声诺维在扩大经直肠超声前列腺穿刺活检中应用.docVIP

声诺维在扩大经直肠超声前列腺穿刺活检中应用 　 作者：陈彤 刘大乐 肖克峰 刘增钦 孙枫 【摘要】 目的 探讨声诺维在扩大的经直肠超声前列腺穿刺活检中的应用。方法 102例患者因血清tPSA＞4ng/ml或伴前列腺硬结接受穿刺活检术，其中43例检查中接受静脉注射超声造影剂-声诺维。声诺维组与普通组比较，平均年龄、平均tPSA以及可疑指检率分别为67.5∶68.7岁、26.2∶28.6ng/ml和24.3%∶25.1%，差别无统计学意义（P＞0.05）。作者采用改良Norberg穿刺方案，即首先系统穿刺8针，若实时超声或注射声诺维后发现可疑低回声结节，再增加1～3针重点穿刺。回顾性比较声诺维组与普通组活检病理阳性率及准确性。结果 声诺维组43例接受穿刺446针，平均10.4针；普通组59例接受穿刺571针，平均9.7针；两组平均穿刺针数差别无统计学意义（P＞0.05）。病理诊断表明，声诺维组前列腺癌9例，阳性率为20.9%，普通组12例，阳性率为20.3%，两组阳性率差别无统计学意义（P＞0.01）。但石蜡病理显示，声诺维组446针标本中，阳性针数54针，阳性率为12.1%；普通组571针标本中，阳性针数46针，阳性率为8.1%；两者阳性率比较，差别有统计学意义（P＜0.01）。在HGPIN或ASAP病例中，声诺维组7例，发生率为16.3%；普通组9例，15.2%；两组差别无统计学意义（P＞0.05）。提示声诺维能提高多普勒超声对前列腺可疑恶性结节的分辨率，但对HGPIN或ASAP诊断帮助不大。结论 采用造影剂-声诺维进行扩大的经直肠多普勒超声活检能明显提高前列腺癌的诊断敏感性。该方法安全易行，便于门诊开展。 【关键词】 超声 前列腺癌 诊断 活检 【Abstract】 Objective To evaluate the use of Sonovue in extended transrectal ultrasound guided prostate biopsy. Methods A total of 102 patients with PSA＞4ng/ml and/ or abnormal digital rectal examination underwent TRUS guided biopsy. 43 of 102 cases received intravenous injection of SonoVue during biopsy. Comparing SonoVue and ordinary groups, the mean age, mean tPSA and DRE suspicion rate was 67.5 vs 68.7, 26.2 vs 28.6ng/ml and 24.3% vs 25.1% respectively (P＞0.05).We performed the biopsy with modified Norbergs protocol that 1 or 3 additional cores were obtained in suspicious sites beside of routine 8 cores biopsy. A retrospective analysis was done to compare the positive rates and accuracy of 2 groups. Results 446 cores ( mean 10.4) and 571 cores (mean 9.7) were done in Sono-Vue and ordinary groups respectively (P＞0.05). Pathology had revealed that 9 cases in SonoVue and 12 cases in ordinary were diagnosed malignant with the positive rate of 20.9% and 20.3% respectively (P＞0.01). The pathological cores showed the positive rates were 12.1% (54/446) or 8.1% (46/571) in SonoVue and ordinary, there were significant difference between the 2 groups (P＜0.05). 7 (16.3%) cases in SonoVue and 9 (15.2%) cases in ordinary were identified with HGPIN or AS