Porsch Markus, Wendler Johann Jakob, Liehr Uwe-Bernd, Lux Anke, Schostak Martin, Pech Maciej
Klinik für Urologie und Kinderurologie, Medizinische Fakultät der Otto-von-Guericke- Universität Magdeburg, Germany.
Institut für Biometrie und Medizinische Informatik, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Germany.
J Ultrason. 2015 Mar;15(60):5-14. doi: 10.15557/JoU.2015.0001. Epub 2015 Mar 30.
This study was designed to evaluate the performance of shear-wave elastography as a diagnostic tool for prostate cancer in a larger cohort of patients than previously reported.
Seventy-three patients with suspected prostate carcinoma were investigated by ultrasound elastography followed by directed biopsy. The elastographic and histological results for all biopsies were compared.
After exclusion of invalid and non-assessable results, 794 samples were obtained for which both a histological assessment and an elastometric result (tissue stiffness in kPa) were available: according to the histology 589 were benign and 205 were malignant. Tissue elasticity was found to be weakly correlated with patient's age, PSA level and gland volume. ROC analysis showed that, for the set of results acquired, elastometry did not fulfil literature claims that it could identify malignant neoplasia with high sensitivity and specificity. However, it did show promise in distinguishing between Gleason scores ≤6 and >6 when malignancy had already been identified. Unexpected observations were the finding of a smaller proportion of tumours in the lateral regions of the prostate than generally expected, and also the observation that the elasticity of benign prostate tissue is region-sensitive, the tissue being stiffest in the basal region and more elastic at the apex.
Shear-wave elastography was found to be a poor predictor of malignancy, but for malignant lesions an elasticity cut-off of 80 kPa allowed a fairly reliable distinction between lesions with Gleason ≤6 and those with Gleason >6. We demonstrate an increase in elasticity of benign prostate tissue from the basal to the apical region.
本研究旨在评估剪切波弹性成像作为前列腺癌诊断工具在比以往报道更大患者队列中的性能。
对73例疑似前列腺癌患者进行超声弹性成像检查，随后进行定向活检。比较所有活检的弹性成像和组织学结果。
排除无效和不可评估结果后，获得了794个样本，这些样本均有组织学评估和弹性测量结果（组织硬度，单位为kPa）：根据组织学结果，589个为良性，205个为恶性。发现组织弹性与患者年龄、前列腺特异抗原（PSA）水平和腺体体积呈弱相关。ROC分析表明，对于所获得的结果集，弹性测量并未达到文献中所声称的能够以高灵敏度和特异性识别恶性肿瘤的效果。然而，当已经确定为恶性时，它在区分Gleason评分≤6和>6方面确实显示出前景。意外发现是前列腺外侧区域肿瘤的比例低于一般预期，并且还观察到良性前列腺组织的弹性具有区域敏感性，基底区域组织最硬，尖部更具弹性。
发现剪切波弹性成像对恶性肿瘤的预测能力较差，但对于恶性病变，80 kPa的弹性阈值能够在Gleason评分≤6和>6的病变之间进行相当可靠的区分。我们证明了良性前列腺组织从基底区域到尖部区域弹性增加。
