Application of transrectal shear wave elastography in diagnosis of prostatic cancer
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摘要: 目的:通过比较超声剪切波弹性成像和普通超声引导经直肠前列腺穿刺活检诊断前列腺癌的敏感性、特异性等指标,探讨超声剪切波弹性成像技术在前列腺癌诊断中的应用价值。方法:采用Supersonic Imagine Aixplorer实时剪切波弹性成像超声诊断仪和普通超声分别检测60例血清前列腺特异性抗原(PSA)在4~10 μg/L之间、f/t<16%的患者。以穿刺6针的标准为基础,增加4针用于可疑病灶区域,如无可疑病灶区域,则4针平均分布于前列腺的外周带。比较超声剪切波弹性组和普通超声组引导前列腺穿刺活检诊断前列腺癌的敏感性和特异性等指标。结果:弹性超声组诊断前列癌的敏感性为89.5%,特异性为90.2%,检出率为31.7%。普通超声引导组的敏感性为53.0%,特异性为52.0%,检出率为28.3%。相对于每针前列腺活检组织而言:弹性超声组检出率29.2%(31/106),普通超声组检出率8.0%(48/600),两组差异有统计学意义(P<0.01)。结论:经直肠超声剪切波弹性成像技术不但可以提高血清PSA在4~10 μg/L之间的患者前列腺癌的检出率,而且可以减少前列腺活检穿刺的针数。Abstract: Objective:To investigate the clinical value of transrectal prostate biopsy guided by shear wave elastography in the diagnosis of prostatic cancer by comparing it with common ultrasound guided transrectal prostate biopsy.Method:Shear wave elastography using Supersonic Imagine Aixplorer (Hitachi Medical, Tokyo, Japan) was done in 120 men with prostate specific antigen between 4-10 μg/L and free-to-total prostate specific antigen ratio of less than 16%. Shear wave elastography was done to evaluate peripheral zone tissue elasticity and hard areas were defined as suspicious. Targeted biopsies with four cores were done in suspicious areas, followed by six-core systematic biopsy. We analyzed the cancer detection rate of shear wave elastography group and common ultrasonic group. Result:In shear wave elastography group:sensitivity was 89.5% and specificity was 90.2%, which detection rate was 37.1%. In common ultrasonic group:sensitivity was 53.0% and specificity was 52.0%, which detection rate was 28.3%. Positive cancer cores were found in real-time elastography targeted cores in 31 of 106 cases (29.2%) and in common ultrasonic targeted cores in 48 of 600 patients (8.0%) (P<0.01).Conclusion:Shear wave elastography targeted biopsy not only increase rate of prostatic cancer detection but also decreased number of cores compared with that of common ultrasonic targeted biopsy in men with total prostate specific antigen 4-10 μg/L.
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