探讨融合成像在初次前列腺穿刺活检中的应用价值。

回顾性分析2014年8月至2015年5月上海市第六人民医院初次行超声引导下前列腺穿刺活检的患者40例。所有患者术前1周均行磁共振检查（MRI）且MRI发现阳性可疑前列腺癌病灶，但相同部位超声无阳性发现。所有患者均经穿刺活检病理证实。采用图像融合技术，首先对MRI可疑前列腺癌病灶进行穿刺，然后行超声引导下10针法系统性前列腺穿刺。采用行×列表资料的χ²检验比较系统性穿刺、融合成像穿刺及两者联合穿刺诊断阳性率；采用四格表资料的χ²检验比较融合成像穿刺与系统性穿刺对前列腺癌的漏检率；采用Fisher确切概率法比较融合成像穿刺与系统性穿刺对Gleason评分≥7分前列腺癌的检出率。

本组40例行前列腺穿刺的患者中，系统性穿刺诊断14例（35.0%），融合成像穿刺诊断19例（47.5%），两者联合穿刺诊断22例（55.0%），诊断阳性率联合穿刺>融合成像穿刺>系统性穿刺，但差异无统计学意义（P>0.05）。融合成像穿刺漏检前列腺癌3例（13.6%，3/22），系统性穿刺漏检前列腺癌8例（36.4%，8/22），系统性穿刺对前列腺癌的漏检率高于融合成像穿刺，且差异有统计学意义（χ²=8.338，P=0.005）。融合成像穿刺诊断的19例前列腺癌中，15例（78.9%，15/22）Gleason评分≥7分；系统性穿刺诊断的14例前列腺癌中，6例（42.9%，6/14）Gleason评分≥7分。融合成像穿刺对Gleason评分≥7分前列腺癌的检出率要高于系统性穿刺，且差异有统计学意义（P=0.039，Fisher确切概率法）。

融合成像穿刺能减少前列腺癌的漏检率，提高高级别前列腺癌的检出率。

To investigate the application of fusion imaging in the initial prostate biopsy.

Retrospective analysis was made on 40 patients who underwent initial ultrasound-guided prostate biopsy in Shanghai Jiao Tong University Affiliated 6th People′s Hospital from August 2014 to May 2015. All patients underwent preoperative magnetic resonance imaging (MRI) scans one week prior to surgery and the results showed that all patients had suspicious positive prostate cancer lesions, while there were no positive findings in the same area in sonography. All patients with prostate cancer have been confirmed by pathologic examination. Image fusion technology was used to guide the biopsy of lesions which were suspected as prostate cancer by MRI, and then the prostate underwent systematic biopsy by 10 needles under the guide of ultrasound. R×C Chi-square test was used to compare the positive ratio among imaging fusion biopsy, systematic biopsy and combined method in the diagnosis of prostate cancer. Fourfold table Chi-square test was used to compare to undetected rate between fusion imaging biopsy and systematic biopsy in the diagnosis of prostate cancer. The differences of detection rate in the Gleason score more than 7 points of prostate cancer between fusion imaging biopsy and systematic biopsy was compared by Fisher exact test.

In this group of 40 patients with prostate biopsy, 14 cases (35.0%) were diagnosed prostate cancer by systematic biopsy, 19 cases (47.5%) were diagnosed prostate cancer by image fusion biopsy, and 22 cases (55.0%) were diagnosed prostate cancer by systematic biopsy combined with image fusion. The difference of diagnostic positive rate among combined method of biopsy, image fusion biopsy and systematic biopsy had not statistically significant (P>0.05). Three cases (13.6%, 3/22) of prostate cancer patients were missed in image fusion method group, and 8 cases (36.4%, 8/22) of prostate cancer patients have not been diagnosed by systematic biopsy, which indicated the undetected rate of systematic biopsy is higher than that of image fusion biopsy in prostate cancer diagnosis, and there was a statistical difference between the two groups (χ²=8.338, P=0.005). Among 19 cases of prostate cancer patients who were diagnosed by image fusion biopsy method, Gleason score were greater than 7 points in 15 cases (78.9%, 15/22). Among 14 cases of prostate cancer patients who were diagnosed by systematic biopsy method, Gleason score were greater than 7 points in 6 cases (42.9%, 6/14). The positive rate of Gleason score ≥ 7 points in fusion imaging biopsy was higher than that of systematic biopsy, which had a statistical difference (Fisher exact probability method, P=0.039).

Image fusion method can be used to reduce the undetected rate of prostate cancer and improve the detection rate of the high-grade prostate cancer.