经直肠剪切波弹性成像对存在下尿路症状的前列腺病变良恶性的鉴别诊断价值及其影响因素分析

Value of transrectal shear-wave elastography in differential diagnosis of benign and malignant prostate lesions with lower urinary tract symptoms and factors related to severity of such symptoms

目的探讨经直肠剪切波弹性成像(SWE)对前列腺癌和前列腺增生的鉴别诊断价值及下尿路症状严重程度的相关影响因素。方法回顾性收集106例自2021年11月至2023年1月天水市第一人民医院诊断为前列腺癌或前列腺增生伴有下尿路症状并行经直肠SWE检查患者的临床资料,其中前列腺癌组33例,前列腺增生组73例。收集所有患者的年龄、总前列腺体积(TPV)、最大杨氏模量值(Emax)、平均杨氏模量值(Emean)、最小杨氏模量值(Emin)、总前列腺特异性抗原(tPSA)、游离前列腺特异性抗原(fPSA)与国际前列腺症状评分(IPSS)等临床数据,采用独立样本t检验比较2组间杨氏模量值的差异,绘制受试者操作特征(ROC)曲线分析杨氏模量值诊断前列腺癌和前列腺增生的诊断效能,并应用Spearman秩相关分析IPSS与年龄、TPV、Emax、Emean、Emin、tPSA、fPSA的相关性。结果前列腺癌组Emax值、Emean值、Emin值大于前列腺增生组[(86.63±21.63)kPa vs(59.60±15.52)kPa;(71.31±23.71)kPa vs(48.37±12.87)kPa;(58.69±26.22)kPa vs(41.34±12.66)kPa],差异均具有统计学意义(t=6.463、5.222、3.616,P<0.001、<0.001、=0.001)。ROC曲线分析显示,Emax、Emean及Emin的曲线下面积分别为0.846、0.785、0.670。以曲线下面积>0.7为具有诊断效能的标准,计算Youden指数,获取Emax的最佳截断值为76.25 kPa,敏感度、特异度为72.7%、83.6%;Emean的最佳截断值为54.3 kPa,敏感度、特异度为78.8%,69.9%。年龄(r=0.332,P=0.001)、TPV(r=0.341,P<0.001)、Emax(r=0.282,P=0.003)、Emean(r=0.308,P=0.001)和Emin(r=0.431,P<0.001)与IPSS呈一定正相关。结论经直肠SWE对前列腺癌与前列腺增生的鉴别诊断有一定的临床价值。此外下尿路症状的严重程度与年龄、前列腺体积与硬度有一定的相关性。

Objective To assess the value of transrectal shear wave elastography(SWE)in the differential diagnosis of prostate cancer and prostatic hyperplasia and identify factors related to the severity of lower urinary tract symptoms.Methods The clinical data of 106 patients diagnosed with prostate cancer or prostatic hyperplasia accompanied by lower urinary tract symptoms from November 2021 to January 2023 were retrospectively collected from the First People's Hospital of Tianshui,including 33 patients with prostate cancer and 73 patients with prostate hyperplasia.Clinical data analyzed mainly included age,total prostate volume(TPV),Emax,Emean,Emin,total prostate specific antigen(tPSA),free prostate specific antigen(fPSA),and international prostate symptom score(IPSS).The difference of Young's modulus between the two groups was compared by t-test.Receiver operating characteristic(ROC)curve analysis was performed to assess the diagnostic efficacy for prostate cancer and prostatic hyperplasia.The correlation between IPSS and age,TPV,Emax,Emean,Emin,tPSA,and fPSA was analyzed by Spearman rank correlation.Results The Emax,Emean,and Emin in the prostate cancer group were significantly higher than those of the prostate hyperplasia group[(86.63±21.63)kPa vs(59.60±15.52)kPa,t=6.463,P<0.001;(71.31±23.71)kPa vs(48.37±12.87)kPa,t=5.222,P<0.001;(58.69±26.22)kPa vs(41.34±12.66)kPa,t=3.616,P=0.001].ROC curve analysis showed that the area under the curve values of Emax,Emean,and Emin for the differential diagnosis of the two disease entities were 0.846,0.785,and 0.670,respectively.AUC>0.7 was taken as the criterion of diagnostic efficacy,and the maximum Youden index was calculated.The optimal cut-off value of Emax was 76.25 kPa,and the sensitivity and specificity were 72.7%and 83.6%,respectively.The optimal cut-off value of Emean was 54.3 kPa,and the sensitivity and specificity were 78.8%and 69.9%,respectively.Age(r=0.332,P=0.001),TPV(r=0.341,P<0.001),Emax(r=0.282,P=0.003),Emean(r=0.308,P=0.001),and Emin(r=0.431,P<0.001)were correlated with IPSS.Conclusion Transrectal shear wave elastography has appreciated clinical value in the differential diagnosis of prostate cancer and prostatic hyperplasia.The severity of lower urinary tract symptoms is associated with age,prostate volume,and prostate stiffiness.