Department of Ultrasound, Peking University Third Hospital, Bejing, China.
Department of Urology, Beijing Tsinghua Changguang Hospital, Bejing, China.
J Endourol. 2020 May;34(5):558-566. doi: 10.1089/end.2019.0902. Epub 2020 Apr 21.
To assess the diagnostic value of transrectal shear wave elastography (SWE) for detecting prostate cancer (PCa) in peripheral zone and compare it with magnetic resonance imaging (MRI). Two hundred twenty-one patients suspected of PCa were enrolled, in which 172 patients of them underwent both SWE and MRI. Elastic value was measured in the area prepared for systematic biopsy and suspicious lesion detected on B-mode or SWE, histopathological result was compared for each biopsy. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were derived by obtaining optimal threshold from receiver operating characteristic (ROC) curve. The correlation between the stiffness of PCa and Gleason scores, prognostic grades, and percentage of cancer in biopsy were evaluated by Spearman rank correlation. Multivariate logistic regression analysis was performed to determine predictors for diagnosing PCa. The diagnostic capacity of MRI and SWE for detecting PCa and clinically significant PCa in the peripheral zone were assessed by comparing area under curve of ROC curve. A value of 42 kPa was used as the cutoff for differentiating benign from malignant prostatic tissue; the sensitivity, specificity, PPV, NPV, and accuracy were 78.97%, 90.67%, 71.30%, 93.66% and 88.03%, respectively. Rank correlation analysis revealed that the stiffness of PCa had a correlation with Gleason score, prognostic grade, and percentage of cancer in biopsy. On multivariate analysis, the age, free prostate-specific antigen (PSA), PSA density, SWE, and MRI were independent predictors for diagnosing PCa. There was no statistical difference for diagnosing PCa between SWE and MRI ( = 0.259). However, for clinically significant PCa, the diagnostic capacity of SWE was a little higher than MRI ( = 0.013). SWE may provide additional information for PCa detection, which could increase the positive rate of PCa in targeted biopsy and reduce unnecessary biopsy. SWE is compatible with MRI for detecting PCa in the peripheral zone.
评估经直肠剪切波弹性成像（SWE）检测外周带前列腺癌（PCa）的诊断价值，并与磁共振成像（MRI）比较。纳入 221 例疑似 PCa 患者，其中 172 例行 SWE 和 MRI 检查。在系统活检准备区和 B 模式或 SWE 检测到的可疑病灶处测量弹性值，对每例活检的组织病理学结果进行比较。通过获得受试者工作特征（ROC）曲线的最佳阈值，得出敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。采用 Spearman 秩相关分析评估 PCa 硬度与 Gleason 评分、预后分级和活检中癌比例的相关性。采用多元逻辑回归分析确定诊断 PCa 的预测因素。通过比较 ROC 曲线下面积评估 MRI 和 SWE 在外周带检测 PCa 和临床显著 PCa 的诊断能力。将 42 kPa 作为区分良性和恶性前列腺组织的截断值；其敏感性、特异性、PPV、NPV 和准确性分别为 78.97%、90.67%、71.30%、93.66%和 88.03%。秩相关分析显示，PCa 的硬度与 Gleason 评分、预后分级和活检中癌比例相关。多因素分析显示，年龄、游离前列腺特异性抗原（PSA）、PSA 密度、SWE 和 MRI 是诊断 PCa 的独立预测因素。SWE 和 MRI 诊断 PCa 无统计学差异（ = 0.259）。然而，对于临床显著 PCa，SWE 的诊断能力略高于 MRI（ = 0.013）。SWE 可为 PCa 检测提供额外信息，可提高靶向活检中 PCa 的阳性率，减少不必要的活检。SWE 与 MRI 在外周带检测 PCa 具有兼容性。
