Diagnostic Value of Transrectal Shear Wave Elastography for Prostate Cancer Detection in Peripheral Zone: Comparison with Magnetic Resonance Imaging
Diagnostic Value of Transrectal Shear Wave Elastography for Prostate Cancer Detection in Peripheral Zone: Comparison with Magnetic Resonance Imaging
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DOI：
10.1089/end.2019.0902
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发表时间：
2020-05-01
影响因子：
2.7
通讯作者：
Cui, Ligang
中科院分区：
文献类型：
--
作者：
Fu, Shuai;Tang, Yuzhe;Cui, Ligang
目的：目的探讨经直肠剪切波弹性成像（SWE）对前列腺癌（PCa）的诊断价值，并与磁共振成像（MRI）进行比较。在准备系统活检的区域和B超或SWE检查发现的可疑病灶处测量弹性值，比较每次活检的组织病理学结果。通过受试者工作特征曲线（ROC）获得最佳阈值，得到灵敏度、特异度、阳性预测值（PPV）、阴性预测值（NPV）和准确度。采用斯皮尔曼等级相关分析PCa硬度与Gleason评分、预后分级和活检癌百分比的相关性。进行多变量logistic回归分析以确定PCa诊断的预测因素。结果：以42 kPa作为前列腺良恶性的临界值;敏感性、特异性、阳性预测值、阴性预测值和准确性分别为78.97%、90.67%、71.30%、93.66%和88.03%。等级相关分析显示，PCa硬度与Gleason评分、预后分级和活检中的癌症百分比相关。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之间诊断PCa的差异无统计学意义（p = 0.259）。结论：SWE可为PCa的检测提供更多信息，提高PCa的靶向活检阳性率，减少不必要的活检。SWE与MRI兼容，用于检测外周区的PCa。
Objective: 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).Materials and Methods: 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.Results: 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 (p = 0.259). However, for clinically significant PCa, the diagnostic capacity of SWE was a little higher than MRI (p = 0.013).Conclusions: 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.