Télécharger la présentation

Fusion IRM – échographie
le principe ‘express’
application en ponction biopsie prostatique
C. Roy -M. Ohana –A. Labani –H. Lang
!
Radiologie B - Service d’Urologie
Nouvel Hôpital Civil
CHU de Strasbourg
Pas de conflit d’intérêt à déclarer
!
"#$$%&!
•!
•!
•!
•!
'()"*!+,&-$#.#+/0.12,%!!#+3&14.%!546718/.#9&%+%60!!&#!!8/0%5-46!8,!5#65%.!8%!&#!
$.470#0%!
*#17!&%!81#:647-5!;6#&!%70!!9#7/!!7,.!!&(%<#+%6!!#6#04+4$#0=4&4:12,%!
'#!$465-46!!914$71%!/5=4:,18/%!!.%70%!!&%!:4&8!70#68#.8!!+#17!>!
–! '(/5=4:.#$=1%!!%684.%50#&%!#!,6%!+#,?#17%!7%67191&10/!!$4,.!8/5%&%.!&%7!@$%-07(!5#65%.7!
–! '%7!ABCAD!!$./&3?%+%607!!/5=4!:,18/7!/0#:/7!70#68#.87!6%!8/0%50%!2,%!EBFCDBF!!8%!
5#65%.7!
–! '#!$465-46!914$71%!/5=4:,18/%!!$%,0!!.%0.4,?%.!8%7!5#65%.7!8%!9#7!:.#8%!2,1!6%!
8%?.#1%60!$#7!6/5%7710%.!8%!0.#10%+%60!#?%5!8465!&%!.172,%!%6!.4,-6%!8%!@7,.!
0.#10%+%60(G!
–! EB!F!8%7!5#65%.7!7%!710,%60!%6!8%=4.7!8%!&#!$#.-%!$470/.1%,.%!!8%!&#!:&#68%!
H&45#&17#-46!8%7!$./&3?%+%607!70#68#.87IG!!
'%7!$%.J%5-466%+%607!#50,%&7!8%!&#!0%5=64&4:1%!8%?.#1%60!$%.+%K.%!!,6%!#+/&14.#.-46!
8%7!$%.J4.+#65%7!8%!&#!$465-46!914$71%!/5=4:,18/%!>!!
!!!!!!!!!!!!!!!!!!!"#$%&'(")"*#+,-#.,/0%/&)"$,-#1,#+)#&.234#)5,$#+)#0)$(+(*6#,*#
+7)$$,--('(+(*6#1,#+76$8%9/).8(,:#
"#$$%&!
•!
)&!%<170%!E!+/0=48%7!$4,.!:,18%.!&%7!$./&3?%+%607!%6!7(#18#60!8%!&#!$%.J4.+#65%!8%!&()"*+$!
•!
L%7!/0,8%7!!$146613.%7!!8#67!&%!5#8.%!8%!0.#?#,<!!8%!.%5=%.5=%!!J#10%7!#?%5!!81M/.%607!0N$%7!8%!
+#0/.1%&!!460!!8/+460./!!&(#,:+%60#-46!8%!&#!8/0%5-46!8,!5#65%.!8%!&#!$.470#0%!%6!,-&17#60!!
,6%!J,7146!)"*!O!/5=4:.#$=1%!!$4,.!&#!$465-46G!P%51!$%.+%K.#10!!7,.04,0!8%!8/0%50%.!8%7!
5#65%.7!8%!=#,0!:.#8%!Q!8465!!$40%6-%&&%+%60!#:.%771J7G!!
*G!*G!R18812,1Q!RG!"#17CS#=.#+1Q!TG!U.,46:!%0!#&GQ!V*#:6%-5!.%746#65%!1+#:16:W,&0.#74,68CJ,7146!914$7N!71:61;5#60&N!,$:.#8%7!$.470#0%!5#65%.!?%.7,7!7N70%+#-5!AXC54.%!0.#67.%50#&!,&0.#74,68!914$7NQY!!"#$%&'()
*#$+$,-Q!?4&G!ZDQ!$$G![AEO[A\Q!XBAEG!
"G!"#7-6%=#8Q!SG!U,.]9%NQ!RG!RG!R#&#+1!%0!#&GQ!V)+$.4?16:!8%0%5-46!4J!5&1615#&&N!71:61;5#60!$.470#0%!5#65%.>!+#:6%-5!.%746#65%!1+#:16:W0.#67.%50#&!,&0.#74,68!J,7146!:,18%8!$.470#0%!914$7NQY!./&)0$"#('+)$1)*#$+$,-Q!
