Departments of Urology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Erasmus University Medical Center, Rotterdam, The Netherlands.
J Urol. 2019 Dec;202(6):1166-1173. doi: 10.1097/JU.0000000000000415. Epub 2019 Jun 27.
Similar to multiparametric magnetic resonance imaging, multiparametric ultrasound represents a promising approach to prostate cancer imaging. We determined the diagnostic performance of B-mode, shear wave elastography and contrast enhanced ultrasound with quantification software as well as the combination, multiparametric ultrasound, for clinically significant prostate cancer localization using radical prostatectomy histopathology as the reference standard.
From May 2017 to July 2017, 50 men with biopsy proven prostate cancer underwent multiparametric ultrasound before radical prostatectomy at 1 center. Three readers independently evaluated 12 anatomical regions of interest for the likelihood of clinically significant prostate cancer on a 5-point Likert scale for all separate ultrasound modalities and multiparametric ultrasound. A logistic linear mixed model was used to estimate diagnostic performance for the localization of clinically significant prostate cancer (any tumor with Gleason score 3 + 4 = 7 or greater, tumor volume 0.5 ml or greater, extraprostatic extension or stage pN1) using a Likert score of 3 or greater and 4 or greater as the threshold. To detect the index lesion the readers selected the 2 most suspicious regions of interest.
A total of 48 men were included in the final analysis. The region of interest specific sensitivity of multiparametric ultrasound (Likert 3 or greater) for clinically significant prostate cancer was 74% (95% CI 67-80) compared to 55% (95% CI 47-63), 55% (95% CI 47-63) and 59% (95% CI 51-67) for B-mode, shear wave elastography and contrast enhanced ultrasound, respectively. Multiparametric ultrasound sensitivity was significantly higher for Likert thresholds and all different clinically significant prostate cancer definitions (all p <0.05). Multiparametric ultrasound improved the detection of index lesion prostate cancer.
Multiparametric ultrasound of the prostate, consisting of B-mode, shear wave elastography and contrast enhanced ultrasound with parametric maps, improved localization and index lesion detection of clinically significant prostate cancer compared to single ultrasound modalities, yielding good sensitivity.
与多参数磁共振成像类似，多参数超声是一种有前途的前列腺癌成像方法。我们使用根治性前列腺切除术的组织病理学作为参考标准，确定了 B 模式、剪切波弹性成像和带有量化软件的对比增强超声以及组合的多参数超声在临床显著前列腺癌定位中的诊断性能。
2017 年 5 月至 2017 年 7 月，在 1 家中心，50 名经活检证实患有前列腺癌的男性在接受根治性前列腺切除术之前接受了多参数超声检查。三位读者分别对 12 个感兴趣的解剖区域进行了 5 分 Likert 评分，以评估每种单独的超声模式和多参数超声对临床显著前列腺癌的可能性。使用逻辑线性混合模型，根据 Likert 评分 3 或更高和 4 或更高作为阈值，对临床显著前列腺癌（任何 Gleason 评分 3+4=7 或更高、肿瘤体积 0.5ml 或更高、前列腺外延伸或 pN1 期）的定位进行诊断性能的估计。为了检测索引病变，读者选择了 2 个最可疑的感兴趣区域。
共有 48 名男性纳入最终分析。多参数超声（Likert 3 或更高）对临床显著前列腺癌的区域特异性敏感性为 74%（95%CI 67-80），而 B 模式、剪切波弹性成像和对比增强超声的敏感性分别为 55%（95%CI 47-63）、55%（95%CI 47-63）和 59%（95%CI 51-67）。对于 Likert 阈值和所有不同的临床显著前列腺癌定义，多参数超声的敏感性均显著更高（均 p<0.05）。多参数超声提高了对指数病变前列腺癌的检测。
由 B 模式、剪切波弹性成像和带有参数图的对比增强超声组成的前列腺多参数超声，与单一超声模式相比，提高了临床显著前列腺癌的定位和指数病变检测，具有良好的敏感性。
