现代泌尿外科杂志2024,Vol.29Issue(3) :278-283.DOI:10.3969/j.issn.1009-8291.2024.03.015

前列腺靶向穿刺活检新进展

The latest progress of prostate targeted biopsy

郑中义 曹晓明
现代泌尿外科杂志2024,Vol.29Issue(3) :278-283.DOI:10.3969/j.issn.1009-8291.2024.03.015

前列腺靶向穿刺活检新进展

The latest progress of prostate targeted biopsy

郑中义 1曹晓明1
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作者信息

  • 1. 山西医科大学第一医院泌尿外科,山西太原 030001
  • 折叠

摘要

影像学引导下靶向活检是当下前列腺癌穿刺活检的主流方式,基于影像学和生化标志物的风险分组可能成为前列腺癌穿刺活检的新标准,本文就前列腺靶向穿刺活检中不同影像学方法的新进展以及活检策略进行综述:超声辅助引导下前列腺活检的方法主要包括直肠超声前列腺活检(TRUS)、经直肠超声造影(TR-CEUS)、经直肠实时弹性成像(TRTE),与活检联合应用能显著增加前列腺癌的诊断率.三维经超声直肠检查(3D-TRUS)技术可适用于先前活检结果为阴性的患者.目前最新的超声手段显微超声(Micro-US)在前列腺靶向活检检出率方面并不逊于多参数磁共振(mp-MRI).mp-MRI靶向活检提高了临床有意义前列腺癌(csPCa)的检出率,目前常见的核磁靶向技术为认知融合活检(MRI-visual-TB)、mp-MRI/TRUS融合活检(MRI-fusion-TB)、mp-MRI直接引导下穿刺活检(MRI-TB).将MRI与Micro-US成像融合用于靶向活检也成为新的靶向活检方式,磁共振(MR)机器人辅助活检正逐渐被应用.正电子发射断层扫描/计算机断层扫描(PET/CT)更加改善了对肿瘤的定位,对初始分期、生化复发后再分期,甚至MRI阴性但仍存在前列腺癌的患者可能都有价值.使用示踪剂的PET/CT靶向活检已经被证明可以获得良好的诊断效能.PET/MRI技术甚至有潜力在未来成为免穿刺活检的影像学检查.技术的发展已经带来临床对活检策略的调整和优化.

Abstract

Image-guided targeted biopsy is currently the mainstream method of prostate cancer puncture biopsy,while risk stratification based on imaging and biochemical markers may become the new standard.This paper comprehensively reviews the latest advancements in various imaging techniques and strategies of targeted prostate biopsy.Ultrasound-assisted prostate biopsy mainly includes transrectal ultrasound(TRUS),transrectal-contrast enhanced ultrasound(TR-CEUS),and transrectal real-time elastography(TRTE),which can significantly increase the diagnosis rate of prostate cancer when combined with biopsy.Three-dimensional transrectal ultrasound(3D-TRUS)technology may be used in patients with a negative previous biopsy.At present,micro-ultrasound(Micro-US),the latest ultrasound method,is not inferior to mp-MRI in targeted biopsy of the prostate.Targeted biopsy by mp-MRI has improved the detection rate of clinically significant prostate cancer(csPCa),and the common NMR targeted technologies are magnetic resonance imaging-visual-targeted biopsy(MRI-visual-TB),magnetic resonance imaging-fusion-targeted biopsy(MRI-fusion-TB),and in-bore magnetic resonance imaging-target biopsy(MRI-TB).The fusion of MRI and Micro-US imaging for targeted biopsy has also become a new targeted biopsy method,and MR robot-assisted biopsy is gradually being applied.PET/CT improves localization of tumors and may be valuable for initial staging,re-staging after biochemical recurrence,even in patients with MRI-negative prostate cancer.PET/CT targeted biopsy using tracer has been shown to yield good diagnostic efficacy.PET/MRI technology has the potential to be the imaging test for needle-free biopsies in the future.The development of technology has led to the adaptation and optimization of biopsy strategies in clinical practice.

关键词

前列腺癌/活组织检查/靶向活检/活检策略/影像学技术/超声辅助/MRI辅助/PET/CT引导

Key words

prostate cancer/biopsy/targeted biopsy/biopsy strategy/imaging technology/ultrasound assisted/MRI assisted/PET/CT guidance

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基金项目

山西省卫生健康委科研项目(2020087)

出版年

2024
现代泌尿外科杂志
西安交通大学

现代泌尿外科杂志

CSTPCD
影响因子:1.106
ISSN:1009-8291
参考文献量52
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