Clinical Study Of Targeted Prostate Biopsy Which Guided By TRUS And Contrast-enhanced Ultrasound Combined With MRI

Objectives To evaluate the clinical value of targeted prostate biopsy which guided by transrectal ultrasound and contrast-enhanced ultrasound combined with MRI.Methods A retrospective analysis was performed in 187 patients which underwent prostate biopsy and which had the operation pathological results,from January 2014 to May 2016 in Tangshan worker Hospital.In 102 of 187 patients had the transrectal ultrasound-guided systematic biopsy,and 85 patients had the targeted biopsy.To compare the positive rate of two groups of prostate cancer,the number of puncture needle and the Gleason score to see whether the difference between the two groups was statistically significant.Results 1 The positive rate of detection of prostate cancers by targeted biopsy was62.35%,and 43.14% was detected by systematic biopsy.The positive coincidence rate of postoperative pathology was 89.83% in the target group,and 70.97% in the systematic group.The targeted biopsy was significantly higher than the systematic biopsy,the difference was statistically significant(P<0.05).2 Systematic biopsy puncture needles were 1020,each one punctured 10 needles,and targeted biopsy were 612,an average of7.2 needles for per person.Single needle positive rate target group was 26.31%,the systematic group was 12.94%.we can see that the targeted puncture reduced the number of puncture needles and improved the positive rate of single needle detection of prostate cancer,the difference was statistically significant(P<0.05).3 There were 33 patients with Gleason score ?7 in targeted biopsy,45 patients with Gleason score ?7 in postoperative pathology;and 20 patients with Gleason score ? 7 in the systematic group,Gleason score? 7 points in 47 cases in postoperative pathology,high rates were 62.26%,45.45%,and the coincidence rate after operation was 73.33%,42.55%.Compared of the two groups of high scores coincidence rate of the two groups,the targeted biopsy was higher than the systematic biopsy,the difference was statistically significant(P<0.05).4 The sensitivity,specificity,positive predictive value and negative predictive value of targeted biopsy was89.83%,84.62%,92.98%,78.57% and 88.24%,of which systematic group was 71.09%,77.50%,83.02%,63.27%,73.53%,The sensitivity,accuracy of targeted biopsy were higher than those of the systematic biopsy group(P<0.05).The specificity,positive predictive value and negative predictive value of the targeted group were higher than those of the systematic group,but the difference was not statistically significant(P>0.05).5 There were 8 cases of hematuria,7 patients with hemodialysis,2 cases of hematoma and 1 case of hypothermia in targeted group,and there were 21 cases of hematuria,15 cases of hematuria,15 cases of blood stasis,5 cases of hematoma and 3 cases of hypothermia,2 cases of Urinary retention in the systematic group.The results showed that the complication rate of the systematic group was higher than that of the targeted group,and the difference of hematuria was statistically significant(P<0.05).The complication rate of the targeted puncture group was lower than that of the systematic group,the difference was statistically significant(P<0.05).6 Comparison of targeted biospy and systematic biopsy based on PSA classification: In patients with a PSA level of less than 10 ng/ml,the detection rate of targeted biopsy and systematic biopsy PCa was31.25% and 19.23% respectively.In patients with the PSA level of 10-20 ng/ml,targeted biopsy and systemic biopsy the detection rates were 42.86% and 32.00% respectively.In the patients with PSA above 20 ng/ml,the detection rate of targeted biopsy and systemic biopsy were 81.25% and 58.82% respectively.The comparison showed that patients with PSA higher than 20ng/ml,the detection of PCa detection rate was higher than the systematic biopsy statistically significant(P <0.05).Conclusions TRUS and contrast-enhanced ultrasound combined with MRI compartmental localization can significantly improve the positive rate of prostate cancer,reduce the number of puncture needles,and improve the detection rate of high Gleason score of prostate cancer,have a higher clinical value.