Русский
Shear wave elastography guided targeted biopsy in the diagnosis of prostate cancer
DOI: https://dx.doi.org/10.18565/urology.2020.6.106-113
A.A. Kamalov, A.V. Kadrev, M.D. Mitkova, N.V. Danilova, D.M. Kamalov, N.I. Sorokin, V.V. Mitkov
1) Lomonosov Moscow State University, Medical Research and Educational Center, Moscow, Russia; 2) Russian Medical Academy of Continuous Professional Education, Moscow, Russia
Objective: to compare the effectiveness of targeted biopsy guided by the shear wave elastography (SWE) and systematic biopsy in the diagnosis of prostate cancer (PCa).
Material and methods. A total of 164 patients with suspected PCa were examined. Multiparametric TRUS, including SWE, was performed to all patients with the use of the Aixplorer ultrasound system (Supersonic Imagine, France), followed by TRUS guided 12-samples systematic prostate biopsy in combination with targeted biopsy from hypoechoic and/or stiff areas according to SWE data. Comparison of the results of histological examination and tissue stiffness measurements were carried out according to the specimens and patients. A total of 2 171 biopsy samples were analyzed (1 968 systematic and 203 targeted). After morphological evaluation all specimens were divided into groups of PCa+ (n=441) and PCa– (n=1 730), and patients to the group of PCa (n=74) and the control group (n=90).
Results. PCa was found in 17.3% of systematic biopsy specimens and in 76.9% of SWE targeted biopsy specimens (P<0.0001). The significant moderate positive correlations of Young’s modulus and Gleason scores (rS=0.51, P<0.0001), Young’s modulus and% specimen involvement (rS=0.59, P<0.0001) were founded in the group of PCa+ biopsy specimens. The percentage of PCa+ specimens was significantly higher with any types of targeted biopsy, than with systematic biopsy. With SWE targeted biopsy the percentage of PCa+ specimens was significantly higher than with B-mode guided targeted biopsy. Similar regularities were observed when comparing these types of targeted biopsy according to morphological prognostic ISUP groups and perineural invasion. Performing of targeted biopsy increased the morphological prognostic group in 5.4% of patients, additionally revealed perineural invasion in 2.7% of patients with PCa, and transferred additional 9.5% of patients from the group of clinically insignificant to the group of clinically significant PCa.
Conclusion. SWE-guided targeted biopsy shows the significantly higher positive biopsy rate than conventional systematic biopsy. The use of SWE-guided targeted biopsy in addition to systematic biopsy can increase clinically significant PCa detection rate and improve the detection of perineural invasion.
Material and methods. A total of 164 patients with suspected PCa were examined. Multiparametric TRUS, including SWE, was performed to all patients with the use of the Aixplorer ultrasound system (Supersonic Imagine, France), followed by TRUS guided 12-samples systematic prostate biopsy in combination with targeted biopsy from hypoechoic and/or stiff areas according to SWE data. Comparison of the results of histological examination and tissue stiffness measurements were carried out according to the specimens and patients. A total of 2 171 biopsy samples were analyzed (1 968 systematic and 203 targeted). After morphological evaluation all specimens were divided into groups of PCa+ (n=441) and PCa– (n=1 730), and patients to the group of PCa (n=74) and the control group (n=90).
Results. PCa was found in 17.3% of systematic biopsy specimens and in 76.9% of SWE targeted biopsy specimens (P<0.0001). The significant moderate positive correlations of Young’s modulus and Gleason scores (rS=0.51, P<0.0001), Young’s modulus and% specimen involvement (rS=0.59, P<0.0001) were founded in the group of PCa+ biopsy specimens. The percentage of PCa+ specimens was significantly higher with any types of targeted biopsy, than with systematic biopsy. With SWE targeted biopsy the percentage of PCa+ specimens was significantly higher than with B-mode guided targeted biopsy. Similar regularities were observed when comparing these types of targeted biopsy according to morphological prognostic ISUP groups and perineural invasion. Performing of targeted biopsy increased the morphological prognostic group in 5.4% of patients, additionally revealed perineural invasion in 2.7% of patients with PCa, and transferred additional 9.5% of patients from the group of clinically insignificant to the group of clinically significant PCa.
Conclusion. SWE-guided targeted biopsy shows the significantly higher positive biopsy rate than conventional systematic biopsy. The use of SWE-guided targeted biopsy in addition to systematic biopsy can increase clinically significant PCa detection rate and improve the detection of perineural invasion.
Keywords: ultrasound shear wave elastography, stiffness, Young’s modulus, systematic biopsy, targeted biopsy, prostate cancer
About the Autors
Corresponding author: A.V. Kadrev – M.D., Ph.D., Head of Ultrasound Diagnostics Department; Researcher, Department of Urology and Andrology, Medical Research and Educational Center, Lomonosov Moscow State University; Assistant Professor, Diagnostic Ultrasound Division, Russian Medical Academy of Continuous Professional Education, Moscow, Russia; e-mail: akadrev@yandex.ru
