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

Aim: To evaluate the diagnostic accuracy of real-time elastography as a method for detecting prostate cancer. Material and methods: Relevant studies applying real-time elastography as the diagnostic modality and biopsy as the reference standard, published by March 1, 2(118 were retrieved from PubMed, EMBASE, Web of Science and Cochrane Library databases. Two independent reviewers inspected all these articles to confirm the matching of the inclusion criteria. One reviewer with methodological expertise extracted the data from the included studies. Sensitivity, specificity and diagnostic odds ratio (DOR) were used to obtain overall estimates. Randomized effect method, meta-regression and subgroup analysis were performed. Results: Twenty-four studies out of 1156 identified articles met the inclusion criteria. Three groups were set: analysis by patient (Group 1), by core (Group 2), and by image (Group 3) and subgroups :set in Group 1. The pooled estimate of real-time elastography sensitivity/ specificity/DOR calculated with the identical P-value 0.00. Within subgroups "Asia" and "PSA>= 10 ng/ml", the pooled sensitivity, specificity and DOR were 0.83, 0.65 (p=0.01, I-2 =73.40%; p=0.02, I-2=69.5%), 0.80, 0.82 (p=0.66, I-2=0.00%; p=0.58, I-2=0.00%) and 20.2, 8.67 (p=0.09, I-2=54.2%, p=0.20, I-2=35.5%), respectively. In these three groups, the areas under the SROC curve were 0.7417, 0.9246, and 0.6213 independently. Conclusions: Real-time elastography is a promising, reliable modality for the non-invasive diagnosis of patients with prostate cancer. The diagnostic accuracy of real-time elastography correlates tightly to the presence of higher PSA level and may help avoid unnecessary biopsy. It seems to be a useful tool in systemic biopsy.