Diagnosis of prostate cancer by multi-modal ultrasound imaging

To evaluate the diagnostic performance of multi-modal ultrasound imaging, combining transrectal ultrasound (TRUS), shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS), for differentiating benign and malignant prostate lesions, and to provide new evidence for the early diagnosis of prostate cancer. A total of 85 patients who prospectively underwent multi-modal ultrasound examination, ultrasound-guided prostate biopsy, and pathological and immunohistochemical marker detection at our hospital between September 2022 and June 2023 were included. All ultrasound examinations and biopsies were performed within a 2-week interval. The diagnostic performance of TRUS, SWE, CEUS, and multi-modal ultrasound imaging was compared, with 95% confidence intervals (CIs) calculated for all accuracy measures. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 89.80% (95% CI: 77.81 to 95.83), 86.11% (95% CI: 70.98-93.91), 88.24%, 89.80%, and 86.11% for TRUS; 85.71% (95% CI: 72.87-92.96), 72.22% (95% CI: 55.72-84.09), 80.00%, 80.77%, and 78.79% for SWE; 93.88% (95% CI: 83.13-97.97), 91.67% (95% CI: 77.46-97.20), 92.94%, 93.88%, and 91.67% for CEUS; and 97.96% (95% CI: 89.21-99.65), 94.44% (95% CI: 81.34-98.48), 96.47%, 96.00%, and 97.14% for multi-modal ultrasound imaging, respectively. The areas under the receiver operating characteristic curves (AUCs) were 0.880 (95% CI: 0.808-0.952), 0.790 (95% CI: 0.694-0.886), 0.928 (95% CI: 0.872-0.984), and 0.962 (95% CI: 0.924-1.000) for TRUS, SWE, CEUS, and multi-modal ultrasound imaging, respectively. The diagnostic performance of multi-modal ultrasound was significantly superior to that of TRUS and SWE (P < .05). Multi-modal ultrasound imaging demonstrates complementary diagnostic advantages, particularly for prostate tumors with atypical ultrasound features that are difficult to diagnose by a single modality. For these tumors, multi-modal ultrasound imaging improves diagnostic accuracy and provides a reliable basis for the differential diagnosis of prostate tumors, warranting further clinical application.