Real-Time Shear Wave Elastography Combined With MRI-Ultrasound Cognitive Fusion Targeted Biopsy for Repeat Prostate Biopsy.

Abstract

Aims: This study aimed to evaluate the diagnostic value of real-time shear wave elastography (SWE) combined with magnetic resonance imaging-ultrasound (MRI-US) cognitive fusion targeted biopsy in repeat prostate biopsy.

Methods: The retrospective cohort study comprised 120 patients who underwent transperineal repeat biopsy. Group A (n = 64) had standard cognitive fusion targeted biopsy plus systematic biopsy; Group B (n = 56) had additional real-time SWE before cognitive fusion to refine targeting. The primary endpoint of the study was the clinically significant prostate cancer (csPCa), which was based on targeted cores. Secondary endpoints encompassed the following: overall PCa detection, core-specific cancer detection rate, agreement with final pathology, diagnostic performance, and complications.

Results: It is evident from the data that Group B had a significantly higher csPCa detection rate in comparison to Group A (p < 0.05). The number of biopsy cores was comparable, yet the core-specific cancer detection rate was higher in Group B (p < 0.05). In Group B, maximum elastic modulus of shear wave elastography (SWE-Emax) values and the proportion of the Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions were significantly higher in csPCa lesions than in benign lesions (p < 0.001). Group B had superior sensitivity, specificity, accuracy, and agreement with final pathology. Receiver operating characteristic (ROC) curve analysis suggested that the combination of SWE-Emax with PI-RADS score yielded a higher diagnostic performance than either individual method (area under the curve (AUC) = 0.904, 95%confidence interval (CI): 0.825-0.983, p < 0.001). Subsequent analysis revealed no significant disparities in complication rates between the two groups (p > 0.05).

Conclusions: The combination of real-time SWE and MRI-US cognitive fusion targeted biopsy has been shown to be associated with a higher detection rate of clinically significant prostate cancer and improved biopsy accuracy during repeat biopsies, offering incremental diagnostic value without additional risks.