CAJ | 학술논문

目的：探讨经直肠超声造影靶向穿刺在检测前列腺癌中的作用。方法151例因血清前列腺特异性抗原升高或直肠指检异常拟行前列腺穿刺活检术的患者，在穿刺前行超声造影检查，前列腺内局部高增强、低增强、快速增强或早消退为前列腺癌可疑病灶，穿刺方案采用10点系统穿刺加超声造影发现异常处2～4点靶向穿刺，通过与前列腺穿刺病理作点对点的对照，并定义Gleason评分≥7的癌灶为高级别肿瘤，Gleason＜7分的为低级别肿瘤，分别统计分析超声造影靶向穿刺及系统穿刺在前列腺癌检测中的作用。结果151例前列腺癌可疑患者中经穿刺活检诊断为前列腺癌61例（404．％），其中靶向穿刺阳性11例（180．％，11／61），系统穿刺法阳性14例（230．％，14／61），靶向穿刺和系统穿刺法均阳性36例（590．％，36／61），采用系统穿刺和超声造影靶向穿刺的前列腺癌检出率分别为331．％及311．％（ P ＝07．12）。151例前列腺癌疑似患者共穿刺1755针，其中系统穿刺1510针，靶向穿刺245针，靶向穿刺的穿刺点阳性率显著高于系统穿刺（522．％对115．％，P ＝0.000）。在61例前列腺癌患者中，经穿刺病理诊断为高级别前列腺癌43例（705．％），低级别前列腺癌18例（295．％）。超声造影靶向穿刺对高级别前列腺癌的诊断敏感性为860．％，显著高于其对低级别前列腺癌的敏感性（556．％，P ＝0.018）。结论经直肠超声造影靶向穿刺能在与系统穿刺方案保持相同前列腺癌检出率的同时减少穿刺点数。尤其对于高级别前列腺癌，超声造影靶向穿刺有着较高的诊断敏感性。
목적：탐토경직장초성조영파향천자재검측전렬선암중적작용。방법151례인혈청전렬선특이성항원승고혹직장지검이상의행전렬선천자활검술적환자，재천자전행초성조영검사，전렬선내국부고증강、저증강、쾌속증강혹조소퇴위전렬선암가의병조，천자방안채용10점계통천자가초성조영발현이상처2～4점파향천자，통과여전렬선천자병리작점대점적대조，병정의Gleason평분≥7적암조위고급별종류，Gleason＜7분적위저급별종류，분별통계분석초성조영파향천자급계통천자재전렬선암검측중적작용。결과151례전렬선암가의환자중경천자활검진단위전렬선암61례（404．％），기중파향천자양성11례（180．％，11／61），계통천자법양성14례（230．％，14／61），파향천자화계통천자법균양성36례（590．％，36／61），채용계통천자화초성조영파향천자적전렬선암검출솔분별위331．％급311．％（ P ＝07．12）。151례전렬선암의사환자공천자1755침，기중계통천자1510침，파향천자245침，파향천자적천자점양성솔현저고우계통천자（522．％대115．％，P ＝0.000）。재61례전렬선암환자중，경천자병리진단위고급별전렬선암43례（705．％），저급별전렬선암18례（295．％）。초성조영파향천자대고급별전렬선암적진단민감성위860．％，현저고우기대저급별전렬선암적민감성（556．％，P ＝0.018）。결론경직장초성조영파향천자능재여계통천자방안보지상동전렬선암검출솔적동시감소천자점수。우기대우고급별전렬선암，초성조영파향천자유착교고적진단민감성。
Objective To assess transrectal contrast enhanced ultrasound (CEUS ) targeted biopsy (TB) for detection prostate cancer (PCa) by comparing with systematic biopsy (SB) .Methods 151 consecutive patients scheduled for prostate biopsy were enrolled in this prospective study with a mean age of 68 8.± 8 0. (47-86) and prostate specific antigen (11 5.± 6 9.)μg/L (0 3.-39 8.μg/L) .CEUS was performed by a single experienced radiologist who was blinded to all clinical data with the Sequoia 512 ultrasonography system equipped with EV8C4 endfire probe .Hypoperfusion lesions ,hyperperfusion lesions and lesions with rapid wash‐in or wash‐out were suspicious for malignant ,and these lesions were sampled with 2-4 cores in addition with 10‐core SB .Results The overall PCa detection rate was 40 4.% (61/151) .Of 61 PCa patients , 11 (18 0.% ) had positive cores in TB ,18 (23 0.% ) had positive cores in SB and 36 (59 0.% ) had positive cores in both biopsy protocols .The PCa detection rate of TB and SB was 33 1.% and 31 1.% respectively (P=0 7.12) .A total of 1 755 cores were sampled including 1 510 SB cores and 245 TB cores .The positive rate for TB was significantly higher than SB (52 2.% vs 11 5.% ,P =0.000) .Of 61 PCa patients ,18 had low‐grade cancer (Gleason score<7) and 43 had high‐grade cancer (Gleason score≥7) .The sensitivity for high‐grade PCa was 86 0.% with TB ,which was significantly higher than low‐grade cancer (55 6.% ,P =0.018) . Conclusions The PCa detection rate of CEUS‐TB was equal with SB ,whereas the positive rate by core of CEUS‐TB was significant higher than SB .Furthermore ,CEUS‐TB was more sensitive in detection of high grade prostate cancer .