?4&G!A\AQ!64G!ZQ!$$G!A[D\OA[^DQ!XBADG!
23)43)5$((6)53)7'8'#'9'(6):3)03)43);'#,$+<=)&8)'+36)>.'#,&8&?)@<$%=-)<()8/&)?&8&AB$()$1)%#$=8'8&)A'(A&#)"=<(,)'()$CA&)@'=&?)D',(&BA)#&=$('(A&)"+8#'=$"(?)1"=<$()?&E<A&6F)0$"#('+)$1)*#$+$,-6)E$+3)GHI6)($3)G6)%%3)HJKIG6)
LMGN3C!
TG!_+#&4,Q!SG!U,.]9%NQ!*G!`G!*%.164Q!aG!'G!P=4N]%Q!SG!`G!b448Q!#68!aG!_G!a1604G!*#:6%-5!.%746#65%!1+#:16:W,&0.#74,68CJ,7146!914$7N!71:61;5#60&N!,$:.#8%7!$.470#0%!5#65%.!?%.7,7!7N70%+#-5!AXC54.%!0.#67.%50#&!
,&0.#74,68!914$7NG!!"#$%&'()*#$+$,-Q!ZD>[AEC[A\Q!XBAEG!
;,-#&6*8%1,-#1,#9<(1)9,#1,-#.%"$=%"-#
./%-*)=><,-#.)/#234#
•! ?%9"(=5,!>!!
–! 71+$&%Q!.#$18%Q!6%!6/5%7710%!$#7!8(/2,1$%+%60!#881-466%&!!
–! )&!7(#:10!8%!$471-466%.!!&(#1:,1&&%!!8%!$./&%?%+%60!%6!/5=4:.#$=1%!!8#67!&#!&45#&17#-46!
J4,.61%!$#.!&()"*!!
–! c&&%!#+3&14.%!&%!.%68%+%60!8%7!914$71%7!$#.!.#$$4.0!d!&#!0%5=612,%!=#910,%&&%!8%!
$./&/?%+%607!#,!=#7#.8G!!
–! R46!8/7#?#60#:%!%70!&#!?#.1#91&10/!8%!&(%..%,.!=,+#16%!8#67!&(%<0.#$4&#-46!8%!&()"*!
%6!/5=4:.#$=1%!
;$$#&)O;6)&8)'+3)#&E"&)?&)+')+<PQ#'8"#&)RLL'#BA+&=S))!"#)*#$+3)LMGL)
:&+$(,A/'D%=)&8)'+3)0$"#('+)$1)*#$+$,-6)E$+3)GHI6)LMGN3)))
T"&A/)&8)'+3)U'?<$+$,-6)E$+3)LJH6)LMGN3)
)
•! @%"$=%"#1(/,$*,#.)/#5%(,#.6/("6)+,#%<#,"1%/,$*)+,#,"#234#
8#67!&#!e46%!7,7$%50%!H%6!/?#&,#-46!5%60.%7!%<$%.07I!
;,-#&6*8%1,-#1,#9<(1)9,#1,-#.%"$=%"-#
./%-*)=><,-#.)/#234#
•! 3,$)+)9,#1,#+7234##-</#+7(&)9,##6$8%9/).8(><,#,"#*,&.-#/,,+##?1#!,6!
&4:151%&!7$/51;2,%!9#7/!!7,.!&%!$.1651$%!8(,6%!J,7146!8%7!8%,<!
1+#:%.1%7G!
–! !P%&&%!51!8410!7%!J#1.%!%6!0%+$7!./%&!$4,.!0.#67J/.%.!&#!e46%!7,7$%50%!04,0!#,!&46:!
8%!&(%<#+%6!!/5=4:.#$=12,%G!
L%,<!$.1651$%7!7460!817$4619&%7!>!!
–! .%5#&#:%!/&#7-2,%!2,1!-%60!54+$0%!8%7!8/J4.+#-467!%0!+4,?%+%607!8%!&#!
:&#68%!d!04,7!+4+%607!#$.37!,6!%6.%:170.%+%60!8%!8466/%7!?4&,+12,%7!!
–! f6!.%5#&#:%!.1:18%!d!$#.-.!8(,6!5#$0%,.!/&%50.4+#:6/-2,%!8%!.%$471-466%+%60!
8#67!&(%7$#5%!!8%7!8%,<!!%<#+%67!8(1+#:%.1%!!!
!
)6546?/61%607!>!+#0/.1%&!#881-466%&!$&,7!4,!+4167!54+$&%<%Q!4$/.#0%,.!%60.#16/!!
