Prostate Cancer: Diagnostic Performance of Real-time Shear-Wave Elastography
Prostate Cancer: Diagnostic Performance of Real-time Shear-Wave Elastography
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DOI：
10.1148/radiol.14140567
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发表时间：
2015-04-01
期刊：
影响因子：
19.7
通讯作者：
Barr, Richard G.
中科院分区：
文献类型：
--
作者：
Correas, Jean-Michel;Tissier, Anne-Marie;Barr, Richard G.
目的：前瞻性评价实时超声（US）剪切波弹性成像（SWE）在前列腺特异性抗原水平高和/或升高和/或直肠指检结果异常的患者中诊断外周带前列腺癌的性能。材料和方法：在签署知情同意书后，接受经直肠前列腺活检的男性被纳入这项符合HIPAA的前瞻性双中心研究，这是在机构审查委员会批准下进行的。在常规经直肠超声检查后和超声引导下12芯六分活检前立即进行经直肠超声前列腺SWE。对于每个六分仪，测量最大SWE值，并与该六分仪活检的病理结果相匹配。在患者和六分仪水平上评估SWE的诊断性能。弹性值最大化的约登指数被用来获得敏感性，特异性，阳性预测值（PPV），和阴性预测值（NPV）。结果：弹性值匹配的病理结果，共1040外周带六分仪在184名男子。129例阳性活检结果（大小，。3 mm; Gleason评分，. 6)在68名患者中发现。SWE以35 kPa为界值鉴别良恶性病变的敏感性、特异性、PPV、NPV和受试者工作特征曲线下面积为96%（95%置信区间[CI]：95%，97%），85%（95% CI：83%，87%），48%（95% CI：46%，50%），99%（95% CI：98%，100%）和95%（95% CI：93%，97%）。在SWE下使用35 kPa阈值可以为前列腺癌的检测和活检引导提供额外的信息，从而能够显著减少活组织检查的数量，同时确保很少的外周区腺癌被遗漏。(C)RSNA，2014年
Purpose: To prospectively evaluate the performance of real-time ultrasonographic (US) shear-wave elastography (SWE) in the diagnosis of peripheral zone prostate cancer in patients with high and/or increasing prostate-specific antigen levels and/or abnormal digital rectal examination results.Materials and Methods: After signing an informed consent form, men referred for transrectal prostate biopsy were enrolled in this prospective HIPAA-compliant two-center study, which was conducted with institutional review board approval. Transrectal US SWE of the prostate was performed after a conventional transrectal US examination and immediately before US-guided 12-core sextant biopsy. For each sextant, the maximum SWE value was measured and matched to the pathologic results of that sextant biopsy. The diagnostic performance of SWE was assessed at both patient and sextant levels. The elasticity value maximizing the Youden index was used to derive sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).Results: The elasticity values were matched to pathologic results for a total of 1040 peripheral zone sextants in 184 men. One hundred twenty-nine positive biopsy findings (size,. 3 mm; Gleason score,. 6) were identified in 68 patients. The sextant-level sensitivity, specificity, PPV, NPV, and area under the receiver operating characteristic curve for SWE with a cutoff of 35 kPa for differentiating benign from malignant lesions were 96% (95% confidence interval [CI]: 95%, 97%), 85% (95% CI: 83%, 87%), 48% (95% CI: 46%, 50%), 99% (95% CI: 98%, 100%), and 95% (95% CI: 93%, 97%), respectively.Conclusion: Use of a 35-kPa threshold at SWE may provide additional information for the detection and biopsy guidance of prostate cancer, enabling a substantial reduction in the number of biopsies while ensuring that few peripheral zone adenocarcinomas are missed. (C) RSNA, 2014