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PROSTAT KANSERİ TANISINDA TRANSREKTAL ULTRASONOGRAFİ BULGULARININ GÖZDEN GEÇİRİLMESİ: RADYOLOJİK VE PATOLOJİK BULGULARIN KARŞILAŞTIRILMASI

Year 2006, Volume: 7 Issue: 2, 31 - 35, 01.08.2006

Abstract

Amaç:Transrektal ultrasonografi (TRUS) eşliğinde prostat biyopsisi yapılan hastaları gözden geçirmek veprostat kanseri tanısında yardımcı olabilecek ultrasonografik kriterleri değerlendirmek.Yöntem:Ocak 2003-Temmuz 2005 tarihleri arasında TRUS eşliğinde prostat biyopsisi alınan ve PSA değerlerigri zonda yer alan (410 ng/dl; ortalama PSA: 6.9 ± 2.7 ng/dl) 129 hasta retrospektif olarak değerlendirildi. TRUSbulguları patoloji sonuçlarıyla karşılaştırıldı. Periferik zon ekoyapısı (homojen ya da heterojen) ve prostat bezikonturları (düzgün ya da düzensiz) subjektif olarak sınıflandı.Bulgular:44 hasta (% 34) prostat kanseri tanısı aldı. İncelenen kriterlerden periferik zon ekoyapısı ile periferikzonda hipoekoik nodül varlığının patoloji sonuçlarıyla istatistiksel olarak anlamlı biçimde ilişkili olduğusaptandı (p=0.000 ve p=0.007). Prostat kanseri yakalama olasılığının, periferik zonun heterojen olduğu durumda7 kat [Odds Oranı (OO): 7.06 (2.98-16.70) % 95 Güven Aralığı (GA)], periferik zonda hipoekoik nodülvarlığında ise 3 kat [OO: 2.73 (1.18-6.28) % 95 GA] arttığı görüldü.Sonuç:Prostat kanseri tanısında TRUS'nin yeri sınırlıdır ve daha çok biyopsi kılavuzu olarak kullanılır. Bununlabirlikte, bu çalışmanın sonuçları bahsedilen TRUS bulgularının varlığında kanser yakalama olasılığının anlamlıbiçimde arttığını ortaya koymaktadır. Nodüle yönelik biyopsi protokollerine benzer şekilde heterojen periferikzon varlığında alınan biyopsi örneklerinin sayısının artırılmasına dayanan bir çalışma planı ile sunulançalışmanın geçerliliği değerlendirilebilir