!!!!!!!!!!!!%0!,6!0%+$7!8(%<#+%6!$&,7!4,!+4167!&46:G!!!!
!!
_?#60#:%7!>!#+9,&#041.%!#?%5!,6%!71+$&%!#6%70=/71%!&45#&%Q!
!!!!!!!!!!!!!!!!!!!!!0%5=612,%!8%!$465-46!,7,%&&%!!
!
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9##1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"
!
;7%'A,*#1,#$,B,#./6-,"*)=%"#,-*#1,#16&%"*/,/#+)#0)(-)'(+(*6##,*#
+7,C$)$(*6#,"#./)=><,#$%</)"*,##.%</#+)#/6)+(-)=%"#1,#.%"$=%"#
'(%.-(,-#./%-*)=><,-#17<"#-D-*E&,#1,#0<-(%"#,"#*,&.-#/6,+#1,#
1%""6,-#234F6$8%9/).8(,#.)/#/,$)+)9,#/(9(1,#)5,$#<"#$).*,</#
6+,$*/%&)9"6=><,##
[!
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"#
;!I#!LH!IG2MNI#
@/%$E1</,#,*#0)(-)'(+(*6#
•! R1+$&1510/!g!!
•! L,./%!8%!&(#$$.%6-77#:%!g!!
•! P46J4.0!$4,.!&(4$/.#0%,.!%0!&%!$#-%60g!
•! L,./%!8%!&#!$.45/8,.%!g!c70C5%!$47719&%!%6!.4,-6%!8#67!&%!5460%<0%!
8(,6%!#5-?10/!h4,.6#&13.%!5=#.:/%g!!
•! P4i0!g!!
•! a47719&%!%6!#+9,&#041.%g!
•! P460.%!16815#-467!g!!
36-<+*)*-##
•! "%68%+%60!8%7!914$71%7g!!!
!!!!!_+/&14.#-46!8,!0#,<!8%!5#65%.7g!!
@+)"!!
@/,&(E/,#.)/=,#
_7$%507!0%5=612,%7!!
@/%$61</,#,*#O)(-)'(+(*6##
!
!
P,<Q(E&,#.)/=,##
N%*/,#,Q.6/(,"$,#,*#/6-<+*)*-#
\!
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"#
@/%$61</,#,*#O)(-)'(+(*6#
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"#
•! @/("$(.,#
!! f6!5=#+$!/&%50.4+#:6/-2,%!8%!9#7!5=#+$Q!,61J4.+%Q!
!!!!!!8(%6?1.46!ZB!5+E!%70!:/6/./!#,04,.!8,!$#-%60G!
!! f6!#1+#60!%0!,6!:/6/.#0%,.!8%!5=#+$!+#:6/-2,%!7460!#h4,0/7!d!&(/5=4:.#$=%!
!! '%!.%$/.#:%!8%!&#!7468%!8#67!&(%7$#5%!7%.#!#77,./!$#.!,6!5#$0%,.C/+%K%,.!
/&%50.4+#:6/-2,%!2,1!%6?41%!7#!$471-46!%6!0%+$7!./%&G!
!! '%7!544.8466/%7!/+17%7!<Q!NQ!e!7460!.%&#-?%7!d!&(%7$#5%!4.0=464.+/!5.//!$#.!&%!
:/6/.#0%,.G!c&&%7!7460!0.#67+17%7!#,!&4:151%&!$%.+%K%60!8%!8/;61.!$./517/+%60!
&#!$471-46!8%!&#!7468%!%0!8%!54../&%.!d!&(1+#:%!)"*!
!! '#!7468%!8410!8465!j0.%!%6!$%.+#6%65%!8#67!&%!?4&,+%!8,!5=#+$!+#:6/-2,%!
#;6!8(#77,.%.!,6!.%$/.#:%!8%!2,#&10/G!!
c<0%.6#&!!*#:6%-5!!k1%&8!!l%6%.#04.7!
m10=!#!.1:18!+48%&!
?%&&,"*)(/,-#
*#0/.1%&!#881-466%&!8%!$%-0%!0#1&&%!Q!7#67!
%654+9.%+%60!
•! a471-466/!7,.!&(/5=4:.#$=%!=#910,%&!%0!&#177/!%6!
$&#5%!7#67!:j6%!$4,.!&%7!#,0.%7!%<#+%67!
•! S.#7!#.-5,&/!#?%5!941-%.!0.#67+%K%,.!$.45=%!
$#-%60!!
•! a%-0!5#$0%,.!#K#5=/!d!&#!7468%!fR!=#910,%&&%!
!
