Research Article: The Value of Contrast-Enhanced Ultrasonography Combined with Real-Time Strain Elastography in the Early Diagnosis of Prostate Cancer

Date Published: June 1, 2018

Publisher: JKL International LLC

Author(s): Ying Chang, Jingchun Yang, Hua Hong, Huijuan Ma, Xin Cui, Li Chen.


To evaluate the performance of a combination of real-time strain elastography (RTSE) and contrast-enhanced transrectal ultrasound (CETRUS) for prostate cancer detection. Patients with serum prostate-specific antigen (PSA) levels of ≥4.0 ng/ml were prospectively enrolled between June 2014 and December 2016. 153 prostate nodules diagnosed by conventional ultrasound were prospectively enrolled and examined by CETRUS and RTSE before a biopsy. Multivariate logistic regression models were established for CETRUS, and CETRUS combined with RTSE to diagnose prostate malignancy. The diagnostic performances of CETRUS, RTSE, and their combined use were evaluated with the receiver operating characteristic (ROC) curve. The multivariate logistic regression for CETRUS combined with RTSE showed that enhanced strength, enhanced uniformity, and elasticity scores were the independent predictors of prostate malignancy. The area under the ROC curve of CETRUS combined with RTSE (0.921±0.023) was higher than that of CETRUS and RTSE (0.88±0.029 and 0.80±0.038, respectively; both p<0.05). Moreover, the sensitivity, accuracy and negative predictive value of CETRUS combined with RTSE were 92.1%, 86.2%, and 84.6%, respectively. The omission diagnostic rate of CETRUS combined with RTSE (7.9%) was reduced. And the diagnostic accuracy of CETRUS combined with RTSE was significantly higher than that of CETRUS and RTSE (p<0.05). While the diagnostic accuracy of CETRUS was close to the RTSE, the difference was not statistically significant (p>0.05). The combined RTSE with CETRUS approach significantly improved the sensitivity and overall accuracy for correctly identifying prostate cancer.

Partial Text

A definitive diagnosis was formulated through histopathological confirmation based on needle biopsy in all patients included in this study. The study comprised 90 patients with prostate cancers (38 with Gleason score 8-10, 43 with Gleason score 5-7, and 9 with Gleason score 4) and 63 patients with benign lesions (27 with benign prostatic hyperplasia, 24 with inflammatory changes, and 12 with prostatic intraepithelial neoplasia).

Based on the low sensitivity and accuracy of TRUS, various ultrasound imaging techniques (e.g., RTSE, CETRUS, and Doppler) have been introduced to optimize the visualization of prostate cancer. Indeed, sensitivity and specificity for prostate cancer detection may be enhanced by adding functional tissue information to structural tissue information [14]. The aim of this study was to evaluate the performance of a combination RTE- and CETRUS-guided biopsy for prostate cancer detection. Results showed that the RTSE/CETRUS combination had a higher sensitivity and accuracy than CETRUS alone.




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