References

  • 1. Jemal A, Murray T, Samuels A, et al. Cancer statistics 2003. CACancer J Clin 2003; 53:526
  • 2. Potosky AL, Miller BA, Albertson PC, Kramer BS. The role increasing detection in the rising incidence of prostate cancer. JAMA1995;273:548-552
  • 3. Rifkin MD, Choi H. Implications of small, peripheral hypoechoic lesions in endorectal US of the prostate. Radiology 1988;166:61922
  • 4. Lee F, Littrup PJ, Torp-Pedersen S, et al. Screening for prostate cancer: comparison of transrectal ultrasound and the digital rectal examination. Radiology 1988;168:38994.
  • 5. Clements R. Ultrasound of prostate cancer. Eur Radiol 2001;11:211925.
  • 6. Chodak GW, Wald V, Parmer E, et al. Comparison of digital rectal examination and transrectal ultrasonography for the diagnosis of prostatic cancer. J Urol 1986;135:9514.
  • 7. Lee F, Torp-Pedersen ST, Siders DB, et al. Transrectal ultrasound in the diagnosis and staging of prostatic carcinoma. Radiology 1989;170:60915.
  • 8. Oyen R, Van Poppel H, Vandevoorde W. The significance of focal hypoechoic lesions in the peripheral zone of the prostate. J Belge Radiol 1995;78:3568.
  • 9. Sibley RI, Sibley AF. Correlation of digital rectal examination, prostate specific antigen and transrectal ultrasound in prostate carcinoma inAfricanAmericans. J Natl MedAssoc 1997;89:31823.
  • 10. Philip J, Roy SD, Ballal M, Foster CS, Javle P. Is a digital examination necessary in the diagnosis and clinical stging of early prostate cancer? BJU Int 2005;95:969-971
  • 11. Newman JS, Bree RL, Rubin JM. Prostate cancer: diagnosis with colour Doppler sonography with histologic correlation of each biopsy site. Radiology 1995;195:8690.
  • 12. Cornud F, Belin X, Piron D. Color Doppler guided prostate biopsies in 591 patients with an elevated serum PSA level: Impact on gleason score for nonpalpable lesions. Urology 1997;49:70915.
  • 13. Cho JY, Kim SH, Lee SE. Peripheral hypoechoic lesions of the prostate: Evaluation with color and power Doppler ultrasound. Eur Urol 2000;37:4438.
  • 14. Takahashi S, Yamada Y, Homma Y. Power Doppler ultrasonography-directed prostate biopsy in men with elevated serum PSAlevels.Adult Urol 2002;60:24852.
  • 15. Sakarya ME, Arslan H, Unal O, et al. The role of power Doppler US in the diagnosis of prostate cancer: a preliminary study. BJU 1998;82:1868.
  • 16. Kelly IMG, Leea WR, Rickards D. Prostate cancer and the role of color Doppler US. Radiology 1993;189:1536.
  • 17. Frauscher F, Klauser A, Halpern EJ, et al. Detection of prostate cancer with a microbubble ultrasound contrast agent. Lancet 2001;357: 184950.
  • 18. Sedelaar JPM, van Leenders GJLH, van de Ka CAH, et al. Microvessel density: correlation between contrast ultrasonography and histology of prostate cancer. Eur Urol 2001;40:28593.
  • 19. Halpern EJ, Rosenberg M, Gomella LG. Prostate cancer: contrast enhancer US for detection. Radiology 2001;219:21925.
  • 20. Frauscher F, Klause A, Volgger H, et al. Comparison of contrast enhanced color Doppler targeted biopsy with conventional systematic biopsy: impact on prostate cancer detection. J Urol 2002;167: 164852.
  • 21. Halpern EJ, Frauscher F, Rosenberg M, Gomella LG. Directed biopsy during contrast enhanced sonography of the prostate.AJR 2002;178:9159.
  • 22. Nava L, Montorsi F, Consonni P, Scattoni V, Guazzoni G, Rigatti PJ. Results of a prospective randomized study comparing 6, 12 and 18 transrectal ultrasound guided sextant biopsies in patients with elevated PSA, normal DRE, and normal prostatic ultrasound. Urology 1997;157:59
  • 23. Fleshner N, Klotz L. Role of ''saturation biopsy'' in the detection of prostate cancer among difficult diagnostic cases. Urology 2002;60:9397
  • 24. Chrouser KL, Lieber MM. Extended and saturation needle biopsy for the diagnosis of prostate cancer. Curr Urol Rep 2004;5:226230
  • 25. Eskicorapci SY, Baydar DE, Akbal C et al. An extended 10-core transrectal ultrasonography guided prostate biopsy protocol improves the detection of prostate cancer. European Urology 2004;45:444-449
  • 26. Loch T, Eppelmann U, Lehmann J et al. Transrectal ultrasound guided biopsy of the prostate: random sextant versus biopsies of sono-morphologically suspicious lesions.World J Urol 2004;22:357360
  • 27. Keetch DW, Catalona WJ, Smith DS. Serial prostatic biopsies in men with persistently elevated serum prostate specific antigen values. J Urol 1994;151:15714.
  • 28. Ellis WJ, Brawer MK. Repeat prostate needle biopsy: who needs it? J Urol 1995;153:14968.
  • 29. Roehrborn CG, Pickens GJ, Sanders JS. Diagnostic yield of repeated transrectal ultrasound-guided biopsies stratified by specific histopathologic diagnoses and prostate specific antigen levels. Urology 1996;47:34752.
  • 30. Stroumbakis N, Cookson MS, Reuter VE, Fair WR. Clinical significance of repeat sextant biopsies in prostate cancer patients. Urology 1997;49(Suppl 3A):1138.
  • 31. Djavan B, Ravery V, Zlotta A et al. Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: When should we stop? J Urol 2001;166:1679- 83
  • 32. Djavan B, Waldert M Zlotta, A et al. Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective European prostate cancer detection study. J Urol 2001;166:2242-6
  • 33. Roy C, Buy X, Lang H et al. Contrast enhanced color Doppler endorectal sonography of the prostate: efficiency for detecting peripheral zone tumors and role for biopsy procedure. J Urol 2003;170:69
  • 34. Vo T, Rifkin MD, Peters TL. Should ultrasound criteria of the prostate be redefined to better evaluate when and where to biopsy. Ultrasound Quarterly 2001;17(3):171-6
  • 35. Özden E, Göğüş Ç, Karamürsel T et al. Transrectal sonographic features of prostatic intraepithelial neoplasia: Correlation with pathologic findings. J Clin Ultasound 2005; 33(1):5-9
  • 36. Karaman CZ, Ünsal A, Akdilli A et al. The value of contrast enhanced power Doppler ultrasonography in differentiating hypoehoic lesions in the peripheral zone of prostate. EJR 2005;54:148-55

