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在现代基于MRI的前列腺癌诊断途径中,异常的数字直肠检查的诊断价值

Wasiq Sajjad¹, Vineetha Thankappannair², Syed Shah²

¹School of Clinical Medicine, University of Cambridge, UK.

Journal of clinical urology

|April 9, 2024

概括

对前列腺癌转诊的异常数字直肠检查 (DRE) 的诊断价值较低. 在磁共振成像 (MRI) 之前使用前列腺特异性抗原 (PSA) 测试可以提高分拣效率并减少不必要的重复检查.

科学领域:

泌尿器科泌尿器科泌尿器科泌尿器科
在瘤学瘤学.
诊断成像诊断成像诊断成像

背景情况:

美国国家卫生和护理卓越研究所 (NICE) 目前建议进行异常的数字直肠检查 (DRE),作为怀疑前列腺癌的独立转诊标准.
与提升前列腺特异性抗原 (PSA) 的转诊不同,这些抗原直接被对磁共振成像 (MRI) 进行分类,异常的DRE需要在进一步调查之前在二级护理中重复检查.

研究的目的:

在当代实践中调查异常DRE作为怀疑前列腺癌的转诊标准的持续临床价值.
评估疑似前列腺癌转诊的患者DRE的诊断产量.
评估将PSA测试纳入异常DRE发现的转诊途径的潜在好处.

主要方法:

在一个英国医院,对158名因DRE异常而疑似患前列腺癌的患者进行了回顾性审查,持续了15个月.
收集的数据包括患者年龄,PSA水平,初级和重复的DRE发现,以及最终诊断.
还分析了30名患者的前性验证队列.

主要成果:

一个异常的DRE单独具有14%的显著癌症检测率.
41%的患者同时出现PSA升高,其中29%患有显著的癌症.
使用PSA先将异常的DRE转移到MRI进行分类,可以将41%的患者重定向,避免重复的DREs (p < 0.0001).

结论:

作为一个独立的转诊标准,异常DRE的诊断产量有限.
前列腺特异性抗原 (PSA) 测试应用于直接对MRI进行异常DRE发现的患者的分组,从而有可能否定重复DRE的需要.
需要进一步的多中心研究来验证这些发现,并完善转诊指南.

关键词:

数字直肠检查 - 数字直肠检查这就是为什么MRI是MRI.诊断诊断诊断诊断诊断诊断前列腺癌是前列腺癌.前列腺特异抗原的前列腺特异抗原.

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