The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer
The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer
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DOI：
10.1016/s0090-4295(97)00306-3
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发表时间：
1997-10-01
期刊：
影响因子：
2.1
通讯作者：
Busch, C
中科院分区：
文献类型：
--
作者：
Norberg, M;Egevad, L;Busch, C
目标。本前瞻性研究的目的是评估六分仪活检方案与更广泛的前列腺癌检测程序相比的敏感性，并定义一种活检模型，以保持诊断准确性所需的最少活检次数。连续512例疑似前列腺癌患者行经直肠超声（TRUS）检查，并行TRUS引导下的核心活检。所有患者都有8或10个标准化活检样本，数量取决于腺体的大小。从预定位置以外的低回声或高回声病变处采集额外的活检样本进行标准化活检（即靶活检）。分析了不同活检样品组合对肿瘤检测的敏感性，并与我们的模型进行了8至10次活检的敏感性比较。总共检测到276例癌症，其中88例（32%）具有等回声表现。TRUS检测局灶性病变的灵敏度为59%，不同系统活检标本组合的灵敏度为85% ~ 97%，系统活检标本和靶活检标本组合的灵敏度为93% ~ 98%。标准六分仪方案的灵敏度为85%，加入目标活检后灵敏度可提高到93%。与更广泛的活检程序获得的结果相比，标准六分仪方案遗漏了15%的癌症。系统采样与目标采样相结合，提高了灵敏度；然而，一个主要的问题是，需要评估通过多次活检检测到的癌症的临床重要性。(C) 1997, Elsevier Science Inc.；版权所有。
Objectives. The aim of this prospective study was to evaluate the sensitivity of the sextant biopsy protocol compared with a more extensive procedure for the detection of prostate cancer and to define a biopsy model with the minimal number of biopsies necessary to maintain diagnostic accuracy.Methods. A total of 512 consecutive patients with suspected prostate cancer were examined with transrectal ultrasound (TRUS) and underwent TRUS-guided core biopsy. All patients had 8 or 10 standardized biopsy samples taken, with the number depending on the size of the gland. Additional biopsy samples were taken from hypoechoic or hyperechoic lesions located outside the predetermined location for the standardized biopsies (ie, target biopsies). The sensitivity of the detection of cancer for different combinations of biopsy samples was analyzed and compared with that of our model with 8 to 10 biopsies.Results. In all, 276 cancers were detected, of which 88 (32%) had an isoechoic appearance. Sensitivity was 59% for focal lesions detected by TRUS, 85% to 97% for different combinations of systematic biopsy samples, and 93% to 98% for a combination of systematic and target biopsy samples. The sensitivity for the standard sextant protocol was 85%, By adding target biopsies, the sensitivity increased to 93%.Conclusions. The standard sextant protocol leaves 15% of cancers undetected compared with results obtained from a more extensive biopsy procedure. By combining systematic and target sampling, the sensitivity increases; however, a major concern is that the clinical importance of cancers detected by multiple biopsies needs to be evaluated. (C) 1997, Elsevier Science Inc. All rights reserved.