Assessment of elastographic Q-analysis score combined with Prostate Imaging-Reporting and Data System (PI-RADS) based on transrectal ultrasound (TRUS)/multi-parameter magnetic resonance imaging (MP-MRI) fusion-guided biopsy in differentiating benign and malignant prostate.

BACKGROUND

Magnetic resonance imaging (MRI) has advantages in the diagnosis of prostate diseases, but there is also overdiagnosis. We compensate for this with fusion imaging and elastography. In this study, we want to evaluate Elastographic Q-analysis score (EQS) combined with Prostate Imaging Reporting and Data System (PI-RADS), based on transrectal ultrasound (TRUS)/multi-parameter magnetic resonance imaging (MP-MRI) fusion biopsy in differentiating benign and malignant prostate lesions.

METHODS

A total of 296 patients with 318 prostate lesions who underwent TRUS/MP-MRI fusion biopsy between October 2017 and October 2019 were retrospectively analysed. The performance of the EQS was evaluated on the sites of the suspicious areas of MP-MRI. The cut-off value of EQS was obtained according to receiver operating characteristic (ROC) curve, which was used to upgrade and downgrade the PI-RADS scores. The area under the curve (AUC), integrated discrimination improvement, and decision curve analysis were used to assess the new PI-RADS performance.

RESULTS

In total, 318 MP-MRI suspicious prostate lesions (94 malignant 224 benign lesions). The EQS optimal threshold was 1.85, and the AUC was 0.816. All cases were constructed three models by using 1.85 as the cut-off value: upgrade-PI-RADS, downgrade-PI-RADS and complex-PI-RADS. The AUC of PI-RADS, upgrade-PI-RADS, downgrade-PI-RADS and complex-PI-RADS were 0.869, 0.867, 0.872 and 0.873 respectively. The diagnostic coincidence rate of PI-RADS was increased from 0.667 to 0.874 by using strain elastography, among which the diagnostic rate of prostate cancer was increased from 0.557 to 0.806, and the diagnostic rate of non-prostate cancer was increased from 0.775 to 0.967. The integrated discrimination improvement indicated that downgrade-PI-RADS had a better diagnostic capability (P<0.05). The net benefit of all models, which downgrade-PI-RADS can maximize the net benefit value of patients by decision curve analysis.

CONCLUSIONS

The combination of PI-RADS and EQS with TRUS/MP-MRI fusion, particularly downgrade-PI-RADS, can reduce unnecessary biopsy procedures and prevent overdiagnosis.