经会阴认知融合靶向穿刺与软件融合靶向穿刺在前列腺癌再活检中的比较

Comparison of Perineal Cognitive Fusion Targeted Puncture and Software Fusion Targeted Puncture in Prostate Cancer Rebiopsy

摘要: 目的：比较经会阴认知融合靶向穿刺(COG-TB)与软件融合靶向穿刺(FUS-TB)对初次活检阴性且前列腺特异性抗原持续升高患者的应用价值。方法：回顾性收集2020年1月至2022年6月期间于青岛大学附属烟台毓璜顶医院行经会阴靶向穿刺的179例患者的临床资料。患者均为二次穿刺，初次活检穿刺阴性，术后复查两次前列腺特异性抗原均 ≥ 4 ng/ml，患者均行多参数磁共振(mpMRI)检查，前列腺影像报告和数据系统2.0版(PI-RADS v2.0)评分 ≥ 3分。按照患者所选取的靶向穿刺方法分为认知融合靶向穿刺组(COG-TB)及软件融合靶向穿刺组(FUS-TB)，两组患者行靶向穿刺后均行常规系统性穿刺活检(TRUS-SB)，比较两组检出前列腺癌的阳性率。结果：COG-TB组纳入113例患者，FUS-TB组纳入66例患者。两组患者的年龄(68.46 ± 8.98岁和67.23 ± 6.97岁)、PSA [9.15 (6.33, 12.62)和9.37 (6.41, 13.98) ng/ml]、前列腺体积[40.55 (26.64, 52.41) ml和41.94 (29.03, 50.62) ml]、PSAD [0.24 (0.16, 0.35) ng/ml2和0.22 (0.16, 0.36) ng/ml2]的差异均无统计学意义(P > 0.05)。COG-TB组和FUS-TB组的前列腺癌检出率为72.57%和77.27%，P = 0.80，有临床意义前列腺癌检出率为62.83%和65.15%，P = 0.71。对于行前列腺根治性切除术(RP)的患者，以根治标本作为金标准，COG-TB组有13例(16.88%)患者术后Gleason评分升级，FUS-TB组有5例(10.64%)，差异无统计学意义(P = 0.78)。结论：对于前列腺初次穿刺活检阴性且PSA持续升高的患者，COG-TB及FUS-TB在PCa、csPCa的检出率及RP术后病理升级率方面差异均无统计学意义。mpMRI引导下的靶向穿刺是临床有效的检查手段。

Abstract: Objective: To compare the application value of transperineal cognitive fusion targeted biopsy (COG-TB) and software fusion targeted biopsy (FUS-TB) in patients with negative initial biopsy and persistent elevated prostate specific antigen. Methods: Clinical data of 179 patients who underwent targeted perineal biopsy in Yantai Yuhuangding Hospital Affiliated to Qingdao University from Jan-uary 2020 to June 2022 were retrospectively collected. All patients underwent secondary puncture, and the initial biopsy puncture was negative. Prostate specific antigen was ≥ 4 ng/ml in two post-operative reexaminations. All patients underwent multi-parameter magnetic resonance imaging (mpMRI) examination, and prostate imaging Report and Data System 2.0 (PI-RADS v2.0) score ≥ 3 points. According to the targeted puncture methods selected by the patients, they were divided into cognitive fusion targeted puncture group (COG-TB) and software fusion targeted puncture group (FUS-TB). Patients in both groups underwent conventional systematic puncture biopsy (TRUS-SB) after targeted puncture, and the positive rates of prostate cancer detected in the two groups were compared. Results: 113 patients were included in the COG-TB group and 66 in the FUS-TB group. Age (68.46 ± 8.98 years and 67.23 ± 6.97 years), PSA (9.15 (6.33, 12.62) and 9.37 (6.41, 13.98) ng/ml), and prostate volume (40.55 (26.64, 52.41) ml) in both groups and 41.94 (29.03, 50.62) ml], PSAD [0.24 (0.16, 0.35) ng/ml2 and 0.22 (0.16, 0.36) ng/ml2] were not statistically significant (P > 0.05). The detection rates of prostate cancer in the COG-TB and FUS-TB groups were 72.57% and 77.27%, P = 0.80, and the detection rates of clinically significant prostate cancer were 62.83% and 65.15%, P = 0.71. For the patients undergoing radical prostatectomy (RP), with radical prostatec-tomy specimens as the gold standard, 13 patients (16.88%) in the COG-TB group had improved Gleason scores, while 5 patients (10.64%) in the FUS-TB group had no statistically significant dif-ference (P = 0.78). Conclusion: For patients with negative initial prostatic biopsy and continuous PSA elevation, there was no statistical significance in the detection rate of PCa and csPCa and the rate of postoperative pathological upgrading of RP. Targeted puncture guided by mpMRI is an effec-tive means of clinical examination.