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目的:探讨经直肠剪切波弹性成像(SWE)技术联合移行区穿刺诊断前列腺癌的临床应用价值。方法:对489例疑诊前列腺癌患者行经直肠超声(TRUS)及SWE引导下的前列腺穿刺活检,并以穿刺活检病理结果作为金标准,评估SWE联合移行区穿刺对提高前列腺癌检出率的作用。结果:489例患者病理结果显示:前列腺癌221例,前列腺良性病变268例。在系统性穿刺基础上,应用SWE联合移行区穿刺诊断前列腺癌的检出率为45.19%,显著高于单独系统性穿刺活检的检出率33.13%(P<0.05);SWE诊断前列腺癌的敏感性、特异性及准确性均明显优于TRUS,差异具有统计学意义(P<0.05);SWE检测癌组织平均杨氏模量值(Emean)为(40.1±9.5)k Pa,良性病灶Emean值为(21.6±8.3)k Pa,两者差异具有统计学意义(P<0.05);应用受试者工作特征曲线(ROC)分析得出,当Emean值为28.5 k Pa时曲线下面积为0.899,诊断敏感性为88.71%,特异性为86.23%。结论:应用SWE联合移行区穿刺可显著提高前列腺癌检出率;当以Emean值28.5 k Pa作为截点时具有最佳的诊断效能。
Objective: To investigate the clinical value of transrectal shear wave elastography (SWE) combined with transsexual zone puncture in the diagnosis of prostate cancer. Methods: 489 suspected prostate cancer patients underwent transrectal ultrasound (TRUS) and SWE-guided prostatic biopsy and the biopsy results were used as the gold standard to evaluate the effect of SWE combined with transsexual stripe on the detection rate of prostate cancer . Results: The pathological findings of 489 patients showed that there were 221 cases of prostate cancer and 268 cases of benign prostatic diseases. On the basis of systematic puncture, the detection rate of prostate cancer using SWE combined with transsexual zone puncture was 45.19%, which was significantly higher than that of the systemic biopsy alone (33.13%, P <0.05). The sensitivity of SWE in the diagnosis of prostate cancer (P <0.05). The mean Young’s modulus (Emean) value of SWE was (40.1 ± 9.5) kPa, and the Emean value of benign lesions was significantly higher than that of TRUS (21.6 ± 8.3) kPa, P <0.05). Using ROC analysis, the area under the curve was 0.899 when the Emean value was 28.5 kPa, The diagnostic sensitivity was 88.71% and the specificity was 86.23%. Conclusion: The detection rate of prostate cancer can be significantly increased by using SWE combined with transsexual zone puncture. The Emean value of 28.5 kPa is the best diagnostic performance.