The clinical study of multi-mode trans-rectal ultrasonic imaging scoring system in the diagnosis of prostate cancer

Objective To establish a multi-modal trans-rectal ultrasonic imaging scoring system for prostate cancer and to evaluate its diagnostic value. Methods From May 2016 to December 2017, 86 patients with suspected prostate cancer who received ultrasound (US) guided biopsy and/or surgery were enrolled in the study. The characteristics of trans-rectal conventional US (TRUS), shear wave sonoelastography (SWE) and contrast enhanced ultrasound (CEUS) were analyzed for each prostate with comparison of pathological results. And multi-mode scoring system were established for the diagnosis of prostate cancer. Results For prostate cancer, TRUS showed low echo, unclear boundary, irregular shape, unclear internal and external gland boundary, capsule invasion, rich blood flow signal and center vascularization; SWE showed asymmetric distribution with higher average elastic modulus [(94.7±44.2) kPa] than that of benign lesions [(60.8±26.0) kPa], the difference was statistically significant (t=-3.578, P=0.001); CEUS showed rapid and high enhancement, heterogeneous distribution (low enhanced area with punctate vascular structure), punctate or nodular enhancement, unclear internal and external gland boundary, capsular or rectal wall invasion. If any of TRUS, SWE and CEUS findings was positive, the sensitivity, negative predictive value and accuracy of multi-mode trans-rectal US were 98.0%, 96.7% and 89.5% respectively. If all of TRUS, SWE and CEUS findings were positive, the specificity and positive predictive value of multi-mode trans-rectal US were 97.3% and 97.1% respectively. Conclusion Trans-rectal multimodal ultrasonic imaging scoring system can improve the diagnostic value of ultrasound on prostate cancer. Key words: Prostate cancer; Transrectal ultrasound; Contrast enhance ultrasound; Sonoelastography