| The diagnosis of prostate cancer relies on histopathological examination.At present,ultrasound-guided 10-12 needle systemic biopsy is the most widely used.However,systemic biopsy has certain limitations due to lack of targets.In recent years,multimodal images have shown great potential in the location and characterization of prostate lesions.Therefore,this paper aims to study the value of multi-modal images in the diagnosis and detection of prostate cancer and discuss the characteristics of multimodal images from the histopathological aspects.Part Ⅰ: Diagnostic value of multimodal ultrasonography in prostate lesionsObjectives: The aim of this study was to evaluate the diagnostic value of multimodal ultrasonography in prostate lesions.Methods: From December 2017 to December 2019,patients with suspected prostate cancer who decided to undergo core needle biopsy at Shengjing Hospital of China Medical University were enrolled.The characteristics of multimodal ultrasonography were analyzed.The pathological results are regarded as the gold standard.By analyzing the value of contrast-enhanced ultrasound and ultrasound elastography in diagnosing prostate cancer,we determine the best diagnostic point of prostate cancer,and observe whether there is any correlation between contrast-enhanced ultrasound parameters,ultrasound elastography and the pathological grade of prostate cancer.Results: Color Doppler flow imaging of grade 2 and grade 3 accounted for 94.67%(71/75)in malignant nodules,and 57.58%(38 /66)in benign nodules,the difference is significant.There are significant differences between the PI,AUC,WIS and TTP of malignant nodules and benign nodules(P < 0.05).The PI,AUC,WIS and TTP values are significantly different between malignant nodules and benign tissues on the opposite position of the same depth(P < 0.05).The PI,AUC and WIS values of malignant nodules are greater while TTP values are smaller than the contralateral benign tissue.PI,MTT,AUC and TTP values are significantly different between the pathological grade 1 prostate cancer and the grade 2 or higher prostate cancer(P < 0.05).The values of PI,MTT,AUC and TTP are significantly different between pathological grade 1+2 and grade 3 or higher prostate cancer(P < 0.05).The PI,MTT and AUC values of pathological grade 3 or higher prostate cancer are greater while the TTP value is shorter.The PI,MTT,AUC,HT and TTP are correlated with the pathological grade of prostate cancer(P < 0.05),and the correlation coefficients are 0.854,0.407,0.572,0.477 and-0.311,respectively,while RT and WIS are not correlated with the pathological grade of prostate cancer(P > 0.05).The area under the ROC curve of PI for the diagnosis of prostate cancer is 0.854,and the maximum Youden index is 0.65,the sensitivity is 86.70%,the specificity is 78.30%,and the best diagnostic point of PI for prostate cancer is 16.47 d B.The area under the ROC curve for the diagnosis of prostate cancer by AUC is 0.824,the maximum Youden index is 0.65,the sensitivity is98.30%,the specificity is 66.70%,and the best diagnostic point is 1340.39 d Bs.The area under the ROC curve of WIS diagnosis of prostate cancer is 0.817,and the maximum Youden index is 0.49,the sensitivity is 95.00%,and the specificity is 53.30%.The best diagnosis point is 1.15 d B/s.Among malignant nodules,77.03%(57/74)had elasticity scores of 4 and 5.Among benign nodules,7.58%(5/66)had elasticity scores of 4 and 5.The elasticity score of malignant nodules is higher than that of benign nodules.There are significant differences between the ultrasound elasticity scores of pathological grades 1and grade 2 prostate cancer,1+2 and grade 3 prostate cancer(P < 0.05),and the elasticity score of prostate cancer above grade 2 is higher than that of grade 1 prostate cancer.The ultrasound elasticity score of prostate cancer above grade 3 is higher than that of grade 1+2prostate cancer.There was a significant correlation between the pathological grade of malignant nodules and the elasticity score(P = 0.0001).The area under the ROC curve for the diagnosis of prostate nodules by ultrasound elastography was 0.881,and the maximum Youden index was 0.684,the sensitivity of the diagnosis of prostate cancer is 76.00%,the specificity is 92.42%,the accuracy is 83.69%,the best diagnostic point for elastography to diagnose prostate cancer is elasticity score of 4.Conclusion: Malignant nodules of the prostate have more blood flow than benign nodules.The parameters PI,AUC,WIS and TTP are of great value in distinguishing benign and malignant prostate nodules.The PI,MTT,AUC and TTP