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目的:探讨以前列腺癌根治术后整体组织病理切片(前列腺大切片)作为“金标准”分别评估DRE、前列腺穿刺活检、MRI、DWI在前列腺癌定位诊断中的价值。方法:回顾性分析2009年10月～2010年3月行腹腔镜前列腺癌根治术19例患者临床资料,除外未行MRI/DWI检查、前列腺手术史、已行内分泌治疗等患者9例,符合条件患者10例,于前列腺癌根治术前收集患者的DRE、前列腺穿刺活检、MRI、DWI资料,术后将前列腺标本制成前列腺大切片。应用“六分区法”对前列腺进行分区,DRE检查记录前列腺结节所在区域,前列腺穿刺活检12针依位置编号将阳性者归入相应区域,与术后整体组织病理进行比对。两位阅片者“盲法”进行阅MRI和MRI/DWI片,每个分区分为5档进行评价:1.正常;2.可能正常;3.不确定;4.可能是癌;5.肯定是癌,当两位阅片者所得结果的平均值≥4时,认定该区域是MRI或MRI+DWI评估为前列腺癌的区域。结果:在10例前列腺癌患者共60个分区中前列腺大切片证实的前列腺癌区域为27个(45%),基底部、中部、尖部的前列腺癌区域分别为8个(40%)、11个(55%)和8个(40%),前列腺癌呈明显的多灶性分布。DRE定位诊断前列腺癌的敏感性、特异性分别为29.6%、72.7%,低于其他检查方法,前列腺穿刺活检定位诊断前列腺癌的敏感性、特异性分别为55.6%、81.8%,与MRI的诊断价值类似(51.9%和84.9%),引入DWI参与前列腺癌的定位诊断,可维持特异性不变的情况下,提高MRI的敏感性至77.8%。对于前列腺尖部、中部MRI诊断的敏感性较差(37.5%和45.5%),但特异性和阳性预测值高(100%和100%),引入DWI可将前列腺尖部、中部MRI诊断的敏感性提高至75%和81.8%。结论:MRI在前列腺癌定位中的价值与前列腺穿刺活检相似,但明显优于DRE;引入DWI可以明显提高MRI定位诊断前列腺癌的敏感性,特别是对于前列腺尖部和中部的肿瘤。
OBJECTIVE: To evaluate the value of DRE, prostate biopsy, MRI and DWI in the diagnosis of prostate cancer by using gross histopathology (large prostate) as the “gold standard” after radical prostatectomy. Methods: The clinical data of 19 patients who underwent laparoscopic radical prostatectomy from October 2009 to March 2010 were retrospectively analyzed. Except for those who did not undergo MRI / DWI examination, history of prostate surgery, and endocrine therapy, 9 patients were eligible. 10 patients were collected before the prostatectomy in patients with DRE, prostate biopsy, MRI, DWI data, the prostate specimens after prostate into large sections. The prostate was subdivided by using the “six-partition method”. The area where the prostate nodule was located was recorded by DRE examination. The 12-pin prostate biopsy was assigned to the corresponding area according to the location number and was compared with the overall histopathology. Two reviewers “Blind ” to read MRI and MRI / DWI films, each subdivision is divided into 5 files to be evaluated: 1. Normal; 2. May be normal; 3. Unsure; 4. May be cancer; 5. Definitely cancer, when the average of the results obtained by the two readers is ≧ 4, the area is considered to be an area of prostate cancer assessed by MRI or MRI + DWI. RESULTS: Prostate cancer was confirmed by prostate biopsies in 60 of 10 prostate cancer patients in 27 (45%) of prostate cancers and 8 (40%) in prostate, basal, middle and apex, respectively (55%) and 8 (40%), prostate cancer showed a clear multifocal distribution. The sensitivity and specificity of DRE in the diagnosis of prostate cancer were 29.6% and 72.7%, respectively, which were lower than those of other methods. The sensitivity and specificity of prostate biopsy for the diagnosis of prostate cancer were 55.6% and 81.8% respectively. With similar values (51.9% and 84.9%), the introduction of DWI in the diagnosis of prostate cancer can improve the sensitivity of MRI to 77.8% under the condition of unchanged specificity. For the prostatic apex, the sensitivity of central MRI diagnosis is poor (37.5% and 45.5%), but the specificity and positive predictive value are high (100% and 100%). The introduction of DWI can sensitize the diagnosis of prostatic and central MRI Sex increased to 75% and 81.8%. CONCLUSION: The value of MRI in prostate cancer location is similar to that of prostatic biopsy, but it is obviously better than that of DRE. The introduction of DWI can significantly improve the sensitivity of MRI in the diagnosis of prostate cancer, especially in the tip and center of the prostate.