Added value of shear-wave elastography in the prediction of extracapsular extension and seminal vesicle invasion before radical prostatectomy

The purpose of this study was to analyze the value of transrectal shear-wave elastography(SWE)in combination with multivariable tools for predicting adverse pathological features before radical prostatectomy(RP).Preoperative clinicopathological variables,multiparametric magnetic resonance imaging(mp-MRI)manifestations,and the maximum elastic value of the prostate(Emax)on SWE were retrospectively collected.The accuracy of SWE for predicting adverse pathological features was evaluated based on postoperative pathology,and parameters with statistical significance were selected.The diagnostic performance of various models,including preoperative clinicopathological variables(model 1),preoperative clinicopathological variables+mp-MRI(model 2),and preoperative clinicopathological variables+mp-MRI+SWE(model 3),was evaluated with area under the receiver operator characteristic curve(AUC)analysis.Emax was significantly higher in prostate cancer with extracapsular extension(ECE)or seminal vesicle invasion(SVI)with both P<0.001.The optimal cutoff Emax values for ECE and SVI were 60.45 kPa and 81.55 kPa,respectively.Inclusion of mp-MRI and SWE improved discrimination by clinical models for ECE(model 2 vs model 1,P=0.031;model 3 vs model 1,P=0.002;model 3 vs model 2,P=0.018)and SVI(model 2 vs model 1,P=0.147;model 3 vs model 1,P=0.037;model 3 vs model 2,P=0.134).SWE is valuable for identifying patients at high risk of adverse pathology.

Multiparametric ultrasound for the assessment of testicular lesions with negative tumoral markers

The purpose of this study was to evaluate the diagnostic performance of multiparametric ultrasound(mpUS;grayscale US,color Doppler US,strain elastography,and contrast-enhanced US)in the assessment of testicular lesions with negative tumoral markers.MpUS imaging data,patient age,serum tumor markers,scrotal pain,cryptorchidism,and related clinical information were retrospectively collected for patients who underwent mpUS examination between January 2013 and December 2019.Histologic results or follow-up examinations were used as the reference standard.In total,83 lesions from 79 patients were included in the analysis.Fifty-six patients were finally diagnosed with benign tumors,and 23 patients were ultimately diagnosed with malignant tumors.Chi-square tests or Fisher's exact tests were used to assess the difference between the two groups.Stepwise multivariate logistic regression analysis showed that lesion diameter(odds ratio[OR]=1.072,P=0.005),vascularization on color Doppler US(OR=4.066,P=0.001),and hyperenhancement during the early phase(OR=6.465,P=0.047)were significant independent risk factors for malignancy;however,when compared with neoplastic lesions,pain(OR=0.136,P<0.001),absence of vascularization on color Doppler US(OR=1.680,P=0.042),and nonenhancement during the late phase(OR=3.461,P=0.031)were strongly associated with nonneoplastic lesions.MpUS features are useful for differentiating testicular lesions with negative tumoral markers and improving the preoperative diagnosis,which may avoid inappropriate radical orchiectomy.

Transrectal ultrasound examination of prostate cancer guided by fusion imaging of multiparametric MRI and TRUS:avoiding unnecessary mpMRI-guided targeted biopsy

The purpose of this study was to explore transrectal ultrasound(TRUS)findings of prostate cancer(PCa)guided by multiparametric magnetic resonance imaging(mpMRI)and to improve the Prostate Imaging Reporting and Data System(PI-RADS)system for avoiding unnecessary mpMRI-guided targeted biopsy(TB).From January 2018 to October 2019,fusion mpMRI and TRUS-guided biopsies were performed in 162 consecutive patients.The study included 188 suspicious lesions on mpMRI in 156 patients,all of whom underwent mpMRI-TRUS fusion imaging-guided TB and 12-core transperineal systematic biopsy(SB).Univariate analyses were performed to investigate the relationship between TRUS features and PCa.Then,logistic regression analysis with generalized estimating equations was performed to determine the independent predictors of PCa and obtain the fitted probability of PCa.The detection rates of PCa based on TB alone,SB alone,and combined SB and TB were 55.9%(105 of 188),52.6%(82 of 156),and 62.8%(98 of 156),respectively.The significant predictors of PCa on TRUS were hypoechogenicity(odds ratio[OR]:9.595,P=0.002),taller-than-wide shape(OR:3.539,P=0.022),asymmetric vascular structures(OR:3.728,P=0.031),close proximity to capsule(OR:3.473,P=0.040),and irregular margins(OR:3.843,P=0.041).We propose subgrouping PI-RADS score 3 into categories 3a,3b,3c,and 3d based on different numbers of TRUS predictors,as the creation of PI-RADS 3a(no suspicious ultrasound features)could avoid 16.7%of mpMRI-guided TBs.Risk stratification of PCa with mpMRI-TRUS fusion imaging-directed ultrasound features could avoid unnecessary mpMRI-TBs.