can be used as indicators to identify clinically significant prostate cancer.The PI,MTT,AUC,HT,and TTP are correlated with the pathological grade of prostate cancer.PI can be used as an important indicator of the pathological grade and prognosis of prostate cancer.The PI,AUC and WIS have high efficiency in the diagnosis of prostate cancer.The best diagnostic points for prostate cancer are 16.47 d B,1340.39 d Bs and 1.15 d B/s,respectively.The elasticity score of prostate malignant nodules is higher than that of benign nodules,and the elasticity score of 4 can be used as the best diagnostic point for prostate cancer.Elastography can be used for the diagnosis and prognosis evaluation of prostate cancer.Part Ⅱ: Research on the value of multimodal image fusion TRUS biopsy in detecting prostate cancerObjectives: Multimodal image fusion transrectal ultrasound was used to guide prostate biopsy,and to explore its application value in the detection rate of prostate cancer and the accuracy of pathological grading.Methods: Patients with suspected prostate cancer who were hospitalized in our hospital from September 2016 to December 2019 were enrolled as the research objects.Before biopsy,we perform transrectal ultrasound,contrast-enhanced ultrasound,ultrasound elastography and magnetic resonance imaging of the prostate to generate multimodal images,identify suspicious prostate cancer lesions,and target the suspicious lesions.After the targeted biopsy was completed,a 12-needle systemic biopsy of the prostate was performed.If the multimodal image does not show suspicious prostate cancer lesions,only systematic biopsy is performed.By comparing the detection rate of prostate cancer,the detection rate of positive needles for prostate cancer,the coincidence rate of biopsy tissue and histopathological grade after radical resection,the application value of multimode image fusion TRUS biopsy is analyzed.Results: Among 231 patients with suspected prostate cancer,109 cases were diagnosed as malignant.109 cases were prostate adenocarcinoma.Among benign cases,there was 1 case of granulomatous tuberculosis,4 cases of prostate intraepithelial neoplasia,and 117 cases of prostatic hyperplasia.The systematic biopsy method detected 94 positive cases,the detection rate was 40.69%(94/231),and the multimodal image fusion TRUS targeted biopsy method detected 99 positive cases,the detection rate was 42.86%(99/231),there was no significant difference between the two methods in the detection rate of prostate cancer(χ~2 = 0.222,P = 0.637).In 231 patients with suspected prostate cancer,the positive needle rate of the systematic method was 19.05%(528/2772),the positive needle rate of targeted method is 50.51%(197/390),the difference is significant(χ~2 = 189.78,P < 0.001).The detection rate of targeted biopsy for pathological grade 3 and above was 75.76%(75/99),and the detection rate of systemic biopsy for pathological grade 3 and above was 60.64%(57/94),the difference is significant(χ~2 = 4.423,P = 0.035).Targeted biopsy method detected level 3 and above needles accounted for 71.57%(141/197)of the total number of positive needles,systemic biopsy method accounted for 58.33%(308/528),the difference is significant(χ~2 = 9.549,P = 0.002).The pathology after radical resection is regarded as the "gold standard".The coincidence rate of the histopathology of the targeted biopsy method and the histopathology after radical resection is 76.79%(43/56),the coincidence rate of systemic biopsy is 57.14%(32/56),the difference is significant(χ~2 = 4.88,P = 0.027),and the coincidence rate of the targeted biopsy method was significantly higher than that of the systematic biopsy method.Conclusion: There is no significant difference between the detection rate of prostate cancer by multimodal image targeted biopsy and systematic biopsy.However,the positive needle rate of targeted biopsy is significantly higher than that of systemic biopsy.In terms of detecting the number of cancers above grade 3,the targeted biopsy method is significantly higher than the systemic biopsy,regardless of the number of positive cases or the number of positive needles.When detecting clinically significant prostate cancer,targeted biopsy method is more advantageous than systemic biopsy.Targeted biopsy has a significantly higher coincidence rate than systemic biopsy,and targeted biopsy has a more accurate assessment of tumor pathological grade.However,the targeted biopsy method cannot replace the systematic biopsy method.The two methods complement each other.The "targeted + system" biopsy mode can not