A Study Of Stratified Multimodal Targeted Puncture With Different PI-RADS Scores

Objective To discuss the application of combined transrectal ultrasound(TRUS),transrectal elastography(TRTE),transrectal Ultrasonic contrast-enhanced(TR-CEUS) and mpMRI in transrectal ultrasound-guided targeted puncture for prostate cancer based on different PI-RADS scores stratification.To investigate whether transrectal ultrasoundguided targeted puncture for prostate cancer under multimodal imaging techniques can be a conditional alternative to systemic puncture.Methods The clinical data of 128 male patients who underwent ultrasound-guided prostate puncture biopsy in the Second Hospital of Dalian Medical University from September 2020 to May 2022 were collected.According to the different PI-RADS scores of multiparameter magnetic resonance(mpMRI),The patients were divided into three groups: group A: PI-RADS score of 3,a total of 64 cases,aged from 45 to 88 years,mean(69.5±8.3)years;group B: PI-RADS score of 4,a total of 29 cases,aged from 46 to 84 years,mean(64.9±9.8)years;group C: PI-RADS score of 5,a total of 35 cases,aged from56 to 84 years,mean(71.6±6.7)years.Retrospective analysis was used to calculate the PSA of each group,the diagnostic efficacy of PI-RADS score and ultrasound multimodal imaging technology in each group was compared,and the patient operating characteristic(ROC)curve was used to evaluate the value of each group in diagnosing prostate target areas.Results In this study,Pathological findings included 61 cases of prostate cancer and 67 cases of benign lesions;serum prostate specific antigen(PSA)ranged from 4.44 to 899.56ng/ml,with a median of 15.52 ng/ml,of which 39 cases had PSA ≤ 10 ng/ml and 89 cases >10 ng/ml.the median PSA in groups A,B and C were 12.74 ng/ml,13.69 ng/ml and 71.60ng/ml,respectively.The median serum prostate specific antigen(PSA)was 12.74 ng/ml,13.69 ng/ml and 71.60 ng/ml in groups A,B and C,respectively,with group C > group B > group A(P < 0.01).The ROC curves were constructed,and the area under the curve(AUC)of mpMRI and ultrasound multimodality imaging for the diagnosis of prostate cancer target area was 0.758 [95% CI(0.679,0.839),P<0.01] and 0.766 [95% CI(0.686,0.845),P<0.01],respectively.When the PI-RADS 4 score and ultrasound multimodality positive criteria were two positives as critical values,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of mpMRI and ultrasound multimodality images in diagnosing prostate cancer target areas were72.13% and 77.05%,70.14% and 70.15%,68.75% and 70.15%,73.44% and 77.05%,71.09%,and 73.44%,respectively.As the number of positive criteria increased,the sensitivity of all three groups tended to decrease and their specificity tended to increase.In group C,when all ultrasound multimodal imaging results were positive,the specificity of its diagnostic target area for prostate cancer was 100%.Conclusion Ultrasound multimodality imaging technology can effectively improve the specificity of diagnostic prostate cancer puncture target areas under different PI-RADS score stratification and reduce unnecessary puncture biopsies.If the patient’s PSA level is mildly elevated and mpMRI suggests PI-RADS score 3,it is recommended to improve ultrasound multimodality examination,and if the results are all negative,regular followup is recommended to dynamically detect PSA and delay puncture;if the patient’s PSA is significantly elevated(both PSA > 20ng/ml),it is recommended "12+X " systemic and targeted puncture.For patients with PI-RADS score of 5 and positive ultrasound multimodality results,it is promising to replace systematic puncture with targeted puncture to ensure positive detection rate while reducing the number of puncture needles,effectively reducing patient pain and postoperative complications.For patients in this group with incomplete positive ultrasound multimodality results,systematic and targeted puncture should still be performed to reduce missed diagnosis and avoid delayed diagnosis.The ultrasound multimodality imaging technique effectively compensates for the low specificity of mpMRI,and the combination of the two imaging techniques has complementary advantages and effectively reduces unnecessary puncture biopsies.