Value of transrectal ultrasound combined with contrast-enhanced ultrasound in the diagnosis of benign and malignant prostate hypoechoic lesions

doi:10.3969/j.issn.1004-583X.2024.07.009

Abstract

Abstract:

Objective To explore the value of transrectal ultrasound (TRUS) combined with contrast-enhanced ultrasound (CEUS) in the diagnosis of benign and malignant prostate hypoechoic lesions. Methods A total of 54 suspected prostate cancer patients (75 hypoechoic lesions of the prostate) from September 2022 to August 2023 who were admitted in our hospital were selected. All patients underwent TRUS and CEUS. With the pathological examination results as the gold standard, the capacity of TRUS combined with CEUS in distinguishing benign from malignant prostate lesions was evaluated. Univariate and multivariate logistic regression analyses were performed to clarify the value of TRUS combined with CEUS in diagnosing benign and malignant prostate hypoechoic lesions. Results Among 75 prostate hypoechoic lesions, 39 malignant lesions and 36 benign lesions were detected through pathological examination. The proportion of lesions with incomplete capsule, calcification within the lesion, irregular lesion morphology, and enhanced contrast peak value was significantly higher in malignant lesions than those of benign lesions. There were significant differences in sonographic characteristics and contrast patterns between the benign and malignant lesions (P<0.05). Multivariate logistic regression analysis showed that the lesion with an incomplete capsule (OR=10.592), stain-like hypoechoic lesions (OR=13.325), fast-in and fast-out (OR=12.960), and high peak contrast enhancement (OR=16.025) were independent risk factors for malignant prostate hypoechoic lesions (P<0.05). The receiver operating characteristic (ROC) curve showed that the area under curve (AUC) of TRUS, CEUS, and their combination for diagnosing benign and malignant prostate hypoechoic lesions was 0.889, 0.837, and 0.953, respectively. The AUC of TRUS combined with CEUS was higher than that of a single examination. Conclusion TRUS combined with CEUS for the diagnosis of benign and malignant prostate hypoechoic lesions has a high diagnostic value. Ultrasound features, such as lesion capsule, ultrasound features, contrast mode, and contrast peak intensity should be concerned.

Key words: prostatic diseases, ultrasonography, contrast-enhanced ultrasound, low echo lesions, diagnostic value

CLC Number:

R697.3

Hao Yuanyuan, Wang Jun, Huang Qian. Value of transrectal ultrasound combined with contrast-enhanced ultrasound in the diagnosis of benign and malignant prostate hypoechoic lesions[J]. Clinical Focus, 2024, 39(7): 635-639.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.07.009

https://huicui.hebmu.edu.cn/EN/Y2024/V39/I7/635

Figures/Tables 5

Tab.1 Univariate analysis of malignant prostate hypoechoic lesions[n(%)]

组别		例数	患者年龄						病灶包膜					病灶钙化
组别		例数	<60岁				≥60岁		不完整		完整			有				无
恶性组		39	7(18.0)				32(82.1)		23(59.0)		16(41.0)			14(35.9)				25(64.1)
良性组		36	9(25.0)				27(75.0)		2(5.6)		34(94.4)			3(8.3)				33(91.7)
χ²值			0.555						24.039					8.114
P值			0.456						<0.001					0.004
组别	病灶形态					声像图特征
组别	不规则			规则		“污渍”样低回声			“奶酪”样低回声			“结节”样低回声			混合回声		伴衰减低回声
恶性组	30(76.9)			9(23.1)		20(51.3)			2(5.1)			4(10.3)			2(5.1)		11(28.2)
良性组	4(11.1)			32(88.9)		5(13.9)			6(16.7)			11(30.6)			10(27.8)		4(11.1)
χ²值	32.717					22.783
P值	<0.001					<0.001
组别	造影模式												造影峰值强度
组别	快进快退				非快进非快退			快进非快退		快退非快进			高增强			非高增强
恶性组	21(53.8)				5(12.8)			8(20.5)		5(12.8)			29(74.4)			10(25.6)
良性组	2(5.6)				25(69.4)			5(13.9)		4(11.1)			4(11.1)			32(88.9)
χ²值	29.760												30.392
P值	<0.001												<0.001

Tab.2 Variable assignment table

变量	序号	赋值
恶性病灶	Y	否=0,是=1
病灶包膜	X1	完整=0,不完整=1
病灶钙化	X2	无=0,有=1
病灶形态	X3	规则=0,不规则=1
声像图特征	X4	“污渍”样低回声=1,“奶酪”样低回声=2,“结节”样低回声=3,混合回声=4,伴衰减低回声=5
造影模式	X5	快进快退=1,非快进非快退=2,快进非快退=3,快退非快进=4
造影峰值强度	X6	非高增强=0,高增强=1

Tab.3 Multivariate logistic regression analysis for the diagnosis of benign and malignant prostate hypoechoic lesions

因素	回归系数	标准误	Wald χ²值	值	值	95%
因素	回归系数	标准误	Wald χ²值	值	值	下限	上限
病灶包膜不完整	2.360	0.760	9.643	0.002	10.592	3.979	35.282
“污渍”样低回声	2.590	0.926	7.821	0.005	13.325	2.579	20.063
快进快退	2.562	0.743	11.889	0.001	12.960	2.606	17.857
造影峰值高增强	2.774	0.907	9.355	0.002	16.025	3.994	32.818

Tab.4 Diagnostic value of different diagnostic methods for benign and malignant prostate hypoechoic lesions

检查方法	AUC	P值	95% $C I$		敏感度	特异度
检查方法	AUC	P值	下限	上限	敏感度	特异度
TRUS	0.889	<0.001	0.809	0.969	0.904	0.789
CEUS	0.837	<0.001	0.742	0.932	0.805	0.801
二者联合	0.953	<0.001	0.911	0.995	0.858	0.925

Tab.4 Diagnostic value of different diagnostic methods for benign and malignant prostate hypoechoic lesions

检查方法	AUC	P值	95% $C I$		敏感度	特异度
检查方法	AUC	P值	下限	上限	敏感度	特异度
TRUS	0.889	<0.001	0.809	0.969	0.904	0.789
CEUS	0.837	<0.001	0.742	0.932	0.805	0.801
二者联合	0.953	<0.001	0.911	0.995	0.858	0.925

Fig.1 ROC curves of different diagnostic methods for the diagnosis of benign and malignant hypoechoic lesions

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