Review of Transrectal Ultrasonography Findings in the Diagnosis of Prostate Cancer: Radiopathological Correlation

Year 2006, Volume: 7 Issue: 2, 31 - 35, 01.08.2006

Abstract

Purpose: To overview transrectal ultrasonography (TRUS) guided prostate biopsy cases and to evaluate the potentially useful sonographic criteria for the diagnosis of prostate cancer. Methods:Between January 2003 and June 2005, TRUS guided prostate biopsy specimens were obtained from 129 patients with a gray zone PSA level (4 - 10 ng/dl; average PSA: 6.9 ± 2.7 ng/dl). TRUS findings were compared with pathology results. Peripheral zone echostructure (homogenous or heterogeneous) and prostate contours (smooth or irregular) were classified subjectively. Presence of a hypoechoic nodule in the peripheral zone was noted, additional samples were obtained from the nodules. Results: 44 patients (34%) were found to have prostate adenocarcinoma. A statistically significant relationship was found between the peripheral zone echostructure - presence of hypoechoic nodule in the peripheral zone and pathological results (p=0.000 and 0.007, respectively). Prostate cancer detection rate increased 7 folds [Odds Ratio (OR): 7.06 (2.98-16.70) 95% Confidence Interval (CI)] when the peripheral zone was heterogeneous and 3 folds [OR: 2.73 (1.18-6.28) 95% CI] when there was a hypoechoic nodule in the peripheral zone. Conclusion:TRUS has a limited role in the diagnosis of prostate cancer and is especially used for biopsy guidance. On the other hand, the results of this study reveal a significant increase in cancer detection rate when the mentioned TRUS findings are present. Similar to the nodule targeted biopsies; the accuracy of the presented study can be evaluated with a prospective study including a larger number of biopsy specimens in case of peripheral zone heterogenity.

