Comparison of meta-analyses among elastosonography (ES) and positron emission tomography/computed tomography (PET/CT) imaging techniques in the application of prostate cancer diagnosis

Abstract

The early diagnosis of prostate cancer (PCa) appears to be of vital significance for the provision of appropriate treatment programs. Even though several sophisticated imaging techniques such as positron emission tomography/computed tomography (PET/CT) and elastosonography (ES) have already been developed for PCa diagnosis, the diagnostic accuracy of these imaging techniques is still controversial to some extent. Therefore, a comprehensive meta-analysis in this study was performed to compare the accuracy of various diagnostic imaging methods for PCa, including 11C-choline PET/CT, 11C-acetate PET/CT, 18F-fluorocholine PET/CT, 18F-fluoroglucose PET/CT, transrectal real-time elastosonography (TRTE), and shear-wave elastosonography (SWE). The eligible studies were identified through systematical searching for the literature in electronic databases including PubMed, Cochrane, and Web of Science. On the basis of the fixed-effects model, the pooled sensitivity (SEN), specificity (SPE), and area under the receiver operating characteristics curve (AUC) were calculated to estimate the diagnostic accuracy of 11C-choline PET/CT, 11C-acetate PET/CT, 18F-fluorocholine (FCH) PET/CT, 18F-fluoroglucose (FDG) PET/CT, TRTE, and SWE. All the statistical analyses were conducted with R language Software. The present meta-analysis incorporating a total of 82 studies demonstrated that the pooled sensitivity of the six imaging techniques were sorted as follows: SWE > 18F-FCH PET/CT > 11C-choline PET/CT > TRTE > 11C-acetate PET/CT > 18F-FDG PET/CT; the pooled specificity were also compared: SWE > 18F-FCH PET/CT > 11C-choline PET/CT > TRTE > 18F-FDG PET/CT > 11C-acetate PET/CT; finally, the pooled diagnostic accuracy of the six imaging techniques based on AUC were ranked as below: SWE > 18F-FCH PET/CT > 11C-choline PET/CT > TRTE > 11C-acetate PET/CT > 18F-FDG PET/CT. SWE and 18F-FCH PET/CT imaging could offer more assistance in the early diagnosis of PCa than any other studied imaging techniques. However, the diagnostic ranking of the six imaging techniques might not be applicable to the clinical phase due to the shortage of stratified analysis.

Value of shear wave elastography for diagnosis of primary prostate cancer: a systematic review and meta-analysis

“…The results of our meta-analysis yielded a pooled SEN, SPE and DOR that were higher than the above meta-analysis. Although our study did not conduct a comparative analysis directly between TRUS and SWE, a similar conclusion could also be observed from previous evidence [21]. In addition, the presence of suspicious SWE findings is an independent predictor of clinically significant PCa [39].…”

“…Multiple investigations have indicated the accuracy of SWE in diagnosing breast cancer [17], malignant cervical lymph nodes [18], rectal cancer [19] and pancreatic tumours [20]. In terms of PCa, a previous study indicated that SWE had a higher degree of diagnostic accuracy compared to TRUS [21]; however, Porsch et al showed that SWE yields poor diagnostic selectivity (sensitivity (SEN) of 62%, specificity (SPE) of 35%) with an area under the curve (AUC) of 0.527 [22]. Hence, the value of SWE in diagnosing PC are mains controversial.…”

Diagnostic Performance of PET Imaging Using Different Radiopharmaceuticals in Prostate Cancer According to Published Meta-Analyses

“…Firstly, Cho PET/CT provided low sensitivity but high specificity in the detection of lymph node metastases [2,20]. Conversely, other studies found good overall accuracy of Cho PET/CT in this setting [17], and also when compared to other functional and morphological imaging tools [11,14]. The best diagnostic performance of Cho PET/CT for staging purpose was shown for the detection of bone metastases [7,15].…”

“…Overall, when compared to other PET tracers for restaging of PCa [3,6,8,11,14], no statistically significant differences were reported comparing radiolabeled Cho PET to PET with PSMA-targeted agents or 18 F-FACBC, even if a superiority of PET with PSMA-targeted agents was demonstrated in detecting PCa lesions at low PSA levels (≤1 ng/mL). On the other hand, a higher diagnostic accuracy of radiolabeled Cho PET compared to 11 C-acetate PET and 18 F-FDG PET was reported.…”

Real-Time Elastography in the diagnosis of prostate cancer: a systematic review

“…The two main types of elastography used in imaging today are compression/ strain and SWE. In the fields of breast, liver and prostate, a series of studies have been reported and meta-analyses were published [5][6][7].…”