核磁联合PSA检查与穿刺活检在前列腺癌早期诊断中的临床研究

发布时间：2018-07-17 20:57

【摘要】：目的:分析核磁共振检查同B超引导下的前列腺穿刺活检结果的临床一致性,并探讨在不同PSA水平下的核磁检查与B超引导下进行前列腺穿刺活检及两者联合对早期诊断前列腺癌(PCa)的价值,同时分析核磁检查对PSA值在灰区(PSA:4—10ng/ml)患者的临床意义,从而提高灰区PCa诊断的准确率,减少过度的对前列腺进行穿刺活检。方法:对临床资料完整的103例住院患者进行了回顾性分析,以其B超引导下前列腺穿刺活检结果为标准,分析说明核磁检查的敏感性和特异性及不同PSA水平下核磁检查在前列腺癌诊断中的价值。结果:通过核磁检查可得前列腺癌的检出率为48.5%,相应的敏感性为96.7%,特异性为71.2%,阳性似然比为3.36,阴性似然比为0.46,约登指数(Youden index)为0.679。超声引导下前列腺穿刺活检的肿瘤检出率则为29.1%。对不同PSA水平的病人(正常组,低危组,中危组,高危组)来说,核磁检查结果和穿刺检查结果一致性良好(符合度分别为80%、83.3%、72.2%、81.8%),其中对PSA值为4-10ng/ml和20ng/ml病人,两种检查方式(核磁检查和穿刺活检)之间有显著的组间差异,即核磁检查更容易发现肿瘤。进一步分析PSA值为4-10ng/ml的病人可知,受试者工作特征曲线(ROC曲线)下fPSA/tPSA为0.125时,诊断PCa的Youden index最大,其所对应的敏感性和特异性分别为80%和66.7%。单位体积前列腺的PSA含量(PSAD)在0.05的显著性水平下,与指南推荐的0.15的临界值有显著的差别。结论:核磁检查在前列腺癌的诊断中具有较高的临床应用价值,且联合血清PSA和超声引导下前列腺穿刺活检能进一步提高诊断的准确率,对灰区患者的诊断价值尤著。
[Abstract]:Objective: to analyze the clinical consistency between MRI and B-ultrasound guided prostate biopsy. To explore the value of nuclear magnetic resonance (NMR) and B-ultrasound guided prostate biopsy under different PSA levels in the early diagnosis of prostate cancer (PCA), and to analyze the clinical significance of nuclear magnetic resonance (NMR) in patients with PSA value in the gray zone (PSA: 4-10ng / ml). Thus, the accuracy of diagnosis of PCA in grey area is improved, and the excessive biopsy of prostate is reduced. Methods: 103 inpatients with complete clinical data were retrospectively analyzed, and the results of B-ultrasound guided prostate biopsy were used as the standard. The sensitivity and specificity of nuclear magnetic examination and the value of nuclear magnetic field in the diagnosis of prostate cancer at different PSA levels were analyzed. Results: the detection rate of prostate cancer was 48.5, the sensitivity was 96.7, the specificity was 71.2, the positive likelihood ratio was 3.36, the negative likelihood ratio was 0.46, and the Youden index was 0.679. The detection rate of prostate biopsy guided by ultrasound was 29.1%. For patients with different PSA levels (normal group, low risk group, moderate risk group, high risk group), the results of nuclear magnetic resonance (NMR) and puncture examination were in good agreement (the coincidence was 80%, 83.3% and 72.2%, respectively), and the PSA values were 4-10ng/ml and 20ng/ml patients. There is a significant difference between the two types of examination (nuclear magnetic examination and puncture biopsy), that is, nuclear magnetic examination is easier to detect tumors. Further analysis of patients with 4-10ng/ml value showed that when the operating characteristic curve (ROC curve) was 0.125, the Youden index for diagnosing PCA was the largest, and the sensitivity and specificity were 80% and 66.7%, respectively. PSA content (PSAD) per unit volume of prostate was significantly different from the threshold of 0.15 recommended by the guidelines at a significant level of 0.05. Conclusion: nuclear magnetic resonance examination has a high clinical value in the diagnosis of prostate cancer, and the combination of serum PSA and ultrasound guided prostate biopsy can further improve the accuracy of diagnosis, especially for patients with gray area.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.25

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