•! c<#+%6!)"*!$./#&#9&%+%60!5=#.:/!8#67!&(/5=4:.#$=%!?1#!
,6!PL!4,!0.#67J%.0!$#.!&%!a_PRG!!
•!
.!
•! a#7!8(4.816#0%,.!7,$$&/+%60#1.%!!
•! L170#65%!d!.%7$%50%.!8%!EB5+!%60.%!,6!$#5%!+#]%.!4.!,6!
#,0.%!7N703+%!/&%50.4+#:6/-2,%!!%0!!&(/+%K%,.!
_$$#.%1&!$.j0!
c<0%.6#&!!*#:6%-5!!k1%&8!!l%6%.#04.7!
m10=!#!.1:18!+48%&!
a.45/8,.%!8%!.%5#&#:%!0%+$7!./%&!%60.%!&%7!8%,<!1+#:%.1%7!
U#6*).,-##
RE/,##6*).,#S/,$)+)9,#9+%')+T!
U6&,#6*).,#S/,$)+)9,#16*)(++6T#!
c<0%.6#&!!*#:6%-5!!k1%&8!!l%6%.#04.7!
m10=!#!.1:18!+48%&!
a.4538,.%!8%!.%5#&#:%!0%+$7!./%&!%60.%!&%7!8%,<!1+#:%.1%7!
RE/,##6*).,#S/,$)+)9,#9+%')+T#>!#8#$0%.!!&(#6:,&#-46!8%!&#!$.470#0%!!$#.!0.#67&#-46!%0!.40#-46!
"%$3.%7!#6#04+12,%7!!H#<%!8%!&(,.30.%Q!54&!?/715#&Q!#$%<Q!
54604,.7!8%!&#!$.470#0%!I!$471-466/7!7,.!&()"*!!
$,17!.%5#&#:%!8%!&!(/5=4:.#$=1%!?1#!&%!!&4:151%&!!
R#:1K#&!!4.1%60#-46!!
c<0%.6#&!!*#:6%-5!!k1%&8!!l%6%.#04.7!
m10=!#!.1:18!+48%&!
a.45/8,.%!8%!.%5#&#:%!0%+$7!./%&!%60.%!&%7!8%,<!1+#:%.1%7!
RE/,##6*).,#S/,$)+)9,#9+%')+T#>!#8#$0%.!!&(#6:,&#-46!8%!&#!$.470#0%!!$#.!0.#67&#-46!%0!.40#-46!
R#:1K#&!!4.1%60#-46!!
n,#71!1670#60#6/!!
c<0%.6#&!!*#:6%-5!!k1%&8!!l%6%.#04.7!
m10=!#!.1:18!+48%&!
!
a.45/8,.%!8%!.%5#&#:%!0%+$7!./%&!%60.%!&%7!8%,<!1+#:%.1%7!
RE/,##6*).,#S/,$)+)9,#9+%')+T#>!#8#$0%.!!&(#6:,&#-46!8%!&#!$.470#0%!!$#.!0.#67&#-46!%0!.40#-46!
#
R#
R#:1K#&!!4.1%60#-46!!
R/2,%65%!XL!UXm!#<1#&%!
U.37!.#$18%!o!!A+16!
U#
V##
c<0%.6#&!!*#:6%-5!!k1%&8!!l%6%.#04.7!
m10=!#!.1:18!+48%&!
!
a.45/8,.%!8%!.%5#&#:%!0%+$7!./%&!%60.%!&%7!8%,<!1+#:%.1%7!
RE/,##6*).,#S/,$)+)9,#9+%')+T#>!#8#$0%.!!&(#6:,&#-46!8%!&#!$.470#0%!!$#.!0.#67&#-46!%0!.40#-46!
n,#71!1670#60#6/!!
R/2,%65%!XL!!UXm!!#<1#&%!
'#!$%.0%!8%!./74&,-46!8,%!d!&#!.40#-46!%6!7#:1K#&!#$.37!
5=#.:%+%60!!8(,6%!7/2,%65%!#<1#&%!$%.+%0!8%!&45#&17%.!
7#67!81p5,&0/7!&%7!$.1651$#,<!.%$3.%7!#6#04+12,%7!!
!
c<0%.6#&!!*#:6%-5!!k1%&8!!l%6%.#04.7!
m10=!#!.1:18!+48%&!
!
a.4538,.%!8%!.%5#&#:%!0%+$7!./%&!%60.%!&%7!8%,<!1+#:%.1%7!
U6&,#6*).,#S/,$)+)9,#16*)(++6T#>!7/&%5-467!8%!$41607!8%!!./J/.%65%!!91%6!?1719&%7!7,.!&%7!8%,<!
