Role of transrectal ultrasound and elastography in the diagnosis of prostate lesions

Abstract

Background: The incidence of malignancy of prostate gland has displayed a rapid rise over recent times. Transrectal ultrasound (TRUS) has brought revolution to radiologist's human prostate imaging methods. Information regarding elasticity of suspicious or abnormal lesions provided by strain elastography can enhance the detection rate of prostate malignancies as well as serve as a reliable visual guide for biopsy from these sites. In this prospective study, we aim to appraise the use of TRUS for diagnosing prostatic lesions, both benign and malignant, and compare it to the utility of strain elastography to precisely locate and guide biopsies of lesions while referring to the pathological diagnosis as the reference standard, wherever possible/needed. Materials and Methods: This was a prospective, cross-sectional study involving 82 male patients who were clinically suspected to have prostate malignancy. The patients were referred to the Department of Radiodiagnosis, AVBRH, where they underwent transrectal ultrasonography and elastography with Hitachi Aloka ultrasound (USG) Machine Arietta S70 with biplane high-frequency transrectal probe (6–10 MHz) with elastography. Results: TRUS had high sensitivity (92.45%) and specificity (78.38%) for cancer detection. Strain elastography had a sensitivity of 96.23%, specificity of 81.08%, positive predictive value (PPV) of 70.83%, and negative predictive value (NPV) of 97.83%. Based on our findings, real-time elastography had more sensitivity and higher NPV than TRUS for the identification of prostatic cancer. Hence, it can be concluded that elastography is an effective assessment tool for ruling out the possibility of malignant tumors, helping to reduce redundant biopsies. Conclusions: Transrectal ultrasonography (TRUS) is an effective tool for the assessment of prostatic lesions. TRUS has high specificity, sensitivity, NPV, and PPV when assessing lesions for prostatic cancer. Elastography has high sensitivity, high specificity, high PPV, and reliable NPV when detecting for prostatic cancer. The combination of TRUS and elastography can help more efficiently assess lesions and guide biopsies to increase the identification rate of prostatic cancer.