多参数经直肠超声对疑似前列腺癌患者的诊断价值：三级护理中心的经验

摘要(中文译文)

探讨灰阶超声、剪切波弹性成像（SWE）和对比增强超声（CEUS）单独及联合多参数经直肠超声（mp-TRUS）在检测前列腺外周带癌（PCa）中的作用，并将mp-TRUS与多参数MRI（mp-MRI）的诊断性能进行比较，以活检作为金标准。本单中心前瞻性研究历时1.5年，共纳入30例临床怀疑PCa的男性患者。所有患者均接受了mp-MRI、mp-TRUS及引导下活检。mp-MRI和mp-TRUS由两名不同的观察者分别进行操作和判读，彼此对对方的结果不知情。在所有患者中，从至少12个预定部位获取活检组织芯，并对灰阶超声、SWE或CEUS提示可疑的病灶额外取材。本组患者中有19例经mp-TRUS引导活检检出恶性病变。共获取386条组织芯，活检阳性率为38%。mp-TRUS的灵敏度、特异度、阳性预测值、阴性预测值和诊断准确率分别为100%、63.63%、82.61%、100%和86.67%，而mp-MRI的相应值分别为94.74%、45.45%、75.00%、83.33%和76.67%。mp-TRUS的ROC曲线下面积为0.818±0.076，高于mp-MRI的0.701±0.083。在诊断前列腺外周带PCa方面，mp-TRUS的性能与mp-MRI相当。通过提高灰阶超声的诊断率，mp-TRUS还可作为靶向活检的重要引导工具，尤其是在灰阶成像未见病灶的患者中。

Abstract

To establish the role of grayscale ultrasonography, shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS) independently and in combination with multiparametric transrectal ultrasound (mp-TRUS) in detecting peripheral zone prostate cancer (PCa) and to compare the performance of mp-TRUS with multiparametric MRI (mp-MRI), keeping biopsy as the gold standard. Thirty men with clinically suspected PCa were enrolled in this single-center-based prospective study conducted over a period of 1.5 years. All patients underwent mp-MRI, mp-TRUS, and guided biopsy. The mp-MRI and mp-TRUS were conducted and interpreted by two different observers who were blinded to each other's findings. In all patients, biopsy cores were taken from a minimum of 12 predetermined sites with extra cores taken from lesions suspicious on either grayscale ultrasonography, SWE, or CEUS. Malignancy was detected in 19 of our patients on mp-TRUS-guided biopsy. A total of 386 cores were obtained with a positive biopsy rate of 38%. mp-TRUS gave a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 100, 63.63, 82.61, 100, and 86.67%, respectively, while the values for mp-MRI were 94.74, 45.45, 75.00, 83.33, and 76.67%, respectively. The area under the ROC curve for mp-TRUS was 0.818 ± 0.076. This value was higher than that for mp-MRI (0.701 ± 0.083). Performance of mp-TRUS is comparable to that of mp-MRI in diagnosing peripheral zone PCa. By improving the diagnostic yield of grayscale ultrasonography, mp-TRUS also acts as a great guiding tool for targeted biopsies, especially in patients where no lesions are seen on grayscale imaging.

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