剪切波弹性成像在双平面超声引导下靶向穿刺诊断前列腺癌的应用价值  

Application value of shear wave elastography in targeted puncture diagnosis of prostate cancer guided by biplane ultrasound

作　　者：钮启明 宋晓 王春光[1] 孙文奎[1] NIU Qiming;SONG Xiao;WANG Chunguang;SUN Wenkui(Department of Ultrasound,Weifang People's Hospital,Weifang 261041,China)

机构地区：[1]山东省潍坊市人民医院超声科,山东潍坊261041

出　　处：《医学影像学杂志》2025年第2期109-112,120,共5页Journal of Medical Imaging

摘　　要：目的探讨剪切波弹性成像(SWE)技术在双平面超声引导下经会阴靶向穿刺活检诊断前列腺癌的临床应用价值。方法选取我院经直肠双平面超声联合SWE检查发现可疑病灶的患者113例,于SWE模式下测量其可疑区弹性模量数值并获得弹性最大值(Emax)、平均值(Emean),在经会阴途径12针系统穿刺前列腺的基础上加穿SWE引导下的靶向穿刺。以前列腺病灶切除后病理结果作为“金标准”,将系统穿刺、SWE靶向穿刺及系统联合靶向穿刺的阳性率、特异度、准确率、阳性预测值、阴性预测值进行比校。分析三种穿刺方法使用的Gleason评分与手术切除后Gleason评分的一致性,并将SWE取得的Emax、Emean值绘制ROC曲线图,评价弹性模量值对癌组织的诊断效能。结果113例患者中术后病理诊断前列腺癌47例,前列腺良性病变66例。其中系统穿刺诊断前列腺癌的穿刺阳性率为61.70%,靶向穿刺诊断前列腺癌的穿刺阳性率为63.83%,系统穿刺联合SWE靶向穿刺阳性率为82.98%,后者显著高于前两者,差异有统计学意义(P<0.05),系统穿刺联合SWE靶向穿刺对诊断前列腺癌的特异度、准确率、阳性预测值、阴性预测值均优于单一穿刺的检查方法。SWE靶向穿刺活检术后Gleason评分升级率(16.67%)与系统联合SWE靶向穿刺活检术后升级率(17.95%)相近,两者明显低于系统穿刺活检术后Gleason评分升级率(41.38%),差异有统计学意义(P<0.05)。SWE模式下检测前列腺癌组织的Emax、Emean值在两组间差异有统计学意义(P<0.05),应用受试者工作特征(ROC)曲线评价Emax、Emean值对癌组织的诊断效能,Emax值取63.4kPa为临界值时,曲线下面积(AUC)为0.849,诊断敏感度和特异度分别为85.11%、71.21%,Emean值取49.9kPa为临界值时,AUC为0.811,诊断敏感度和特异度分别为87.23%、63.64%。结论双平面超声SWE引导下靶向穿刺联合系统穿刺可显著提高前列腺癌的检出率,Gleason评分�Objective To explore the clinical application value of shear wave elastography(SWE)in the diagnosis of prostate cancer by perineal targeted needle biopsy guided by biplanar ultrasound.Methods A total of 113 patients who underwent transrectal biplanar ultrasound combined with SWE and found suspicious lesions in our hospital were selected,and the elastic modulus values of the suspicious area were measured in SWE mode and the elastic maximum(Emax)and mean value(Emean)were obtained.The pathological results after prostate lesion resection were used as the"gold standard",and the positive rate,specificity,accuracy,positive predictive value and negative predictive value of systematic puncture,SWE targeted puncture and systematic combined targeted puncture were compared.The consistency of the Gleason scores was used in the three puncture methods and the Gleason scores after surgical resection was analyzed,and the Emax and Emean values obtained by SWE were plotted as ROC curves to evaluate the diagnostic performance of elastic modulus values on cancer tissues.Results Postoperative pathology showed that among the 113 patients,47 had prostate cancer and 66 had benign prostate lesions.Among them,the positive rate of systematic puncture for the diagnosis of prostate cancer was 61.70%,the positive rate of targeted puncture for the diagnosis of prostate cancer was 63.83%,and the positive rate of systematic combined SWE targeted puncture was 82.98%,which was significantly higher than that of the first two(P<0.05).The escalation rate of Gleason score after SWE targeted needle biopsy(16.67%)was similar to that of systematic combined SWE targeted needle biopsy(17.95%),which was significantly lower than that of Gleason score after systematic needle biopsy(41.38%),and the difference was statistically significant(P<0.05).There was a statistically significant difference in the Emax and Emean values of prostate cancer tissue detected in SWE mode between the two groups(P<0.05).The Emean value was 0.849,and the diagnostic sensitivity and s

关 键 词：前列腺癌 剪切波弹性成像 靶向穿刺活检 超声检查 

分 类 号：R737.25[医药卫生—肿瘤] R445.1[医药卫生—临床医学]