References

  • 1. Jemal A, Murray T, Samuels A, et al. Cancer statistics 2003. CACancer J Clin 2003; 53:526
  • 2. Potosky AL, Miller BA, Albertson PC, Kramer BS. The role increasing detection in the rising incidence of prostate cancer. JAMA1995;273:548-552
  • 3. Rifkin MD, Choi H. Implications of small, peripheral hypoechoic lesions in endorectal US of the prostate. Radiology 1988;166:61922
  • 4. Lee F, Littrup PJ, Torp-Pedersen S, et al. Screening for prostate cancer: comparison of transrectal ultrasound and the digital rectal examination. Radiology 1988;168:38994.
  • 5. Clements R. Ultrasound of prostate cancer. Eur Radiol 2001;11:211925.
  • 6. Chodak GW, Wald V, Parmer E, et al. Comparison of digital rectal examination and transrectal ultrasonography for the diagnosis of prostatic cancer. J Urol 1986;135:9514.
  • 7. Lee F, Torp-Pedersen ST, Siders DB, et al. Transrectal ultrasound in the diagnosis and staging of prostatic carcinoma. Radiology 1989;170:60915.
  • 8. Oyen R, Van Poppel H, Vandevoorde W. The significance of focal hypoechoic lesions in the peripheral zone of the prostate. J Belge Radiol 1995;78:3568.
  • 9. Sibley RI, Sibley AF. Correlation of digital rectal examination, prostate specific antigen and transrectal ultrasound in prostate carcinoma inAfricanAmericans. J Natl MedAssoc 1997;89:31823.
  • 10. Philip J, Roy SD, Ballal M, Foster CS, Javle P. Is a digital examination necessary in the diagnosis and clinical stging of early prostate cancer? BJU Int 2005;95:969-971
  • 11. Newman JS, Bree RL, Rubin JM. Prostate cancer: diagnosis with colour Doppler sonography with histologic correlation of each biopsy site. Radiology 1995;195:8690.
  • 12. Cornud F, Belin X, Piron D. Color Doppler guided prostate biopsies in 591 patients with an elevated serum PSA level: Impact on gleason score for nonpalpable lesions. Urology 1997;49:70915.
  • 13. Cho JY, Kim SH, Lee SE. Peripheral hypoechoic lesions of the prostate: Evaluation with color and power Doppler ultrasound. Eur Urol 2000;37:4438.
  • 14. Takahashi S, Yamada Y, Homma Y. Power Doppler ultrasonography-directed prostate biopsy in men with elevated serum PSAlevels.Adult Urol 2002;60:24852.
  • 15. Sakarya ME, Arslan H, Unal O, et al. The role of power Doppler US in the diagnosis of prostate cancer: a preliminary study. BJU 1998;82:1868.
  • 16. Kelly IMG, Leea WR, Rickards D. Prostate cancer and the role of color Doppler US. Radiology 1993;189:1536.
  • 17. Frauscher F, Klauser A, Halpern EJ, et al. Detection of prostate cancer with a microbubble ultrasound contrast agent. Lancet 2001;357: 184950.
  • 18. Sedelaar JPM, van Leenders GJLH, van de Ka CAH, et al. Microvessel density: correlation between contrast ultrasonography and histology of prostate cancer. Eur Urol 2001;40:28593.
  • 19. Halpern EJ, Rosenberg M, Gomella LG. Prostate cancer: contrast enhancer US for detection. Radiology 2001;219:21925.
  • 20. Frauscher F, Klause A, Volgger H, et al. Comparison of contrast enhanced color Doppler targeted biopsy with conventional systematic biopsy: impact on prostate cancer detection. J Urol 2002;167: 164852.
  • 21. Halpern EJ, Frauscher F, Rosenberg M, Gomella LG. Directed biopsy during contrast enhanced sonography of the prostate.AJR 2002;178:9159.
  • 22. Nava L, Montorsi F, Consonni P, Scattoni V, Guazzoni G, Rigatti PJ. Results of a prospective randomized study comparing 6, 12 and 18 transrectal ultrasound guided sextant biopsies in patients with elevated PSA, normal DRE, and normal prostatic ultrasound. Urology 1997;157:59
  • 23. Fleshner N, Klotz L. Role of ''saturation biopsy'' in the detection of prostate cancer among difficult diagnostic cases. Urology 2002;60:9397
  • 24. Chrouser KL, Lieber MM. Extended and saturation needle biopsy for the diagnosis of prostate cancer. Curr Urol Rep 2004;5:226230
  • 25. Eskicorapci SY, Baydar DE, Akbal C et al. An extended 10-core transrectal ultrasonography guided prostate biopsy protocol improves the detection of prostate cancer. European Urology 2004;45:444-449
  • 26. Loch T, Eppelmann U, Lehmann J et al. Transrectal ultrasound guided biopsy of the prostate: random sextant versus biopsies of sono-morphologically suspicious lesions.World J Urol 2004;22:357360
  • 27. Keetch DW, Catalona WJ, Smith DS. Serial prostatic biopsies in men with persistently elevated serum prostate specific antigen values. J Urol 1994;151:15714.
  • 28. Ellis WJ, Brawer MK. Repeat prostate needle biopsy: who needs it? J Urol 1995;153:14968.
  • 29. Roehrborn CG, Pickens GJ, Sanders JS. Diagnostic yield of repeated transrectal ultrasound-guided biopsies stratified by specific histopathologic diagnoses and prostate specific antigen levels. Urology 1996;47:34752.
  • 30. Stroumbakis N, Cookson MS, Reuter VE, Fair WR. Clinical significance of repeat sextant biopsies in prostate cancer patients. Urology 1997;49(Suppl 3A):1138.
  • 31. Djavan B, Ravery V, Zlotta A et al. Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: When should we stop? J Urol 2001;166:1679- 83
  • 32. Djavan B, Waldert M Zlotta, A et al. Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective European prostate cancer detection study. J Urol 2001;166:2242-6
  • 33. Roy C, Buy X, Lang H et al. Contrast enhanced color Doppler endorectal sonography of the prostate: efficiency for detecting peripheral zone tumors and role for biopsy procedure. J Urol 2003;170:69
  • 34. Vo T, Rifkin MD, Peters TL. Should ultrasound criteria of the prostate be redefined to better evaluate when and where to biopsy. Ultrasound Quarterly 2001;17(3):171-6
  • 35. Özden E, Göğüş Ç, Karamürsel T et al. Transrectal sonographic features of prostatic intraepithelial neoplasia: Correlation with pathologic findings. J Clin Ultasound 2005; 33(1):5-9
  • 36. Karaman CZ, Ünsal A, Akdilli A et al. The value of contrast enhanced power Doppler ultrasonography in differentiating hypoehoic lesions in the peripheral zone of prostate. EJR 2005;54:148-55
There are 36 citations in total.

Details

Other ID JA43ST37GE
Journal Section Research Article
Authors

Alparslan Ünsal This is me

Füsun Taşkın This is me

İbrahim Meteoğlu This is me

Burçin Uz This is me

Can Zafer Karaman This is me

Publication Date August 1, 2006
Published in Issue Year 2006 Volume: 7 Issue: 2

Cite

EndNote Ünsal A, Taşkın F, Meteoğlu İ, Uz B, Karaman CZ (August 1, 2006) Review of Transrectal Ultrasonography Findings in the Diagnosis of Prostate Cancer: Radiopathological Correlation. Meandros Medical And Dental Journal 7 2 31–35.