经直肠超声造影和直肠超声剪切波弹性成像联合血清前列腺特异性抗原诊断早期前列腺癌的价值

Early diagnosis of prostate cancer by contrast-enhanced ultrasound and shear-wave elastography combined with prostate specific antigen detection

目的观察早期前列腺癌患者直肠超声造影(contrast-enhanced ultrasound,CEUS)、直肠超声剪切波弹性成像(shear-wave elastography,SWE)的声像学特征及血清前列腺特异性抗原(prostate specific antigen,PSA)的表达情况,探讨三者联合对早期前列腺癌的诊断效能。方法拟诊前列腺癌患者108例,均行直肠CEUS、SWE检查和穿刺活检组织病理检查,采用ELISA法检测血清PSA水平。根据穿刺活检组织病理检查结果分为前列腺癌组60例和非前列腺癌组48例,比较2组体质量指数、C反应蛋白水平等临床资料及CEUS和SWE声像学特征、血清PSA水平。以组织病理检查结果为金标准,比较CEUS、SWE及血清PSA对早期前列腺癌的诊断准确率。绘制ROC曲线,评估血清PSA、CEUS、SWE三者单独及联合诊断早期前列腺癌的效能。结果2组年龄、体质量指数、C反应蛋白水平、白细胞计数、有吸烟史比率比较差异均无统计学意义(P>0.05)。前列腺癌组血清PSA水平[(39.89±16.75)μg/L]及SWE弹性值衡量平均值[(57.91±23.02)kPa]、弹性模量最小值[(46.68±19.99)kPa]、弹性模量最大值[(66.48±25.36)kPa]均高于非前列腺癌组[(19.69±8.78)μg/L、(27.02±10.86)kPa、(21.45±8.64)kPa、(33.09±12.06)kPa](P<0.05),CEUS达峰时间[(28.95±10.09)s]、显影时间[(13.75±5.95)s]均短于非前列腺癌组[(36.01±14.32)、(21.86±8.81)s](t=3.001,P=0.003;t=5.693,P<0.001)。SWE诊断早期前列腺癌的准确率(88.3%)高于血清PSA(73.3%)(χ^(2)=4.357,P=0.037),与CEUS(75.0%)比较差异无统计学意义(χ^(2)=3.562,P=0.059);血清PSA诊断早期前列腺癌的准确率与CEUS比较差异无统计学意义(χ^(2)=0.043,P=0.835)。CEUS的达峰时间、SWE弹性模量最大值、血清PSA水平的最佳截断值分别为25.92 s、53.26 kPa、3.87μg/L时,诊断早期前列腺癌的AUC分别为0.749(95%CI:0.657~0.841,P<0.001)、0.882(95%CI:0.817~0.947,P<0.001)、0.728(95%CI:0.633~0.824,P<0.001),灵敏度分别为66.8%、76.6%、81.0%,特异度分别为70.2%、99.5%、59.6%;三者联合诊断早期前列腺癌的AUC[0.946(95%CI:0.907~0.985,P=0.028)]大于单独检测(Z=21.420,P=0.037;Z=7.380,P=0.046;Z=9.840,P=0.041),灵敏度为76.7%,特异度为99.5%。结论早期前列腺癌患者血清PSA水平及SWE弹性模量最大值、最小值和平均值均增高,CEOS达峰时间和显影时间缩短;CEUS、SWE联合血清PSA检测对早期前列腺癌的诊断价值较高。

Objective To observe the features of transrectal contrast-enhanced ultrasound(CEUS),transrectal ultrasound shear-wave elastography(SWE)and prostate specific antigen(PSA)detection in patients with early prostate cancer,and to investigate the diagnostic efficiency of combination of them three.Methods A total of 108patients with suspected prostate cancer were examined by transrectal CEUS,SWE and biopsy histopathology.The level of serum PSA was detected by ELISA.According to the histopathological examination results of puncture biopsy,108patients were divided into prostate cancer group(n=60)and non-prostate cancer group(n=48).The body mass index,C-reactive protein level,CEUS and SWE imaging features,and serum PSA level were compared between two groups.Taking the histopathological results as the gold standard,the accuracies of CEUS,SWE and serum PSA in the early diagnosis of prostate cancer were compared.ROC curve was drawn to evaluate the efficiencies of single and combined application of serum PSA level,CEUS and SWE on the early diagnosis of prostate cancer.Results There were no significant differences in the age,body mass index,C-reactive protein,leukocyte count and percentage of patients with smoking history between two groups(P>0.05).The levels of serum PSA,E_(mean),E_(min) and E_(max) were higher in prostate cancer group[(39.89±16.75)μg/L,(57.91±23.02)kPa,(46.68±19.99)kPa,(66.48±25.36)kPa]than those in non-prostate cancer group[(19.69±8.78)μg/L,(27.02±10.86)kPa,(21.45±8.64)kPa,(33.09±12.06)kPa](P<0.05),and the peak time of CEUS and the developing time were shorter in prostate cancer group[(28.95±10.09),(13.75±5.95)s]than those in non-prostate cancer group[(36.01±14.32),(21.86±8.81)s](t=3.001,P=0.003;t=5.693,P<0.001).The accuracy of SWE in the early diagnosis of prostate cancer(88.3%)was higher than that of PSA(73.3%)(χ^(2)=4.357,P=0.037),and showed no significant difference compared with that of CEUS(75.0%)(χ^(2)=3.562,P=0.059).There was no significant difference in the accuracy of PSA in the early diagnosis of prostate cancer compared with CEUS(χ^(2)=0.043,P=0.835).When the optimal cut-offvalues of CEUS peak time,SWE E_(max) and PSA were 25.92s,53.26kPa and 3.87μg/L,the AUCs for the early diagnosis of prostate cancer were 0.749(95%CI:0.657-0.841,P<0.001),0.882(95%CI:0.817-0.947,P<0.001)and 0.728(95%CI:0.633-0.824,P<0.001),the sensitivities were 66.8%,76.6%and 81.0%,and the specificities were 70.2%,99.5%and 59.6%,respectively.The AUCof combination of them three[0.946(95%CI:0.907-0.985,P=0.028)]was greater than that of single detection(Z=21.420,P=0.037;Z=7.380,P=0.046;Z=9.840,P=0.041),the sensitivity was 76.7%and the specificity was 99.5%.Conclusions Serum PSA level,E_(mean),E_(min) and E_(max) increase,and the CEUS peak time and developing time are shortened.The combination of transrectal CEUS,SWE and PSA detection has a high value to the early diagnosis of prostate cancer.