经直肠超声弹性成像对前列腺增生和前列腺癌的鉴别意义

The significance of transrectal ultrasound elastography in the differential diagnosis of prostatic hyperplasia and prostate cancer

目的:探讨经直肠超声弹性成像(TRTE)鉴别诊断前列腺增生(BPH)和前列腺癌(PCa)的临床价值,分析超声弹性分级与前列腺恶性病灶Gleason评分的相关性。方法:选取2018年5月至2020年8月我院诊治的107例疑似前列腺癌患者,对其进行TRTE检查及超声引导前列腺穿刺活检。采用超声弹性分级法和超声弹性应变率比值法分别对107例患者的121个病灶进行诊断,以前列腺穿刺活检病理结果作为对照;绘制两种诊断方法的ROC曲线,分别计算其诊断BPH和PCa的灵敏度、特异度、准确度及曲线下面积(AUC值);对比两种方法鉴别诊断BPH、PCa的准确性;采用Spearman相关性分析超声弹性分级与前列腺癌Gleason评分的相关性。结果:107例患者(121个病灶)经穿刺活检病理诊断为PCa 48例(44.9%)(49个病灶),BPH 59例(55.1%)(72个病灶)。121个病灶超声弹性分级Ⅰ级-Ⅴ级分别为22个、44个、19个、27个和9个。超声弹性分级法诊断BPH、PCa的灵敏度为79.6%、特异度为77.8%、准确度为78.5%,AUC值为0.803(95%CI:0.714-0.867)。应变率比值法诊断BPH、PCa的最佳阈值为4.672,灵敏度为85.7%、特异度为79.2%、准确度为81.8%,AUC值为0.847(95%CI:0,798-0.912)。两种方法诊断准确度无显著统计学差异(P>0.05),诊断AUC值均介于0.7-0.9。Spearman相关性分析显示,超声弹性分级与Gleason评分间存在正相关性(r=0.655,P=0.000)。结论:TRTE技术用于鉴别诊断BPH、PCa具有较高的临床价值,利于前列腺癌的临床诊断及预后评估。

Objective:To investigate the clinical value of transrectal ultrasound elastography(TRTE)in the differential diagnosis of prostate hyperplasia(BPH)and prostate cancer(PCa),and to analyze the correlation between ultrasonic elasticity grading and Gleason score.Methods:From May 2018 to August 2020,107 patients with suspected prostate cancer treated in our hospital were selected for TRTE examination and transrectal ultrasound-guided prostate biopsy.The ultrasonic elasticity grading method and strain rate ratio method were used to diagnose 121 lesions in 107 patients respectively,and the pathological results of puncture biopsy were taken as the"gold standard".ROC curves of the two diagnostic methods were drawn to calculate the sensitivity,specificity,accuracy and area under the curve of BPH and PCa respectively.Spearman correlation analysis was used to analyze the correlation between ultrasonic elasticity grading and Gleason score of prostate cancer.Results:The 107 patients(121 lesions)were pathologically diagnosed with PCa in 48 cases(44.9%)(49 lesions)and BPH in 59 cases(55.1%)(72 lesions)by biopsy.121 lesions ultrasonic elasticity classⅠ-Ⅴrespectively 22,44,19,27 and 9.The sensitivity,specificity,accuracy and AUC of BPH and PCa were 79.6%,77.8%,78.5%and 0.803(95%CI:0.714-0.867)respectively.The best threshold value,sensitivity,specificity,accuracy and AUC for BPH and PCa were 4.672,85.7%,79.2%,81.8%and 0.847(95%CI:0,798-0.912).There was no statistically significant difference in the diagnostic accuracy between the two methods(P>0.05),and the diagnostic AUC value was between 0.7-0.9.Spearman correlation analysis showed that there was a positive correlation between ultrasonic elasticity grading and Gleason score(r=0.655,P=0.000).Conclusion:TRTE technology has high clinical value for differential diagnosis of BPH and PCa,and is helpful for clinical diagnosis and prognosis assessment of prostate cancer.