Institute of Biomedical Engineering, Shanghai University, Room 803, Xiangying Building, No. 333, Nanchen Rd, Shanghai, 200444, China.
Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, 200438, China.
Radiol Med. 2017 Dec;122(12):944-951. doi: 10.1007/s11547-017-0803-1. Epub 2017 Aug 23.
To examine the role of quantitative real-time elastography (RTE) features on differentiation between high-risk prostate cancer (PCA) and non-high-risk prostatic diseases in the initial transperineal biopsy setting.
We retrospectively included 103 patients with suspicious PCA who underwent both RTE and initial transperineal prostate biopsy. Patients were grouped into high-risk and non-high-risk categories according to the D'Amico's risk stratification. With computer assistance based on MATLAB programming, three features were extracted from RTE, i.e., the median hardness within peripheral gland (PG) (H ), the ratio of the median hardness within PG to that outside PG (H ), and the ratio of the hard area within PG to the total PG area (H ). A multiple regression model incorporating an RTE feature, age, transrectal ultrasound finding, and prostate volume was used to identify markers for high-risk PCA.
Forty-seven patients (45.6%) were diagnosed with PCA and 34 (33.0%) were diagnosed with high-risk PCA. Three RTE features were all statistically higher in high-risk PCA than in non-high-risk diseases (p < 0.001), indicating that the PGs in high-risk PCA patients were harder than those in non-high-risk patients. A high H , high age, and low prostate volume were found to be independent markers for PCAs (p < 0.05), among which the high H was the only independent marker for high-risk PCAs (p = 0.012). When predicting high-risk PCAs, the multiple regression achieved an area under receiver operating characteristic curve of 0.755, sensitivity of 73.5%, and specificity of 71.0%.
The elevated hardness of PG identified high-risk PCA and served as an independent marker of high-risk PCA. As a non-invasive imaging modality, the RTE could be potentially used in routine clinical practice for the detection of high-risk PCA to decrease unnecessary biopsies and reduce overtreatment.
探讨实时超声弹性成像（RTE）定量参数在经会阴前列腺初始穿刺活检中鉴别高危前列腺癌（PCA）与非高危前列腺疾病中的作用。
回顾性纳入 103 例经 RTE 及经会阴前列腺初始穿刺活检疑似 PCA 的患者。根据 D'Amico 风险分层，将患者分为高危和非高危组。基于 MATLAB 编程的计算机辅助，从 RTE 中提取 3 个参数，即外周带（PG）内中位数硬度（H）、PG 内中位数硬度与 PG 外中位数硬度比值（H）和 PG 内硬区与 PG 总面积比值（H）。采用包含 RTE 特征、年龄、经直肠超声表现和前列腺体积的多元回归模型来识别高危 PCA 的标志物。
47 例（45.6%）诊断为 PCA，34 例（33.0%）诊断为高危 PCA。高危 PCA 的 3 个 RTE 特征均显著高于非高危疾病（p<0.001），提示高危 PCA 患者的 PG 比非高危患者更硬。高 H、高龄和低前列腺体积是 PCA 的独立标志物（p<0.05），其中高 H 是高危 PCA 的唯一独立标志物（p=0.012）。预测高危 PCA 时，多元回归分析的受试者工作特征曲线下面积为 0.755，灵敏度为 73.5%，特异度为 71.0%。
PG 硬度升高可识别高危 PCA，并作为高危 PCA 的独立标志物。作为一种非侵入性成像方式，RTE 可用于常规临床实践中检测高危 PCA，以减少不必要的活检并降低过度治疗。
