超声引导下经直肠前列腺穿刺活检漏诊前列腺癌患者临床特征及原因分析OACSTPCD
Clinical Characteristics and Cause of Missed Diagnosis of Prostate Cancer by Ultrasound-guided Transrectal Prostate Biopsy
目的 探讨超声引导下经直肠前列腺穿刺活检漏诊前列腺癌患者临床特征及原因.方法 选取 2021年7 月—2023 年3 月收治的疑似前列腺癌80 例,依据超声引导下经直肠前列腺穿刺活检和术后病理检查结果是否符合分为不符组31 例和符合组49 例,比较2 组临床资料,采用多因素Logistic回归分析探讨超声引导下经直肠前列腺穿刺活检漏诊前列腺癌的影响因素,R3.3.2 软件和rms软件包构建超声引导下经直肠前列腺穿刺活检漏诊前列腺癌的列线图预测模型,受试者工作特征(ROC)曲线、校准曲线和临床决策曲线评价该列线图预测模型的诊断效能.结果 不符组年龄及前列腺特异性抗原(PSA)、PSA密度、经直肠指检(DRE)阳性占比、经直肠超声阳性占比、前列腺影像报告和数据系统(PI-RADS)评分≥4 分占比低于符合组,前列腺体积(PV)大于符合组(P＜0.05,P＜0.01).多因素Logistic回归分析结果显示,年龄、PSA、PV、DRE、PI-RADS评分是超声引导下经直肠前列腺穿刺活检前列腺癌漏诊的独立危险因素(P＜0.05,P＜0.01).基于危险因素构建的列线图预测模型预测超声引导下经直肠前列腺穿刺活检漏诊前列腺癌的概率为 82.00%,绘制其 ROC 曲线显示,曲线下面积为 0.836(95%CI 0.786,0.899),敏感度为81.20%,特异度为77.40%;校准曲线及临床决策曲线表明该列线图预测模型准确性、有效性高,临床实用性强.结论 超声引导下经直肠前列腺穿刺活检诊断前列腺癌有较高的漏诊率,年龄、PSA、PV、DRE、PI-RADS评分均是其漏诊的独立危险因素,故对存在上述危险因素者需增加活检取样数等,以降低前列腺癌漏诊风险.
Objective To investigate the clinical characteristics and causes of missed diagnosis of prostate cancer by ultrasound-guided transrectal prostate biopsy.Methods A total of 80 patients with suspected prostate cancer admitted from July 2021 to March 2023 were selected and divided into non-consistency group(n =31)and consistency group(n =49)ac-cording to consistency of the results of ultrasound-guided transrectal prostate biopsy and postoperative pathological examina-tion.The clinical data of the two groups were compared.Multivariate Logistic regression analysis was used to explore the influ-encing factors of missed prostate cancer by ultrasound-guided transrectal prostate biopsy.The nomogram prediction model of missed prostate cancer by ultrasound-guided transrectal prostate biopsy was constructed by R3.3.2 software and rms software package.Receiver operating characteristic(ROC)curve,calibration curve and clinical decision curve were used to evaluate the diagnostic efficiency of the predictive model.Results Age,prostate-specific antigen(PSA),PSA density(PSAD),proportion of positive direct rectal examination(DRE)results,proportion of positive transrectal ultrasound(TRUS)examina-tion results,and proportion of prostate imaging reporting and data system(PI-RADS)score≥4 were lower in the non-consistency group than in the consistency group,while the prostate volume(PV)was larger than that of the consistency group(P＜0.05,P＜0.01).Results of multivariate Logistic regression analysis showed that age,PSA,PV,DRE and PI-RADS score were independent risk factors for missed diagnosis of prostate cancer in ultrasound-guided transrectal prostate biopsy(P＜0.05,P＜0.01).The nomogram prediction model built based on risk factors predicted that the probability of missing prostate cancer by ultrasound-guided transrectal prostate biopsy was 82.00%,and the ROC curve showed that the area under the ROC curve was 0.836(95%CI 0.786,0.899),the sensitivity was 81.20%,and the specificity was 77.40%.Calibra-tion curve and clinical decision curve showed that the prediction model had high accuracy,effectiveness and clinical practica-bility.Conclusion Ultrasound-guided transrectal prostate biopsy has a high rate of missed diagnosis of prostate cancer.Age,PSA,PV,DRE and PI-RADS score are independent risk factors for missed diagnosis of prostate cancer.Therefore,the num-ber of biopsy samples of the above risk factors should be increased to reduce the risk of missed diagnosis of prostate cancer.
樊丽丽;兰琦玉;毛玲玲;郭龚映;邓红梅;吴杭
610100 成都,四川护理职业学院附属医院 四川省第三人民医院超声科610100 成都,四川护理职业学院附属医院 四川省第三人民医院超声科610100 成都,四川护理职业学院附属医院 四川省第三人民医院超声科610100 成都,四川护理职业学院附属医院 四川省第三人民医院超声科610100 成都,四川护理职业学院附属医院 四川省第三人民医院超声科629000 四川 遂宁,遂宁市第一人民医院超声介入科
临床医学
前列腺肿瘤活组织检查,针吸超声引导术后病理漏诊临床特征列线图受试者工作特征曲线
Prostatic neoplasmsBiopsy,needleUltrasound-guidedPostoperative pathologyMissed diagnosisClinical characteristicsNomogramsReceiver operating characteristic curve
《临床误诊误治》 2023 (9)
22-27,33,7
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