title: Prostate cancer: diagnostic performance of real-time shear-wave elastography.
abstract: OBJECTIVE
  To prospectively evaluate the performance of real-time ultrasonographic (US) shear-wave elastography (SWE) in the diagnosis of peripheral zone prostate cancer in patients with high and/or increasing prostate-specific antigen levels and/or abnormal digital rectal examination results.
  
  
  METHODS
  After signing an informed consent form, men referred for transrectal prostate biopsy were enrolled in this prospective HIPAA-compliant two-center study, which was conducted with institutional review board approval. Transrectal US SWE of the prostate was performed after a conventional transrectal US examination and immediately before US-guided 12-core sextant biopsy. For each sextant, the maximum SWE value was measured and matched to the pathologic results of that sextant biopsy. The diagnostic performance of SWE was assessed at both patient and sextant levels. The elasticity value maximizing the Youden index was used to derive sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
  
  
  RESULTS
  The elasticity values were matched to pathologic results for a total of 1040 peripheral zone sextants in 184 men. One hundred twenty-nine positive biopsy findings (size, ≥3 mm; Gleason score, ≥6) were identified in 68 patients. The sextant-level sensitivity, specificity, PPV, NPV, and area under the receiver operating characteristic curve for SWE with a cutoff of 35 kPa for differentiating benign from malignant lesions were 96% (95% confidence interval [CI]: 95%, 97%), 85% (95% CI: 83%, 87%), 48% (95% CI: 46%, 50%), 99% (95% CI: 98%, 100%), and 95% (95% CI: 93%, 97%), respectively.
  
  
  CONCLUSIONS
  Use of a 35-kPa threshold at SWE may provide additional information for the detection and biopsy guidance of prostate cancer, enabling a substantial reduction in the number of biopsies while ensuring that few peripheral zone adenocarcinomas are missed.
authors.affiliation: From the Departments of Adult Radiology (J.M.C., A.M.T., A.K.) and Histopathology (V.V., O.H.), Necker University Hospital, Paris, France; Department of Urology, Hôpital Européen Georges Pompidou, Paris, France (A.M.); Department of Urology, Northeastern Ohio Medical University, Youngstown, Ohio (R.M.); and Radiology Consultants, 250 DeBartolo Pl, Youngstown, OH 44512 (R.G.B.).
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Correas
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Tissier
authors.forename: Ahmed
authors.initials: A
authors.lastname: Khairoune
authors.forename: Viorel
authors.initials: V
authors.lastname: Vassiliu
authors.forename: Arnaud
authors.initials: A
authors.lastname: Méjean
authors.forename: Olivier
authors.initials: O
authors.lastname: Hélénon
authors.forename: Richard
authors.initials: R
authors.lastname: Memo
authors.forename: Richard G
authors.initials: RG
authors.lastname: Barr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D054459:Elasticity Imaging Techniques; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D018084:Ultrasonography, Interventional