摘要目的 采用根治性前列腺切除术后病理对经会阴途径前列腺穿刺活检的准确性及诊断价值进行评估.方法 2013年4月至2015年12月前瞻性入组行模板引导下经会阴11区前列腺穿刺活检证实为前列腺癌的患者,患者均行腹腔镜根治性前列腺切除术.术后行系统性大病理切片并行肿瘤病灶立体重建,比较根治术后病理与经会阴前列腺穿刺活检病理,分析主要肿瘤的穿刺活检检出率、经会阴前列腺穿刺活检的敏感性和特异性,以及Gleason评分的变化.结果 本研究纳入103例患者,年龄(65±6)岁.血清PSA中位值11.7 ng/ml(IQR 7.2～ 19.1 ng/ml).Gleason评分6～9分.临床分期T1c～T3a.前列腺体积中位值33.0 ml(IQR 26.0～43.0 ml).103个主要肿瘤中,穿刺活检发现89个(86.4％),肿瘤体积中位值为1.2 ml(IQR 0.5 ～3.3 ml),穿刺最大肿瘤长度(0.6±0.4)cm.经会阴途径穿刺活检各区的总体敏感性为53.3％,特异性为94.2％.大体病理与穿刺活检病理的Gleason评分比较,75例(72.8％)相符,24例(23.3％)升高,4例(3.9％)降低.结论 模板引导下经会阴前列腺穿刺活检能检出大部分主要肿瘤,其Gleason评分和根治术后病理一致性较好,但前列腺各区活检的总体敏感性不足,对指导局部治疗仅能作为参考.

abstractsObjective To evaluate the diagnostic value of template-guided transperineal prostate biopsy (TTPB) by comparing biopsy-derived pathological results with findings from radical prostatectomy (RP) specimens.Methods From April 2013 to December 2015,patients who were diagnosed prostate cancer by transperineal template-guided 11-region prostate biopsy were enrolled in our study,and underwent laparoscopic RP.All whole-mount slices were reconstructed via a three-dimensional prostate model.Pathological features of the biopsy and RP specimens were compared.Detection rate of index lesions,overall sensitivity and specificity of TTPB,Gleason scores (GSs) in comparisons of biopsy and RP specimens were analyzed.Results One hundred and three patients were enrolled in our study,and the mean age was (65 ± 6)years.The median serum PSA was 11.7 ng/ml(IQR 7.2-19.1 ng/ml).The Gleason score ranged from 6 to 9.The clinical stage was T1c-T3a and the median prostate volume was 33.0 ml(IQR 26.0-43.0 ml).Eighty-nine of the 103 index lesions (86.4％) were detected by biopsy.The median volume was 1.2 ml (IQR 0.5-3.3 ml) and the mean maximum tumor length was (0.6 ± 0.4)cm.The overall sensitivity and specificity of the transperineal prostate biopsies were 53.3％ and 94.2％,respectively.RP-derived GSs were unchanged,upgraded and downgraded relative to the corresponding biopsy-derived GSs in 75 (72.8％),24 (23.3％) and 4 (3.9％) patients,respectively.Conclusions Stematic transperineal template-guided prostate biopsy could detect most of the index lesions.This biopsy approach was less able to determine tumour focal positioning and could only serve as a reference for guiding focal therapy.