经直肠剪切波弹性成像技术联合移行区穿刺在前列腺癌诊断中的应用价值

Transrectal shear wave elastography combined with transition zone biopsy for detecting prostate cancer

目的:探讨经直肠剪切波弹性成像(SWE)技术联合移行区穿刺诊断前列腺癌的临床应用价值。方法:对489例疑诊前列腺癌患者行经直肠超声(TRUS)及SWE引导下的前列腺穿刺活检,并以穿刺活检病理结果作为金标准,评估SWE联合移行区穿刺对提高前列腺癌检出率的作用。结果:489例患者病理结果显示:前列腺癌221例,前列腺良性病变268例。在系统性穿刺基础上,应用SWE联合移行区穿刺诊断前列腺癌的检出率为45.19%,显著高于单独系统性穿刺活检的检出率33.13%(P<0.05);SWE诊断前列腺癌的敏感性、特异性及准确性均明显优于TRUS,差异具有统计学意义(P<0.05);SWE检测癌组织平均杨氏模量值(Emean)为(40.1±9.5)k Pa,良性病灶Emean值为(21.6±8.3)k Pa,两者差异具有统计学意义(P<0.05);应用受试者工作特征曲线(ROC)分析得出,当Emean值为28.5 k Pa时曲线下面积为0.899,诊断敏感性为88.71%,特异性为86.23%。结论:应用SWE联合移行区穿刺可显著提高前列腺癌检出率;当以Emean值28.5 k Pa作为截点时具有最佳的诊断效能。

Objective： To evaluate the application of shear wave elastography（ SWE） combined with transition zone biopsy in the detection of prostate cancer（ PCa）. Methods： A total of 489 patients with suspected PCa underwent transrectal ultrasonography（ TRUS） and SWE-guided prostatic biopsy. We evaluated the role of SWE combined with transition zone biopsy in promoting the detection rate in comparison with the results of biopsy pathology. Results： The pathological results confirmed 221 malignant and 268 benign cases. Based on systematic biopsy,SWE combined with transition zone biopsy achieved a detection rate of 45. 19%,significantly higher than that of systematic biopsy alone（ 33. 13%）（ P〈0. 05）. The diagnostic sensitivity,specificity,and accuracy of SWE were significantly better than those of TRUS（ P〈0. 05）. The mean elasticity（ Emean） of SWE was remarkably higher for malignant than for benign lesions（ [40. 1 ± 9. 5]vs [21. 6 ± 8. 3]k Pa,P〈0. 05）. With 28. 5 k Pa as the threshold of the Emean value,the area under the ROC curve was 0. 899,and the diagnostic sensitivity and specificity were 88. 71% and 86. 23%,respectively. Conclusion：SWE combined with transition zone biopsy could significantly improve the detection rate of prostate cancer.