Shear-wave elastography: role in clinically significant prostate cancer with false-negative magnetic resonance imaging

Objectives To analyze the diagnostic value of adding SWE to MRI for the diagnosis of clinically significant prostate cancer with false-negative MRI results. Methods This was a retrospective study of 367 patients who underwent MRI, SWE, and prostate biopsy between March 2016 and November 2018 at the Shanghai Tenth People’s Hospital. Serum prostate-specific antigen (PSA) and free PSA (fPSA) were measured preoperatively. Diagnostic value and accuracy was determined for MRI alone and MRI + SWE using the receiver operator characteristic curve (ROC) analysis. Results MRI misdiagnosed 17.9% (21/117) clinically significant prostate cancers, including 15 lesions in the peripheral zone and 6 in the central zone. Both qualitative and quantitative SWE could help detect 66.7% (10/15) significant prostate cancers with false-negative MRI, but there was no association with the Gleason score ( p > 0.05). When considering the sextant of the peripheral zone, a significant association was not seen with histopathology in qualitative SWE ( p = 0.071) and quantitative SWE ( p = 0.598). Among age, PSA, fPSA, volume of the prostate gland, fPSA/PSA, and PSAD, only PSAD ( p = 0.019) was associated with SWE results in patients with negative MRI. Conclusions Adding SWE to MRI in patients with negative MRI for prostate examination could allow the correct diagnosis of additional patients and reduce the false-negative rate. Key Points • MRI plays an important role in clinically significant prostate cancers diagnosis. • SWE plays an important role in clinically significant prostate cancers with negative MRI. • Adding SWE to MRI in patients with negative MRI for prostate examination could allow the correct diagnosis of additional patients and reduce the false-negative rate.