targeted biopsy

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基金资助

2020年宝鸡市中心医院面上项目(BZXJJMS-2020-6)