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Shear-wave elastography: role in clinically significant prostate cancer with false-negative magnetic resonance imaging

  • Ultrasound
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To analyze the diagnostic value of adding SWE to MRI for the diagnosis of clinically significant prostate cancer with false-negative MRI results.

Methods

This was a retrospective study of 367 patients who underwent MRI, SWE, and prostate biopsy between March 2016 and November 2018 at the Shanghai Tenth People’s Hospital. Serum prostate-specific antigen (PSA) and free PSA (fPSA) were measured preoperatively. Diagnostic value and accuracy was determined for MRI alone and MRI + SWE using the receiver operator characteristic curve (ROC) analysis.

Results

MRI misdiagnosed 17.9% (21/117) clinically significant prostate cancers, including 15 lesions in the peripheral zone and 6 in the central zone. Both qualitative and quantitative SWE could help detect 66.7% (10/15) significant prostate cancers with false-negative MRI, but there was no association with the Gleason score (p > 0.05). When considering the sextant of the peripheral zone, a significant association was not seen with histopathology in qualitative SWE (p = 0.071) and quantitative SWE (p = 0.598). Among age, PSA, fPSA, volume of the prostate gland, fPSA/PSA, and PSAD, only PSAD (p = 0.019) was associated with SWE results in patients with negative MRI.

Conclusions

Adding SWE to MRI in patients with negative MRI for prostate examination could allow the correct diagnosis of additional patients and reduce the false-negative rate.

Key Points

• MRI plays an important role in clinically significant prostate cancers diagnosis.

• SWE plays an important role in clinically significant prostate cancers with negative MRI.

• Adding SWE to MRI in patients with negative MRI for prostate examination could allow the correct diagnosis of additional patients and reduce the false-negative rate.

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Abbreviations

95%CI:

95% confidence intervals

ADC:

Apparent diffusion coefficient

AHH:

Atypical adenomatous hyperplasia

AP/CP:

Acute/chronic prostatitis

ASAP:

Atypical small acinar hyperplasia

AUC:

Area under the ROC

BPH:

Benign prostatic hyperplasia

DCE:

Dynamic contrast enhancement

DWI:

Diffusion-weighted imaging

fPSA:

Free PSA

HGPIN:

High-grade prostate intraepithelial neoplasia

LGPIN:

Low-grade prostate intraepithelial neoplasia

mp-MRI:

Multiparameter magnetic resonance imaging

NCI:

National Cancer Institute

NPV:

Negative predictive value

NSGP:

Non-specific granulomatous prostatitis

PCa:

Prostate cancer

PI-RADS:

Prostate Imaging Reporting and Data System

PPV:

Positive predictive value

PSA:

Prostate-specific antigen

PSAD:

PSA density

ROC:

Receiver operator characteristic

ROI:

Region of interest

sPCa:

Clinically significant prostate cancer

SWE:

Shear-wave elastography

T1WI:

T1-Weighted imaging

T2WI:

T2-Weighted imaging

TRUS-Bx:

Transperineal prostate biopsy guided by transrectal ultrasound

US:

Ultrasound

V:

Volume of the prostate gland

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Funding

This study has received funding through Grant SHDC12016233 from the Shanghai Hospital Development Center, Grant 17411967400 from the Science and Technology Commission of Shanghai Municipality, and Grants 81471673 and 81671699 from the National Natural Science Foundation of China.

Author information

Author notes

  1. Li-Hua Xiang and Yan Fang contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, No. 301, Yanchangzhong Road, Shanghai, 200072, China

    Li-Hua Xiang, Yan Fang, Jing Wan, Guang Xu, Ming-Hua Yao, Shi-Si Ding, Hui Liu & Rong Wu

  2. Ultrasound Research and Education Institute, Tongji University School of Medicine, No. 301, Yanchangzhong Road, Shanghai, 200072, China

    Li-Hua Xiang, Yan Fang, Jing Wan, Guang Xu, Ming-Hua Yao, Shi-Si Ding & Hui Liu

  3. Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200080, China

    Rong Wu

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  1. Li-Hua Xiang
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Corresponding author

Correspondence to Rong Wu.

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Guarantor

The scientific guarantor of this publication is Rong Wu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

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• retrospective

• diagnostic or prognostic study

• performed at one institution

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Xiang, LH., Fang, Y., Wan, J. et al. Shear-wave elastography: role in clinically significant prostate cancer with false-negative magnetic resonance imaging. Eur Radiol 29, 6682–6689 (2019). https://doi.org/10.1007/s00330-019-06274-w

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  • DOI: https://doi.org/10.1007/s00330-019-06274-w

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