[Shear wave elastography for guiding prostate puncture and differential diagnosis of prostatic lesions]

To assess the value of transrectal shear wave elastography (SWE) in improving the detection of PCa and differentiating benign from malignant prostatic lesion.

We performed transrectal ultrasonography (TRUS) and SWE for 83 PCa-suspected patients and measured the maximum (Emax) and mean elastic modulus (Emean) of the lesions. In addition to conventional "6+X" puncture, we conducted SWE-guided prostate puncture and evaluated SWE in improving the detection rate of PCa based on the pathological results. Then, we obtained the threshold value of the Emax using the ROC curve and analyzed its correlation with the clinicopathological data.

SWE-guided puncture was completed in all the 83 patients, of whom 31 were pathologically diagnosed with PCa and the other 52 with BPH. Compared with the BPH patients, the men with PCa showed significantly higher values of Emax (［47.13 ± 9.95］ vs ［63.70 ± 14.29］ kPa, P < 0.05) and Emean (［33.25 ± 4.61］ vs ［43.04 ± 8.57］ kPa, P < 0.05). The area under the ROC curve of Emax was 0.913, with a sensitivity of 90.1% and a specificity of 80.2%, with 54.15 kPa as the diagnostic threshold. The positive rates of PCa detected by SWE-guided puncture and single-needle puncture were 32.53% and 72.38%, respectively, significantly higher than 28.92% and 17.27% by TRUS-guided puncture and single-needle puncture (P < 0.05). Compared with TRUS, SWE exhibited a remarkably higher sensitivity (54.84% vs 80.65%, P < 0.05), specificity (67.31% vs 86.54%, P < 0.05), accuracy (62.65% vs 84.34%, P < 0.05), positive predictive value (50.00% vs 78.13%, P < 0.05) and negative predictive value (71.43% vs 88.26%, P < 0.05) in the differential diagnosis of benign and malignant prostatic lesions. Emax was positively correlated with the Gleason scores of the PCa patients.

SWE can help determine the biopsy target, improve the detection of PCa and differentiate PCa from BPH.