Re-biopsy of the prostate using a stereotactic transperineal technique
Re-biopsy of the prostate using a stereotactic transperineal technique
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DOI：
10.1016/j.juro.2006.06.030
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发表时间：
2006-10-01
影响因子：
6.6
通讯作者：
Conterato, Dean J.
中科院分区：
文献类型：
--
作者：
Moran, Brian J.;Braccioforte, Michelle H.;Conterato, Dean J.
目的：在这项研究中，我们调查了立体定向经会阴前列腺再活检的检出率和发病率与三维标测诊断不可触及的等回声隐匿性前列腺恶性肿瘤。材料和方法：共有180例前列腺特异性抗原持续升高且既往至少有1次良性经直肠前列腺活检的连续患者在一家门诊机构接受了立体定向经会阴前列腺活检，2004年4月和2006年3月。与前列腺近距离放射治疗程序类似，患者被置于背侧截石位。在患者全身麻醉下，使用经直肠超声、会阴近距离放射治疗模板和稳定装置，将前列腺定位在植入物网格上。根据中腺轴向图像上的x和y坐标，将其等分为8个切片（八分区）。每个患者的轴向和矢状前列腺图像的中平面确定了将占据每个八分圆的x、y和z坐标。最初从顶端获得组织芯。八分圆，然后是基底八分圆的相同x和y坐标。从每个特定的八分体标本被放置在1的8个标本罐和病理学审查reportsessors.Results：立体定向经会阴前列腺活检产生阳性活检确定腺癌68 180例（38%）。180例患者中有18例（10%）在出院回家后需要留置导尿管。所有患者的估计失血量均小于5 cc，疼痛评分中位数为1/10。结论：立体定向经会阴前列腺活检术具有良好的耐受性，可用于诊断不可触及的等回声隐匿性前列腺恶性肿瘤。此外，立体定向经会阴前列腺活检提供了全面的组织取样，并在这一选定的患者组中提供了准确的恶性肿瘤三维标测。
Purpose: In this study we investigated the detection rate and morbidity of stereotactic transperineal prostate re-biopsy with 3-dimensional mapping for diagnosis of nonpalpable isoechoic occult prostate malignancy.Materials and Methods: A total of 180 consecutive patients with continued increasing total prostate specific antigen and at least 1 prior benign transrectal prostate biopsy underwent stereotactic transperineal prostate biopsy at a single outpatient institution between April 2004 and March 2006. Similar to a prostate brachytherapy procedure, patients were placed in the dorsal lithotomy position. With the patient under general anesthesia, and using transrectal ultrasound, a perineal brachytherapy template and stabilizing device, the prostate was positioned on the implant grid. It was equally divided into 8 sections (octants) according to x and y coordinates on the mid gland axial image. The midplanes of axial and sagittal prostate gland images for each patient determined the x, y and z coordinates that would occupy each octant. Tissue cores were initially obtained from the apical. octants, followed by identical x and y coordinates of the basilar octants. Specimens from each specific octant were placed in 1 of 8 specimen jars and pathological review was reported accordingly.Results: Stereotactic transperineal prostate biopsy yielded positive biopsies identifying adenocarcinoma in 68 of 180 (38%) patients. Acute urinary retention developed in 18 of 180 (10%) patients requiring an indwelling urinary catheter upon discharge home. In all patients estimated blood loss was less than 5 cc and median pain score was 1 of 10.Conclusions: Stereotactic transperineal prostate biopsy is extremely well tolerated and useful for diagnosis of nonpalpable isoechoic occult prostate malignancy. Additionally, stereotactic transperineal prostate biopsy provides comprehensive tissue sampling with accurate 3-dimensional mapping of malignancy in this select group of patients.