1+#:%.1%7!!%0!.%5#&#:%!?1#!&%!&4:151%&!8%!J,7146!!C!#$$.45=%!10/.#-?%!!
a&,71%,.7!7/&%5-467!!8%!$41607!8%!./J/.%65%!%60.%!Z!d!AX!7%&46!&%!5#7!!!O!%6.%:170.%+%60!!!!
n,#71!1670#60#6/!!
c<%+$&%!8%!.%5#&#:%!8/0#1&&/!8(,6!$%-0%!e46%!!
c<0%.6#&!!*#:6%-5!!k1%&8!!l%6%.#04.7!
m10=!#!.1:18!+48%&!
!
_,!;6#&!#?#60!&#!914$71%!
U%+$7!#881-466%&!!8#67!!640.%!!%<$/.1%65%!>!WXV#&("#HDCABI!
!!
•! '#!$.45/8,.%!8%!7N65=.4617#-46!!54+916/%!!91$&#6Q!#<1#&%!%0!7#:1K#&%!!
%70!!$47719&%!+j+%!!$4,.!,6!:,18#:%!!,612,%+%60!!#<1#&!!
•! '%7!7/2,%65%7!UXm!#<1#&%!!4,!7#:1K#&%!!$%,?%60!!j0.%!!,-&17/%7!!!
!!!!!!J465-46!8%7!=#910,8%7!8%!5=#5,6G!!
•! '#!$.45/8,.%!!8%!7N65=.4617#-46!!%70!!J#51&%!!
!!!!!!d!+%K.%!!%6!4%,?.%!
•! cp5#510/!%0!.#$1810/!8%!&#!7N65=.4617#-46!!!
c<0%.6#&!!*#:6%-5!!k1%&8!!l%6%.#04.7!
m10=!#!.1:18!+48%&!
!
_,!;6#&!#?#60!&#!914$71%!
U%+$7!#881-466%&!!8#67!!640.%!!%<$/.1%65%!>!WXV#&("#HDCABI!!
!
'%!.%5#&#:%!$%,0!j0.%!+481;/!d!04,0!+4+%60!$%68#60!&#!914$71%!
q$10=/&14+#!81M,7!l&%#746!DrD!
$c&5=16:sGG!
c<0%.6#&!!*#:6%-5!!k1%&8!!l%6%.#04.7!
m10=!#!.1:18!+48%&!
!
_,!;6#&!#?#60!&#!914$71%!
?%&&,"*)(/,-!
@/6$(-(%"!>!16J/.1%,.%!4,!/:#&%!d!^!++!!
4)(-!7,p7#60%!$4,.!#K%168.%!&(49h%5-J!!%6!0%+$7!./%&!!!
'%!.%5#&#:%!$%,0!j0.%!+481;/!d!04,0!+4+%60!$%68#60!&#!914$71%!
c<0%.6#&!!*#:6%-5!!k1%&8!!l%6%.#04.7!
m10=!#!.1:18!+48%&!
!
_,!;6#&!#?#60!&#!914$71%!
c<%+$&%7!8%!.%5#&#:%!8%!e46%7!7,7$%50%7!%6!)"*O!.%+#.2,%e!&(#7$%50!64.+#&!8%!&(/5=4:.#$=1%!!
d!:#,5=%!a)t!8%!=#,0!:.#8%!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!d!8.410%!/$10=/&14+#!l&%#746!ErE!O!?17%,.!8%!$465-46!%6!$&#5%
c<0%.6#&!!*#:6%-5!!k1%&8!!l%6%.#04.7!
m10=!#!.1:18!+48%&!
!
_,!;6#&!#?#60!!&#!914$71%!
?%&&,"*)(/,-!!
a.45/8,.%!8%!J,7146!81p51&%!71!>!
•! TN$%.$&#71%!1+$4.0#60%!
•! Pu6%7!8(4+9.%!#.0/J#5-%&7!!
•! 5#&51;5#-467!
•! 7$=1650%.!$/.1!,./0.#&!
c<0%.6#&!!*#:6%-5!!k1%&8!!l%6%.#04.7!
m10=!#!.1:18!+48%&!
!
!a.45/8,.%!8%!S14$71%!#$.37!J,7146!
*j+%!$#-%60!>!X!914$71%7!8(,6%!e46%!7,7$%50%!)"*!9#7%!8.410%!O!/$10=/&14+#!!l&%#746!ErE!!
$T4,64,sGG!
