| Objective By comparing magnetic resonance imaging-transrectal ultrasound(MRI-TRUS)fusion targeted biopsy puncture in combination with routinely systematic biopsy puncture method of prostate with routinely systematic biopsy puncture method of prostate by transrectal ultrasound(TRUS)guided under different detection indexes to analyze their positive rate and the incidence of complications and the consistency of the two puncture methods,evaluate the precision and safety in the diagnosis of prostate cancer,and explore the fusion targeted biopsy puncture technique in the application value of early diagnosis of prostate cancer.Then the whole pathological sections of prostate were compared with the routine pathological sections to explore the clinical value of whole pathological sections and verify the value of MRI in accurate diagnosis of prostate cancer.Methods A total of 521 patients who underwent transrectal prostatectomy in urology department of our hospital from July 2017 to December 2019 were collected,421 of whom met the inclusion criteria.According to different puncture methods,421 patients were divided into two groups,namely Group A(137 cases): MRI-TRUS fusion targeted puncture combined with conventional systematic puncture.Group B(284 cases): routinely systematic biopsy puncture of prostate by TRUS guided.Patients in group A underwent MRI-TRUS fusion targeted puncture and routinely systematic puncture(10+X needles).Patients in group B underwent transrectal ultrasound guided prostate routinely systematic puncture(10 or 10+X needles).Among the 55 patients undergoing laparoscopic radical prostatectomy,prostate specimens of 24 cases were made into whole pathological sections,and the rest were made into routine pathological sections.Collect and summary the general information,the biopsy results and postoperative pathological results,using statistical methods to compare two groups of patients' t PSA,f PSA/t PSA,PSAD,PV,PI-RADS score,positive pin number,T staging of the tumor and centesis complications,etc.,and compare the differences of postoperative whole pathological sections with routine pathological sections.Compare sensitivity,specificity,positive predictive value and negative predictive value of TRUS,mp MRI and transrectal prostate biopsy in the accurate detection of prostate cancer foci.Results 1.In the two groups,the total positive rate of puncture in group A was higher than that in group B(P < 0.001).2.The positive rate of the f PSA/t PSA?0.16 group was higher than that of the f PSA/t PSA>0.16 group(P=0.006).When f PSA/t PSA?0.16 and f PSA/t PSA>0.16,the puncture positive rate of group A was significantly higher than that of group B(P<0.001,P=0.003).3.The puncture positive rate of patients with PSAD?0.15 was higher than that of patients with PSAD<0.15(P<0.001).When PSAD<0.15 and PSAD?0.15,the puncture positive rate of group A was significantly higher than that of group B(P=0.011,P<0.001).4.When the score of PI-RADS was 3-5 points,the higher the score,the higher the positive rate of puncture(P<0.001).When the PI-RADS score was 3 and 4 points,the puncture positive rate of group A was higher than that of group B(P=0.011,P=0.002).When the PI-RADS score was 5 points,the puncture positive rate of group A was higher than that of group B(P=0.059).5.When the prostate volume(PV)was in the range of 0 ? 50 m L,50 ? 80 m L,and >80m L,respectively,the positive rate of puncture gradually decreased(P<0.001).And the positive rate of puncture in group A was higher than that in group B(P<0.001,P=0.037,P=0.002).6.The positive rate of fusion-targeted puncture needles was significantly higher than that of conventional systematic puncture(P<0.001),and more patients with tumor stage T?2 were found(P < 0.001).The fusion-targeted puncture method had a good consistency with the conventional systematic puncture method(P<0.001),and there was no significant statistical difference in postoperative complications(P>0.05).7.The incidence of tumor nerve involvement and capsule involvement was higher in the large biopsy group than in the conventional biopsy group(P=0.038,P=0.016).In the p T staging of pathological large sections after radical prostatectomy,more cases with p T?3 were found in the large section group than in the conventional section group(P=0.007).The pathological Gleason score after radical surgery was higher in both groups than that before surgery(P=0.458).8.MRI has high application value in the precise location and diagnosis of prostate cancer.Conclusion Compared with the routine systematic puncture,MRI-TRUS fusion targeted puncture not only improves the detection rate of cancer,but also does not increase the incidence of complications,and can guarantee the safety and efficacy of puncture,which has the value of clinical application.Compared with conventional pathological sections,whole pathological sections have obvious advantages,which can obtain more accurate lesion information and verify that MRI has higher accuracy in the diagnosis of prostate cancer.Furthermore,the advantages of targeted puncture by MRI-TRUS fusion were confirmed again. |
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