only minimize missed diagnosis,but also accurately assess the tumor grade.Part Ⅲ: Study on the relationship between the characteristics of multimodal ultrasound images of the prostate and the histopathology of the lesion.Objectives: By studying the relationship between the features of prostate multimodal ultrasound image and the tissue composition of prostate lesions,we explore the pathological basis of multimodal ultrasound images.Methods: Patients with suspected prostate cancer and multimodal ultrasound suggesting focal prostate lesions were enrolled as the research objects.Ultrasound-guided needle biopsy was used to obtain tissue strips of the lesion,and the tissues were stained by immunohistochemistry(CD34,VEGF and α-SMA),Masson staining and Sirius red staining.We count the microvessel density,the expression of VFGF and α-SMA in the tissue,and determine the content of collagen fibers and muscle fibers in the tissue.The measured data are compared with the pathology of the lesion and the characteristics of multimodal ultrasound images,the relationship between the ultrasound features of the prostate lesion and the composition of pathological tissues was analyzed,and the pathological basis of multimodal ultrasound imaging was explored.Results: There are significant differences in the expression of CD34,VEGF,and α-SMA in benign and malignant prostate tissues.There is a positive correlation between VEGF and MVD expression,α-SMA and VEGF expression,α-SMA and MVD expression.MVD and α-SMA expression has a significant positive correlation with PCa pathological grade.The expression of collagen fiber content,muscle fiber content and Col Ⅰ content in prostate benign and malignant lesions are significantly different,while the difference of Col Ⅲ content in prostate benign and malignant tissues is not statistically significant.In benign and malignant lesions,the content of Col Ⅰ was significantly higher than that of Col Ⅲ.α-SMA expression has a correlation with collagen fiber content,Col Ⅰ content,and collagen fiber/muscle fiber ratio,and a higher negative correlation with muscle fiber content.The pathological grade of PCa has a positive correlation between the content of collagen fibers and Col Ⅰ,while a negative correlation with the content of muscle fibers.The blood flow grade of prostate lesions has a positive correlation with MVD and VEGF expression.The MVD count and VEGF expression of lesions in the rich blood flow group were higher than those in the non-rich group.There is a positive correlation between PI-MVD,AUC-MVD, HT-MVD,PI-VEGF,AUC-VEGF,HT-VEGF and WIS-VEGF.The content of collagen fibers and Col Ⅰ in the hard nodules group was higher than that in the soft nodules group,while the content of muscle fibers was lower.There was no significant difference in the content of Col Ⅲ between soft nodules and hard nodules.The ultrasound elasticity score has a positive correlation between the content of collagen fiber,the content of Col Ⅰ,the ratio of collagen fiber/muscle fiber and the ratio of Col Ⅰ/Col Ⅲ.There is a negative correlation between the ultrasound elasticity score and muscle fiber content.The arrangement of Col Ⅰ and Col Ⅲ between soft nodules and hard nodules is different.The soft nodules group are mainly arranged in a layered manner,and the hard nodules group are mainly arranged in a crossed manner.The expression of α-SMA in the lesion has a positive correlation with the ultrasound elasticity score,PI and AUC,and the blood flow grade.Conclusion: The blood flow grade of prostate lesions is related to the expression of MVD and VEGF.PI and AUC are related to the expression of MVD and VEGF.The expression of MVD and VEGF affects the characteristics of ultrasound blood flow imaging and contrast-enhanced ultrasound.The high expression of the two is closely related to the rich blood flow in the lesion.Ultrasound elasticity score is related to collagen fiber content,Col Ⅰ content,Col Ⅰ/Col Ⅲ ratio,collagen fiber/muscle fiber ratio,muscle fiber content.The lesions with high collagen fiber content,high Col Ⅰ content and low muscle fiber content are hard.The arrangement of Col Ⅰ and Col Ⅲ influences the hardness of the nodules.The lesions with hierarchical arrangement are softer,while those with cross-arrangement are harder.The expression of α-SMA is related to ultrasound elasticity score,blood flow grade,contrast parameter PI and AUC.α-SMA labeled CAFs may be an important factor affecting ultrasound elastography and blood flow imaging characteristics of prostate lesions. |
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