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"#
!LH!IG2MNI###F##3!@MNI!I#
#
@/%$E1</,#,*#0)(-)'(+(*6#
•! R1+$&1510/g!%<(#
•! L,./%!8%!&(#$$.%6-77#:%g!!$%</*,##-(#./)=><,#1,#+76$8%9/).8(,#,"1%#$)5(*)(/,##
•! P46J4.0!$4,.!&(4$/.#0%,.!%0!&%!$#-%60g!%<(##
•! L,./%!8%!&#!$.45/8,.%!g!c70C5%!$47719&%!!
!!!!!!71!#5-?10/!h4,.6#&13.%!5=#.:/%g!%<(##
#######.)-#1,#*,&.-#)11(=%"",+##/6,+#!
•! P4i0!g!)65466,!!
•! _5-?10/!#+9,&#041.%g#%<(#
•! P460.%!16815#-467!g!!
#####./6$)<=%"##/,-.,$*#17<",#1(-*)"$,#VY#$&##
#######$).*,</#F.)$,#&)J,/#
!
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"#
36-<+*)*-##1,#"%*/,#,Q.6/(,"$,#
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"!
•!
4!GZMP#[NP#4[G!32[;I!
•!
AED!$#-%607!H+%#6!ZXG\!N%#.7Q!.#6:%!>!^BC[EI!!
•!
!m10=!%&%?#0%8!aR_!&%?%&7!H+%#6!^GD^!6:W+&!Q!.#6:%!>!EG\CXBGXIG!!
•!
*"!%<#+16#-467!!H!E!U!_5=1%?#Q!a=1&1$7!*%815#&!RN70%+7Q!S%70Q!0=%!t%0=%.&#687I!!!!!!!!!!!!!!!!!!!!!
!!!!!!!!!!!!!!!!!!!!!!!%684.%50#&!541&!#77451#0%8!04!#6!%<0%.6#&!E<E!5=#66%&!5#.81#5!541&!
•!
*"!8#0#7%07!$.%?14,7&N!&4#8%8!1604!0=%!,&0.#74,68!7N70%+!H_$&14!^BBQ!U47=19#!*%815#&!
RN70%+7Q!`#$#6I!?1#!PLG!!
•!
_<1#&!UX!1+#:%7!m%.%!J,7%8!16!.%#&C-+%!+48%!
•!
v$%.#04.7!>!46%!O!P"!4.!*v!!.#814&4:1707!
•!
_!AZ!54.%!.#684+1e%8!$.470#0%!914$7N!!
!!!!!!!#881-46#&!0#.:%0%8!54.%7!HXCEI!m%.%!0#]%6!16!7,7$1514,7!#.%#7G!!
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"!
c<%+$&%7!
S#7%!:#,5=%!>!/$10=/&14+#!l&%#746!ErD!
$c&7#%77%.ss!
_$%<!8.410!>!/$10=/&14+#!l&%#746!ErE!
!!
$*,&&%.ss!
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"!
a#-%607!HAEDI!
?8)/)$*,/(-=$-#
_:%!HN%#.7I!
!
a.470#0%!?4&,+%!H+'I!
!
aR_!H6:W+'I!
!
U1+%!9%0m%%6!*")!
#68!S14$71%7!H8#N7I!!
!
4,)"#
ZXG\!
!
^EG\!
!
^GD^!
!
E^!
IP#
ZGA!
!
EDGZ!
!
XG[!
!
D[GE!
3)"9,#
^BC[E!
!
A^CAXB!
!
EG\CXBGX!
!
ECXEA!
!
"/7,&0#07!>!8466/%7!=1704&4:12,%7!
•! RU\!$#-%607!H\XQ^FI!#?#1%60!8%7!#64+#&1%7!=1704&4:12,%7!
!
6wx\#
HZZFI!
Adénocarcinome
6wXZ!
HA\FI!
Prostatite chronique
Autres remaniements
6w\!
6wAB! H[FI!
HxFI!
Tissu prostatique normal
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"!
a#-%607!HAEDI!
P#.5164+#!
6w\D#
HZZFI!
P=.4615!!!
$.470#--7!
6wAx!
HA\FI!
6wAB!v0=%.7!
6wAX! H[FI!
HxFI!
t4.+#&!!-77,%!
T1704&4:15#&!.%7,&07!
#I<-.($(%<-#&.432!
P#.5164+#!
v0=%.7!
t4.+#&!-77,%!
!a)"_LR!XrE!
AB!
AZ!
[!
EE!
!a)"_LR!Dr^!
xD!
AX!
^!
ABA!
\D!
Xx!
AX!
RV\!
