ABSTRACT
Objective:To analyze the diagnostic efficacy of targeted biopsy (TB) versus targeted biopsy combined with systematic biopsy (TB+ SB) for patients with multi-parametric magnetic resonance imaging (mpMRI) prostate imaging-reporting and data system (PI-RADS) score of 4-5.Methods:The clinical data of 378 patients with mpMRI PI-RADS score of 4-5 in Nanjing Drum Tower Hospital from January 2018 to February 2020 who received prostate TB+ SB were retrospectively analyzed. Median age was 69 (64, 75) years old, median prostate specific antigen was 9.5 (6.7, 16.3) ng/ ml, and median prostate volume was 34.1 (23.5, 48.4) ml. There were 240 cases with PI-RADS score of 4 and 138 cases with PI-RADS score of 5. Evaluating Gleason score of positive biopsy pathology and using χ 2 test or Fisher exact test to analyze the detection of prostate cancer (PCa) and clinically significant prostate cancer(CsPCa) by TB versus TB+ SB. Results:Of the all 378 cases, 88 cases (23.3%) were negative and 290 cases (76.7%) were positive. The average number of needle for TB was 2.4 per person, while SB was 12 per person. TB and SB had no statistically significant difference in the detection rate of PCa (73.3% vs. 68.3%, P=0.129) and CsPCa (55.8% vs. 49.7%, P=0.094) and in the accuracy (79.1% vs. 77.8%, P=0.658), but had a statistically significant difference in the positive rate (64.2% vs. 23.1%, P < 0.001). The pathological coincidence rate of TB and TB+ SB was 92.3%. There was no statistical difference in the detection rate of PCa (73.3% vs. 76.7%, P=0.275) and CsPCa (55.8% vs. 62.2%, P=0.076) between TB and TB+ SB. The missed diagnosis rate of TB for PCa was 4.5%, for CsPCa was 10.2%. For patients with PI-RADS score of 4, TB had no significant difference in the detection rate of PCa (65.4% vs. 69.2%, P=0.381) and CsPCa (46.7% vs. 52.9%, P=0.171) from TB+ SB. The accuracy of TB was 82.1%. The missed diagnosis rate of TB for PCa was 5.4%, for CsPCa was 11.8%. For patients with PI-RADS score of 5, TB had no significant difference in the detection rate of PCa (87.0% vs. 89.9%, P=0.452) and CsPCa (71.7% vs. 78.3%, P=0.211) from TB+ SB. The accuracy of TB was 73.9%. The missed diagnosis rate of TB for PCa was 3.2%, for CsPCa was 8.3%. Conclusions:For high-risk prostate cancer patients with PI-RADS score of 4-5, TB can obtain a detection effect similar to that of TB+ SB with fewer needles, but there is still the possibility of inaccurate diagnosis and missed diagnosis.
ABSTRACT
Objective To assess the value of free-hand transperineal multiparametric nagnetic resonance imaging/transrectal ultrasound (mpMRI/TRUS) fusion-guided targeted biopsy (TB) for the diagnosis of prostate cancer(PCa).Methods Patients with elevated PSA level and/or an abnormal DRE finding were recruited prospectively between January 2015 and September 2016.Patients were classified to various scores from 2 to 5 according to prebiopsy mpMRI PI-RADS.Based on free-hand transperineal mpMRI/TRUS fusion-guiding,a 2-cores TB for each cancer-suspicious lesion were carried out and followed 12-cores systematic biopsy (SB) protocol.Pathological findings of biopsy and radical prostatectomy (RP) specimens were analyzed.Results A total of 397 patients were enrolled in this study.The median age of the patients was (68.2 ± 7.4) years old,ranging 42-78 years.The median PSA level was (15.0 ±12.4)ng/ml,ranging 3.0-88.3 ng/ml.DRE showed abnormality in 28 patients(7.1％).The median prostate volume was (41.6 ± 16.4)cm3,ranging 24.6-89.8 cm3.The PCa detection rate of TB was significantly increased compared with SB (44.8 ％ vs.34.8％) (P =0.003),especially in clinically significant PCa (P ＜ 0.001) and intermediate/high-risk PCa (P =0.003),respectively.Of the all 588 mpMRI targeted lesions,277 lesions were positive.A total of 105 index tumors were identified in RP specimens,the locations of TB-proven cancer showed 96.6％ (85/88) in correspondence with the location of the index lesion in RP specimens.Conclusions Free-hand transperineal mpMRI/TRUS fusion-guided TB providing greater detection of intermediate-high risk PCa while limits over detection of low risk PCa.Moreover,TB can reliably predict the location of an index tumor.
ABSTRACT
Objective To investigate the effect of pelvic floor muscle exercise on perimenopausal female sexual dysfunction. Methods Forty six patients with perimenopausal female sexual dysfunction received pelvic floor muscle exercise. Sexual function and pelvic floor muscle strength were compared between pre-and post-exercises. Result The patients′pelvic floor muscle strength and sexual function after exercises were significantly better than those before the exercises (P<0.05). Conclusion Implementation of the pelvic floor muscles exercise in the patients with perimenopausal sexual dysfunction can strengthen pelvic floor muscle and thus alleviate their sexual dysfunction.
ABSTRACT
Objective To investigate the clinical characteristics and prognosis of young patients with endometrial cancer. Methods Eighty-two cases with endometrial cancer were analyzed retrospectively,31 cases in the young group were ≤ 45 years old, and 51 cases in the old group were ＞ 45 years old. The clinical characteristics, diagnosis, treatment and prognosis between the two groups were compared. Results Twelve cases with primary infertility took up 38.7% in the young group,23 cases with less than 3 times of pregnancy occupied 74.2%, and there was no statistical difference,compared with the old group [3.9%(2/51)and 29.4% (15/51)] (P＜0.05). There was statistically significant between the two groups in myometrial invasion (P ＜ 0.05 ); while there was no significance between the two groups in pathological type, histological grade,clinical stage, 5-year survival rate and recurrence period (P＞0.05). Conclusion Infertility or less pregnancy are risk factors for endometrial cancer in the young; the degree of endometrial invasion in the young is more shallow than that in the old; there is no significant difference between the young and the old in pathological type, histological grade and clinical stage; but the prognosis is similar between the young and the old patients.
ABSTRACT
Objective To retrospectively compare analysis of two kinds of surgery which were nerve-sparing radical hysterectomy (NSRH) and the traditional radical hysterectomy (RH) for cervical cancer was done to find out the effect on urinary function in postoperative patients. Methods Among 57cervical cancer with clinical stage Ⅰ B1- Ⅱ A 31 cases treated with NSRH,26 cases treated with RH. The postoperative bladder function of the two methods were evaluated, and postoperative recovery of urinary function and postoperative recurrence of tumor were compared. Results The period of indwelling catheter for the postoperative patients with NSRH was (8.5 ± 3.2) days, obviously less than that for traditional RH patients which was ( 12.8 ± 3.8) days. The difference was statistically significant(P < 0.01 ). And two methods of postoperative patients were alive without tumor recurrence and metastasis after 1-4 years follow-up.Conclusions NSRH is better than traditional RH in remaining pelvic autonomic nervous system and improving the early urinary function of postoperative patients of cervical cancer. Otherwise, it doesn't effect the radical cure of tumor.