Prospective evaluation of a 21-sample needle biopsy procedure designed to improve the prostate cancer detection rate
Prospective evaluation of a 21-sample needle biopsy procedure designed to improve the prostate cancer detection rate
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DOI：
10.1016/s0090-4295(03)00108-0
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发表时间：
2003-06-01
期刊：
影响因子：
2.1
通讯作者：
Abbou, CC
中科院分区：
文献类型：
--
作者：
de la Taille, A;Antiphon, P;Abbou, CC
目标.前瞻性评价21例超声引导穿刺活检术对血清前列腺特异性抗原升高和/或直肠指检异常的前列腺癌患者的诊断率。2000年12月至2002年5月，303例患者在局麻下接受了21次穿刺活检，包括45 °角的六等分活检，80 °角的每个外周区3次活检，每个移行区（TZ）3次活检，中线外周区3次活检。对发病率进行临床评估。连续90名患者填写了一份简短的调查问卷。结果。使用6个活检样本（仅六分活检）、12个样本（六分加侧活检）、18个样本（六分加侧加TZ活检）和21个样本（六分加侧加TZ，加中线活检）的癌症检出率分别为22.7%、28.3%、30.7%和31.3%。相对于6样本程序，21样本程序在统计学上将癌症检出率提高了37.9%。前列腺体积大于40 cm 3的患者（48.3%）、T1 c期前列腺疾病患者（44.9%）、接受重复活检的患者（66.2%）和前列腺特异性抗原水平大于10 ng/mL的患者（38.5%）的改善最为显著。不良反应不常见（3%），包括3名患者的前列腺炎，6名患者的急性尿潴留，1名服用阿司匹林的患者需要住院治疗的直肠出血。使用问卷调查，84%的患者报告肉眼血尿平均3.4天，血精12.8天，45%报告轻微直肠出血持续1.1天。平均疼痛评分为4.56，视觉模拟评分范围为0（无疼痛）至10（剧烈疼痛）。相对于6个样本的程序，21个样本的穿刺活检程序增加了前列腺癌的检出率，而没有增加发病率。前列腺特异性抗原值升高的患者应进行6次活检，外周区至少6次，TZ区至少6次。(C)2003年爱思唯尔公司
Objectives. To evaluate prospectively the diagnostic yield of a 21-sample ultrasound-guided needle biopsy procedure for prostate cancer in patients with elevated serum prostate-specific antigen and/or abnormal digital rectal examination findings.Methods. Between December 2000 and May 2002, 303 patients underwent 21-sample needle biopsy under local anesthesia, comprising sextant biopsies at a 45degrees angle, 3 biopsies in each peripheral zone at an 80degrees angle, 3 biopsies in each transition zone (TZ), and 3 biopsies in the midline peripheral zone. Morbidity was assessed clinically. A short questionnaire was filled out by 90 consecutive patients.Results. The cancer detection rate using 6 biopsy samples (sextant biopsies only), 12 samples (sextant plus lateral biopsies), 18 samples (sextant plus lateral plus TZ biopsies), and 21 samples (sextant plus lateral plus TZ, plus midline biopsies) was 22.7%, 28.3%, 30.7%, and 31.3%, respectively. The 21-sample procedure statistically improved the cancer detection rate by 37.9% relative to the 6-sample procedure. The improvement was most marked in patients with a prostate volume of more than 40 cm(3) (48.3%), patients with Stage T1c prostate disease (44.9%), patients undergoing repeat biopsy (66.2%), and patients with prostate-specific antigen levels greater than 10 ng/mL (38.5%). Adverse effects were infrequent (3%), consisting of prostatitis in 3 patients, acute urinary retention in 6 patients, and rectal bleeding requiring hospitalization in 1 patient taking aspirin. Using the questionnaire, 84% of patients reported macroscopic hematuria for an average of 3.4 days and hematospermia for 12.8 days, and 45% reported minor rectal bleeding lasting 1.1 days. The mean pain score, with a visual analog scale ranging between 0 (no pain) and 10 (intense pain), was 4.56.Conclusions. A 21-sample needle biopsy procedure increased the prostate cancer detection rate relative to a 6-sample procedure, without increasing morbidity. Patients with elevated prostate-specific antigen values should undergo sextant biopsies and at least 6 additional biopsies in the peripheral zone and 6 in the TZ. (C) 2003 Elsevier Inc.