T1704&4:15#&!.%7,&07!!C!*"!7,7$15146!!4J!!+#&1:6#65N!
a.1651$#&!./7,&0#0!>!54+$#.#1746!8%7!
914$71%7!7N70/+#-2,%7!%0!519&/%7!!
36-<+*)*-#1,-#'(%.-(,-#
G%<*,-#)"%&)+(,-#
?)"$,/#
RS!6/:#-?%7!%0!US!$471-?%7!
^^!
D\!
RS!%0!US!$471-?%7!
^Z!
EA!
RS!$471-?%7!%0!US!6/:#-?%7!
AE!
\!
RS!%0!US!6/:#-?%7!
AB!
!
D^!
RS!w!914$71%7!7N70/+#-2,%7!
US!w!914$71%7!519&/%7!H0#.:%0%8I!
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"!
a#-%607!HAEDI!
S14$71%7!#964.+#&!.%7,&07!O!0#.:%0!914$7N!
S14$71%7!5#.5164+#!.%7,&07!!C!0#.:%0!914$7N!
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"!
a#-%607!HAEDI!
tUwEXGAF!!!!!!!!!!!U!w!^\F!!
tUw^AG^F!!!!!!!!!!!U!w!xDGEF!!
\B!
[B!
[B!
ZB!
ZB!
^B!
^B!
DB!
]#
]#
xB!
DB!
EB!
EB!
XB!
XB!
AB!
AB!
B!
B!
t46!0#.:%0!!!!!!!!!!!!!!!!!!!!!!U#.:%0!!
_964.+#&!-77,%!
t4.+#&!-77,%!
S14$71%7!.%7,&07!C!_964.+#&1-%7!
RN70%+#-5!914$7N!O!0#.:%0!914$7N!
t46!0#.:%0!!!!!!!!!!!!!!!!!!!!!!U#.:%0!!
P#.5164+#!
t4.+#&!-77,%!
S14$71%7!.%7,&07!O!P#.5164+#!!
RN70%+#-5!914$7N!O!0#.:%0!914$7N!
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"!
a#-%607!HAEDI!
tUwEXGAF!!!!!!!!!!!U!w!^\F!!
tUw^AG^F!!!!!!!!!!!U!w!xDGEF!!
\B!
[B!
[B!
ZB!
ZB!
^B!
^B!
DB!
]#
]#
xB!
DB!
EB!
EB!
XB!
XB!
AB!
AB!
B!
B!
t46!0#.:%0!!!!!!!!!!!!!!!!!!!!!!U#.:%0!!
P#.5164+#!
t4.+#&!-77,%!
S14$71%7!.%7,&07!O!P#.5164+#!a)"_LR!ErD!
RN70%+#-5!914$7N!O!0#.:%0!914$7N!
t46!0#.:%0!!!!!!!!!!!!!!!!!!!!!!U#.:%0!!
P#.5164+#!
t4.+#&!-77,%!
S14$71%7!.%7,&07!O!P#.5164+#!a)"_LR!XrE!
RN70%+#-5!914$7N!O!0#.:%0!914$7N!
_6#&N7%!70#-7-2,%!
•! S14$71%7!#?%5!#64+#&1%7!=1704&4:12,%7!
#
RS!w!^AQ^F!5460.%!G^#_#`\XV]##
#
!
\B!
xB!
[B!
!
!
ZB!
]#
!
!
!
^B!
DB!
EB!
XB!
AB!
B!
!
!
!
!
!
!!!
!
!
!
!
!
!
_6#&N7%!70#-7-2,%!
•! S14$71%7!#?%5!5#65%.!
#
RS!w!EXQAF!5460.%!G^#_#abXY]##
!
!
!
[B!
ZB!
^B!
DB!
]#
!
EB!
XB!
AB!
B!
!
!
!
!
!
!
!!!
!
!
!
!
!
!
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"!
•! 3!IH;G[GI!
!"#$%&#'(
345(
!
)"*+$&,-"(
!./0)1*,&$+(!*,'#"#$#$'( /,*-"2(
(((((((((((66(
((((((((((((((((((((((47(
36(
!$89:;(4<7(
4>(
34(
36(
=>(
>>?7@(
44?4@(
77?=@(
!$89:;(><=(
B>(
33(
A=(
6=?7@(
3>?A@(
((((((((((C(
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"!
•! 3!IH;G[GI!
!"#$%&#'(
345(
)"*+$&,-"(
!./0)1*,&$+(!*,'#"#$#$'( /,*-"2(
(((((((((((66(
((((((((((((((((((((((47(
36(
!$89:;(4<7(
4>(
34(
36(
=>(
>>?7@(
44?4@(
77?=@(
!$89:;(><=(
B>(
33(
A=(
6=?7@(
3>?A@(
((((((((((C(
!
