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血PSA、MRI和超声造影联合应用在前列腺癌中的诊断价值
作者:付贤  何华东  王于勇  王旭亮  谢玺  李宁 
单位:浙江大学医学院附属杭州市第一人民医院泌尿外科  浙江 杭州 310006 
关键词:前列腺肿瘤/诊断 前列腺特异抗原/代谢 前列腺肿瘤/超声检查 造影剂 超声检查 多普勒 彩色 活组织检查 针吸 磁共振成像 诊断 鉴别 
DOI:10.13267/j.cnki.syzlzz.2018.06.007
出版年,卷(期):页码:2018,33(6):529-532
摘要:

目的 探讨前列腺特异性抗原(prostate specific antigen,PSA)、超声造影及MRI检查对诊断前列腺癌(prostate cancer,PCa)的价值。方法 回顾性分析经血PSA、超声造影或MRI检查怀疑为PCa的患者388例,所有患者均行经直肠超声引导下经会阴前列腺穿刺活检。以病理结果为金标准,探讨三者联合诊断PCa的临床价值。结果 患者血PSA水平≤ 4、>4~10、>10~20和>20 ng/mL时,前列腺穿刺活检对PCa的检出率分别为16.7%(6/36)、22.4%(37/165)、44.2%(42/95)和71.7%(66/92),差异具有统计学意义(P﹤0.01)。血PSA、超声造影及MRI检查诊断PCa的敏感度分别为96.0%、82.1%和80.8%,特异度分别为12.7%、68.4%和65.0%。血PSA联合超声造影和血PSA联合前列腺MRI检查诊断PCa的敏感度分别为90.1%和92.7%,特异度分别为83.5%和84.0%。结论 血PSA检测联合超声造影或MRI检查在鉴别诊断PCa中的临床价值高于PSA单独应用,可提高诊断PCa的特异度。

Objective To investigate the clinical value of prostate biopsy combined with serum prostate specific antigen (PSA) test,contrast enhanced ultrasonography (CEUS) and magnetic resonance imaging(MRI)in the diagnosis of prostate cancer (PCa). Methods The clinical data of 388 patients with suspected PCa,according to the results of PSA,CEUS and MRI,were retrospectively analyzed.All the patients were then examined by transrectal ultrasound guided prostate biopsy.Using the pathological results as the gold standard,we evaluated the clinical value of the above three combined assays in the clinical diagnosis of PCa. Results In patients with blood PSA level ≤ 4,>4~10,>10~20 and >20 ng/mL,the detection rate of PCa in prostate biopsy was 16.7%(6/36),22.4%(37/165),44.2%(42/95) and 71.7%(66/92),respectively,and the difference was statistically significant (P<0.01).Besides,the sensitivity of serum PSA,CEUS and MRI was 96.0%,82.1%,and 80.8% respectively in diagnosis of PCa,whereas the respective specificity was 12.7%,68.4% and 65.0%.Finally,when PAS was combined with CEUS test,the sensitivity was 90.1%,and the specificity was 83.5%.When PSA was combined with MRI test,the sensitivity was 92.7%,and the specificity was 84.0%. Conclusion The clinical value of PSA combined with CEUS or MRI in the differential diagnosis of PCa is higher than that of PSA alone,thus the combined assays can greatly improve the specificity of PCa diagnosis.

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