Performance characteristics of transrectal shear wave elastography (SWE) imaging in the evaluation of clinically localised prostate cancer: a prospective study
Trannsrectal ultrasound shear wave elastography (SWE) is an emerging technology potentially useful in the detection of prostate cancer (PCa). The aim was to test the diagnostic accuracy assessment of SWE for the detection and phenotypic characterisation of the PCa compared with whole-mount radical prostatectomy histopathology
Prospective single centre diagnostic accuracy study. 212 consecutive men undergoing laparoscopic radical prostatectomy for clinically localised PCa were recruited into the study. Quantitative stiffness data of the prostate gland was obtained in each patient using an endocavitory transrectal probe before the radical prostatectomy and compared with the detailed histopathological examination of radical prostatectomy specimen using 3-D printing mold based technology ensuring improved image-histology orientation
Quantitative stiffness data estimated in kilopascals (kPa) was significantly higher in malignant area (150±39.8 kPa vs 27.9±7.9 kPa) compared with benign areas. With a cut-off value of 87.3 kPa, the sensitivity and specificity of SWE were 97.7% and 67.5%, respectively (p<0.01). Significant differences were observed for different grades of cancer with Young’s moduli 127.3 kPa, 141.9kPa and 166.1kPa for low (Gleason score 6), intermediate (Gleason score 7) and high grade (Gleason score ? 8) PCa respectively (p<0.01). SWE also detected capsular breaches with significant prediction of PCa pathologic staging</p>
Quantitative SWE via transrectal approach accurately detected cancer foci and showed significant differences between cancerous and normal benign tissues. Moreover, this technique can be used to reliably phenotype PCa cancer aggressiveness.
Funding: Prostate Cancer UK, PC12-39