"%+#.2,%7!>!!
•! %6!5#7!8%!J4.0%!7,7$15146!)"*!>!$#7!8%!64.+#&10/!d!&(#6#04+4$#0=4&4:1%!!
•! %6!5#7!8%!J#19&%!7,7$15146!)"*!>!XWE!8(#64+#&1%7!+#17!$#7!8(#,:+%60#-46!8%!&(%p5#510/!8%!
8/0%5-46!8,!5#65%.!!
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"!
c<%+$&%!
_$%<!8.410!>!/$10=/&14+#!l&%#746!ErD!
$'%5&%.5sGG!
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"
!
c<%+$&%!
y$!8.410%!>!!
/$10=/&14+#!l&%#746!ErE!
z/.1;5#-46!8%!&#!&45#&17#-46!!
8%7!$./&3?%+%607!!
d!&#!;6!8%!&#!$.45/8,.%!
$"1%=&!
*")!O!U"fR!:,18%8!914$7N!
@P4:61-?%!J,7146(!
*")!%<#+16#-46!!!#?#1&#9&%!!8,.16:!!0=%!914$7N!!$.45%77!46!#!75.%%6!6%#.!0=%!fR!+#5=16%!
R#+%!4$%.#04.7!!P"!!!!*v!
P!"4NQ!"!a#72,#&1Q!_!*#0#,Q!l!S#e1&&%Q!T!'#6:!
"u&%!8%!&()"*!8%!81M,7146!$4,.!&#!8/0%5-46!8,!5#65%.!8%!&#!$.470#0%!#?#60!$465-46!914$71%!>!/0,8%!+,&-$#.#+/0.12,%!8%!
AAA!$#-%607!d!E!U%7&#!
G8,#/%+,#%0#1(c<-(%"#VFG,-+)#432#("#1,*,$="9#./%-*)*,#$)"$,/#',0%/,#",,1+,#'(%.-Dd#&<+=.)/)&,*/($#-*<1D#%0#RRR#.)=,"*-:#
DX!
e#3)1(%+#UYRYfbRdRRURF`#
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"#
!LH!IG2MNI#F##3!@MNI!I#
36-<+*)*-#
#
•! cp5#510/g!!!M<(X#-(#234#*/E-#-<-.,$*,##
!L1p5,&0/7!8%!J,7146!!
!%6!5#7!8%!?4&,+16%,7%!=N$%.$&#71%!!
!4,!1+$4.0#60%7!5#&51;5#-467!
#
!!!_,:+%60#-46!8%!&#!8/0%5-46!8%7!5#65%.7!5&1612,%+%60!71:61;5#-J7!g!!
d!546;.+%.!!
432FG3HI#0<-(%"#&%1,+##
,+,$*/%&)9",=$#*/)$J("9#1,5($,#K(*8##)#/(9(1#/,9(-*/)=%"!
?%"$+<-(%"#
•! a.45/8,.%!8%!J,7146!J#51&%!%0!.#$18%!!
!!!!$47719&%!%6!.4,-6%!5&1612,%!!
•! a#7!8%!J,7146!7,9+1&&1+/0.12,%!!
!!!!!+#17!./7,&0#07!7#-7J#17#607!!
•! a#7!8%!54+$%67#-46!8%!+4,?%+%60!%6!0%+$7!./%&!!
!!!!!!!+#17!54..%5-46!8%!&#!J,7146!$47719&%!d!04,7!+4+%607!!
•! _+/&14.#-46!6%K%!8%7!$%.J4.+#65%7!8%!&#!914$71%!!
!!!!!$4,.!&%7!$%-0%7!e46%7!J4.0%+%60!7,7$%50%7!%6!)"*!!
!!!!!!$4,.!5%.0#16%7!&45#&17#-467!>!#$%<Q!#60/.1%,.!%0!9#7%!!
•! f6%!5%.0#16%!$#.-51$#-46!8%!J,7146!54:61-?%!!#,!54,.7!8%!
5%K%!$.45/8,.%!%70!$.49#9&%!!
!!!!!!H5#.!#6#&N7%!0.37!.1:4,.%,7%!8%!&()"*!%6!0%+$7!./%&I!
"%+%.51%+%607!!
!
d!&(/2,1$%!fR!U47=19#!*%815#&!k.#65%!O!"/:146!c70!
!
#,<!+#61$,&#0.15%7!./J/.%60%7!/5=4:.#$=1%!"#814&4:1%!
S!!
D^!