对于初次前列腺穿刺活检阴性的病人的处理—刘明.pdfVIP

对于初次前列腺穿刺活检阴性的病人 的处理 北京医院泌尿外科 刘明，王建业 • 重复穿刺的病例选择 • 重复穿刺结果的影响因素 重复穿刺的病例选择 谁应该进行重复穿刺谁应该进行重复穿刺 “ 12 biopsy cores using an 18-gauge needle allowallow histologicalhistological examinationexamination ofof justjust 0.04%0.04% ofof a prostate with a typical volume” 重复穿刺的阳性率：10-35%。 FleshnerFleshner NENE, OO’SullivanSullivan MM, FairFair WRWR. PrevalencePrevalence andand predictorspredictors ofof aa positivepositive repeatrepeat transrectal ultrasound guided needle biopsy of the prostate. J. Urol. 1997; 158: 505–8. 重复穿刺的指征 1. 怀怀疑仍有肿瘤存在仍有肿瘤存在 • PSA持续异常或进一步上升 • DRE异常 • Atypical small acinar proliferation of prostate （（ASAPASAP ）） • 多灶性高级别PIN 2. 患者的年龄患者的年龄、身体状身体状况、患者意愿患者意愿！！ Fleshner NE, O’Sullivan M, Fair WR. Prevalence and predictors of a positive repeat transrectal ultrasound guided needle biopsy of the prostate. J. Urol. 1997; 158: 505–8. 重复穿刺结果的影响因素 如何预测重复穿刺的结果 1. 初次穿刺针数 系统性6针穿刺 •• HodgeHodge etet alal； • 系统性6针穿刺可能漏掉大约50%的小前列腺癌； • InIn thethe StanfordStanford seriesseries, thethe PCaPCa detectiondetection raterate waswas 39%39% followingfollowing aa negative sextant biopsy compared to 28% when ePBx was adopted as the initial biopsy scheme. • Eskicorappci et al. showed that 14-core reppeat bioppsyy detected PCa in 36.1% and 18.7% of the patients who had a previous sextant biopsy and 10-core biopsy protocol, respectively. HongHong YMYM, LaiLai FCFC, ChonChon CHCH, McNealMcNeal JEJE, PrestiPresti JCJC JrJr. ImpactImpact ofof priorprior biopsybiopsy schemescheme onon pathologicpathologic featuresfeatures ofof cancerscancers detected on repeat biopsies. Urol. Oncol. 20