经直肠超声前列腺活检的标测：质量控制和图像处理的学习曲线评估
Mapping of transrectal ultrasonographic prostate biopsies: quality control and learning curve assessment by image processing
摘要：
目的：经直肠超声（TRUS）前列腺活检的标测对于前列腺癌的诊断目的或管理和治疗具有根本重要性，但核心的定位似乎不准确。我们的目的是评估操作员在二维TRUS引导下计划经直肠前列腺活检的能力，使用配准算法代表活检在参考三维超声体积中的定位。研究方法：32名患者在局部麻醉下接受了一系列12次前列腺活检，由1名操作员使用TRUS探头结合特定的第三方软件进行，以验证活检确实在计划的目标范围内进行。研究结果：术者达到了71%的计划靶点，其差异性取决于靶点的定位（中、右侧椎旁部位靶点的成功率为100%，左侧基底部靶点的成功率为53%）。在每次活检后，该系统的反馈使术者能够在一段时间内显著提高其灵活性（前16例患者：中位数评分，10例中有7例，目标中累积的中位数活检长度为90 mm;后16例患者，中位数评分，10例中有9例，累积的中位数长度为121 mm; P = 0.046）。结论：除了是一个有用的工具，以改善前列腺活检的分布，该系统的潜力是最重要的是准备一个详细的“地图”的每个病人显示活检区，而没有实质性的变化，在常规的临床实践。
英文摘要：
Objective: Mapping of transrectal ultrasonographic (TRUS) prostate biopsies is of fundamental importance for either diagnostic purposes or the management and treatment of prostate cancer, but the localization of the cores seems inaccurate. Our objective was to evaluate the capacities of an operator to plan transrectal prostate biopsies under 2-dimensional TRUS guidance using a registration algorithm to represent the localization of biopsies in a reference 3-dimensional ultrasonographic volume. Methods: Thirty-two patients underwent a series of 12 prostate biopsies under local anesthesia performed by 1 operator using a TRUS probe combined with specific third-party software to verify that the biopsies were indeed conducted within the planned targets. RESULTS: The operator reached 71% of the planned targets with substantial variability that depended on their localization (100% success rate for targets in the middle and right parasagittal parts versus 53% for targets in the left lateral base). Feedback from this system after each series of biopsies enabled the operator to significantly improve his dexterity over the course of time (first 16 patients: median score, 7 of 10 and cumulated median biopsy length in targets of 90 mm; last 16 patients, median score, 9 of 10 and a cumulated median length of 121 mm; P = .046). Conclusions: In addition to being a useful tool to improve the distribution of prostate biopsies, the potential of this system is above all the preparation of a detailed "map" of each patient showing biopsy zones without substantial changes in routine clinical practices.
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