Kamalov A A, Kadrev A V, Mitkova M D, Danilova N V, Kamalov D M, Sorokin N I, Mitkov V V
Lomonosov Moscow State University, Medical Research and Educational Center, Moscow, Russia.
Russian Medical Academy of Continuous Professional Education, Moscow, Russia.
Urologiia. 2020 Dec(6):106-113.
to compare the effectiveness of targeted biopsy guided by the shear wave elastography (SWE) and systematic biopsy in the diagnosis of prostate cancer (PCa).
A total of 164 patients with suspected PCa were examined. Multiparametric TRUS, including SWE, was performed to all patients with the use of the Aixplorer ultrasound system (Supersonic Imagine, France), followed by TRUS guided 12-samples systematic prostate biopsy in combination with targeted biopsy from hypoechoic and/or stiff areas according to SWE data. Comparison of the results of histological examination and tissue stiffness measurements were carried out according to the specimens and patients. A total of 2 171 biopsy samples were analyzed (1 968 systematic and 203 targeted). After morphological evaluation all specimens were divided into groups of PCa+ (n=441) and PCa- (n=1 730), and patients to the group of PCa (n=74) and the control group (n=90).
PCa was found in 17.3% of systematic biopsy specimens and in 76.9% of SWE targeted biopsy specimens (P<0.0001). The significant moderate positive correlations of Youngs modulus and Gleason scores (rS=0.51, P<0.0001), Youngs modulus and% specimen involvement (rS=0.59, P<0.0001) were founded in the group of PCa+ biopsy specimens. The percentage of PCa+ specimens was significantly higher with any types of targeted biopsy, than with systematic biopsy. With SWE targeted biopsy the percentage of PCa+ specimens was significantly higher than with B-mode guided targeted biopsy. Similar regularities were observed when comparing these types of targeted biopsy according to morphological prognostic ISUP groups and perineural invasion. Performing of targeted biopsy increased the morphological prognostic group in 5.4% of patients, additionally revealed perineural invasion in 2.7% of patients with PCa, and transferred additional 9.5% of patients from the group of clinically insignificant to the group of clinically significant PCa.
SWE-guided targeted biopsy shows the significantly higher positive biopsy rate than conventional systematic biopsy. The use of SWE-guided targeted biopsy in addition to systematic biopsy can increase clinically significant PCa detection rate and improve the detection of perineural invasion.
比较剪切波弹性成像（SWE）引导下的靶向活检与系统活检在前列腺癌（PCa）诊断中的有效性。
共检查了164例疑似PCa的患者。使用Aixplorer超声系统（法国Supersonic Imagine公司）对所有患者进行包括SWE在内的多参数经直肠超声检查，随后进行经直肠超声引导下的12针系统前列腺活检，并根据SWE数据对低回声和/或硬区进行靶向活检。根据标本和患者对组织学检查结果和组织硬度测量结果进行比较。共分析了2171个活检样本（1968个系统样本和203个靶向样本）。在形态学评估后，将所有标本分为PCa+组（n = 441）和PCa-组（n = 1730），患者分为PCa组（n = 74）和对照组（n = 90）。
在系统活检标本中发现PCa的比例为17.3%，在SWE靶向活检标本中为76.9%（P<0.0001）。在PCa+活检标本组中，发现杨氏模量与Gleason评分之间存在显著的中度正相关（rS = 0.51，P<0.0001），杨氏模量与标本受累百分比之间存在显著的中度正相关（rS = 0.59，P<0.0001）。任何类型的靶向活检中PCa+标本的百分比均显著高于系统活检。与B模式引导的靶向活检相比，SWE靶向活检中PCa+标本的百分比显著更高。根据形态学预后ISUP组和神经周围浸润情况比较这些类型的靶向活检时，观察到类似的规律。进行靶向活检使5.4%的患者的形态学预后组得到改善，另外在2.7%的PCa患者中发现了神经周围浸润，并将9.5%的临床意义不显著的患者转移到了临床意义显著PCa组。
SWE引导下的靶向活检显示出比传统系统活检显著更高的阳性活检率。除系统活检外，使用SWE引导下的靶向活检可提高临床意义显著PCa的检出率，并改善神经周围浸润的检测。
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