[实时弹性成像在前列腺癌诊断中的应用：个人经验]

[Real-time elastography in the diagnosis of prostate cancer: personal experience].

作者信息

Romagnoli Andrea, Autieri Gaspare, Centrella Danilo, Gastaldi Christian, Pedaci Giuseppe, Rivolta Lorenzo, Pozzi Emilio, Anghileri Alessio, Cerabino Maurizio, Bianchi Carlo Maria, Roggia Alberto

机构信息

U.O. Urologia, Ospedale Gallarate (Varese), Italy.

出版信息

Urologia. 2010 Oct-Dec;77(4):248-53.

PMID:21234867

Abstract

INTRODUCTION

Prostate cancer is the most common cancer in men. In the future, a significant further increase in the incidence of prostate cancer is expected. The indication to perform a prostate biopsy is digital rectal examination suspicious for prostate cancer, total prostate specific antigen (PSA) value, free PSA/total PSA ratio, PSA density and PSA velocity, and an evidence of hypoechoic area at transrectal ultrasound scan. Unfortunately the specificity and sensibility are still poor. The aim of this retrospective study is to evaluate the specificity and sensibility of real time elastography versus ultrasound transrectal B-mode scan.

METHODS

We retrospectively evaluated 108 pts. having undergone TRUS-guided transrectal prostate biopsy (10 samples). The indication for biopsy is: digital rectal examination, total prostate specific antigen (PSA) value, PSA ratio, PSA density and PSA velocity suspicious for prostate cancer, and/or an evidence of hypoechoic area at transrectal ultrasound scan, and/or hard area at real-time elastography. The mean age of patients is 66.8 years, mean PSA 6.5 ng/mL, and mean ratio 16.5%. We compared the histopathological findings of needle prostate biopsies with the results of transrectal ultrasound and transrectal real-time elastography.

RESULTS

32/108 (29.6%) pts. were positive for prostate cancer (mean Gleason score 7.08), mean PSA 14 ng/mL and mean ratio 9.5%. Transrectal ultrasound scan shows a sensibility of 69% and specificity of 68%. Transrectal ultrasound scan shows a VPP of 51.4%. Transrectal ultrasound scan shows a VPN of 80.9%. Real-time elastography shows a sensibility of 56% and specificity of 85.7%. Real-time elastography shows a VPP of 60.1%. Real-time elastography shows a VPN of 83%.

CONCLUSIONS

Elastography has a significantly higher specificity for the detection of prostate cancer than the conventionally used examinations including DRE and TRUS. It is a useful real-time diagnostic method because it is not invasive, and simultaneous evaluation is possible while performing TRUS.

摘要

引言

前列腺癌是男性中最常见的癌症。未来，预计前列腺癌的发病率将进一步显著上升。进行前列腺活检的指征包括直肠指检怀疑前列腺癌、总前列腺特异性抗原（PSA）值、游离PSA/总PSA比值、PSA密度和PSA速率，以及经直肠超声扫描发现低回声区。不幸的是，其特异性和敏感性仍然较差。本回顾性研究的目的是评估实时弹性成像与经直肠B超扫描的特异性和敏感性。

方法

我们回顾性评估了108例接受经直肠超声引导下经直肠前列腺活检（10个样本）的患者。活检指征为：直肠指检、总前列腺特异性抗原（PSA）值、PSA比值、PSA密度和PSA速率怀疑前列腺癌，和/或经直肠超声扫描发现低回声区，和/或实时弹性成像发现硬区。患者的平均年龄为66.8岁，平均PSA为6.5 ng/mL，平均比值为16.5%。我们将经针穿刺前列腺活检的组织病理学结果与经直肠超声和经直肠实时弹性成像的结果进行了比较。

结果

108例患者中有32例（29.6%）前列腺癌阳性（平均Gleason评分7.08），平均PSA为14 ng/mL，平均比值为9.5%。经直肠超声扫描的敏感性为69%，特异性为68%。经直肠超声扫描的阳性预测值为51.4%。经直肠超声扫描的阴性预测值为80.9%。实时弹性成像的敏感性为56%，特异性为85.7%。实时弹性成像的阳性预测值为60.1%。实时弹性成像的阴性预测值为83%。