Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jun;14(57):130-41.
doi: 10.15557/JoU.2014.0013. Epub 2014 Jun 30.

Sonoelastographic evaluation with the determination of compressibility ratio for symmetrical prostatic regions in the diagnosis of clinically significant prostate cancer

Artur Przewor  1 , Rafał Z Słapa  2 , Wiesław S Jakubowski  2 , Bartosz Migda  2 , Tadeusz Dmowski  1
Affiliations

Sonoelastographic evaluation with the determination of compressibility ratio for symmetrical prostatic regions in the diagnosis of clinically significant prostate cancer

Artur Przewor et al. J Ultrason. 2014 Jun.

Abstract
in English, Polish

Aim: Sonoelastography is a technique that assesses tissue hardness/compressibility. Utility and sensitivity of the method in prostate cancer diagnostics were assessed compared to the current gold standard in prostate cancer diagnostics i.e. systematic biopsy.

Material and methods: The study involved 84 patients suspected of prostate cancer based on elevated PSA levels or abnormal per rectal examination findings. Sonoelastography was used to evaluate the prostate gland. In the case of regions with hardness two-fold greater than that of symmetric prostate area (strain ratio >2), targeted biopsy was used; which was followed by an ultrasound-guided 8- or 10-core systematic biopsy (regardless of sonoelastography-indicated sites) as a reference point.

Results: The mean age of patients was 69 years. PSA serum levels ranged between 1.02 and 885 ng/dl. The mean prostate volume was 62 ml (19-149 ml). Prostate cancer was found in 39 out of 84 individuals. Statistically significant differences in strain ratios between cancers and benign lesions were shown. Sonoelastography guided biopsy revealed 30 lesions - overall sensitivity 77% (sensitivity of the method - 81%). Sonoelastographic sensitivity increased depending on cancer stage according to the Gleason grading system: 6-60%, 7-75%, 8-83%, 9/10-100%. The estimated sensitivity of systematic biopsy was 92%.

Conclusions: Sonoelastography shows higher diagnostic sensitivity in prostate cancer diagnostics compared to conventional imaging techniques, i.e. grey-scale TRUS, Doppler ultrasound. It allows to reduce the number of collected tissue cores, and thus limit the incidence of complications as well as the costs involved. Sonoelastography using the determination of compressibility ratio for symmetrical prostatic regions may prove useful in the detection of clinically significant prostate cancer.

Cel pracy: Elastosonografia jest techniką oceniającą twardość/ściśliwość tkanek. Badano użyteczność i czułość tej metody w diagnostyce raka stercza w porównaniu z obecnie obowiązującym złotym standardem w diagnostyce raka gruczołu krokowego – biopsją systematyczną.

Materiał i metoda: Badaniu poddano 84 chorych z podejrzeniem raka stercza na podstawie podwyższonego poziomu PSA lub nieprawidłowości w badaniu per rectum. Ocenę gruczołu krokowego wykonywano przy pomocy elastosonografii. W przypadku miejsc o twardości przekraczającej ponad dwukrotnie twardość symetrycznego obszaru prostaty (stosunek odkształcenia >2) stosowano biopsję celowaną; następnie u każdego chorego przeprowadzano pod kontrolą USG biopsję systematyczną 8- lub 10-rdzeniową (niezależnie od wskazań elastosonografii), jako punkt odniesienia.

Wyniki: Średni wiek chorych wynosił 69 lat. Poziom PSA w surowicy krwi mieścił się w zakresie 1,02–885 ng/dl. Średnia objętość gruczołu krokowego wynosiła 62 ml (19–149 ml). Pośród 84 badanych raka prostaty ujawniono u 39 osób. Wykazano statystycznie istotne różnice wartości stosunku odkształcenia między rakami i zmianami łagodnymi. Biopsja pod kontrolą elastosonografii ujawniła 30 zmian – czułość (overall sensitivity) 77% (sensitivity of the method – 81%). Czułość elastosonografii wzrastała w zależności od stopnia zaawansowania w skali Gleasona: 6–60%, 7–75%, 8–83%, 9/10–100%. Czułość biopsji systematycznej oszacowano na 92%.

Wnioski: Elastosonografia ma wyższą czułość w diagnostyce raka stercza niż konwencjonalnie używane techniki obrazowania, tj.: TRUS w skali szarości, USG dopplerowskie. Pozwala zredukować liczbę pobieranych rdzeni tkankowych, a co za tym idzie – zmniejszyć liczbę powikłań i ograniczyć koszty. Elastosonografia z oznaczeniem stosunku ściśliwości symetrycznych obszarów stercza może być pomocna w wykryciu klinicznie istotnego raka gruczołu krokowego.

Keywords: core needle biopsy; prostate cancer; sonoelastography.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Patient aged 76 years; PSA – 31.4; histopathological examination of this specimen revealed prostate cancer with Gleason score of 8 (4 + 4). A. Sonoelastography image of prostate gland in the ROI 1 (yellow) shows a suspected area (compressibility ratio of symmetrical areas – strain ratio = 4.7); B. An analogous B-mode image with marked areas used to determine the compressibility ratio and to select sites for targeted biopsy (SE)
Fig. 2
Fig. 2
Patient aged 52 years. A. Sonoelastography – biopsy of the indicated area revealed tumor with Gleason score of 8 (4 + 4); ROI 1, strain ratio 4.1; B. B-mode image of the cancerous region; C. Radical laparoscopic prostatectomy specimen; D. Fixed specimen with visible cancerous lesions (arrow)
Fig. 3
Fig. 3
Patient aged 62 years; PSA = 20.09. Histopathological examination of this specimen revealed prostate cancer with Gleason score of 6 (3 + 3) (strain ratio = 9.8)
Fig. 4
Fig. 4
Patient aged 80 years; PSA 11.45 ng/ml; 10- core systematic biopsy failed to reveal tumor, whereas targeted biopsy of SE-indicated area revealed prostate cancer with Gleason score of 7 (3 + 4) (biopsy involved ROI 3; strain ratio = 2.3)
Fig. 5
Fig. 5
A comparison between a group of lesions with confirmed cancerous character (SR1) and inflammatory/postoperative lesions with no confirmed cancerous character (SR2)
Fig. 6
Fig. 6
A comparison between a group of lesions with confirmed cancerous character (SR1) and lesions with no confirmed pathology in histopathological examination (SR3)
Fig. 7
Fig. 7
A comparison: postinflammatory and postoperative lesions (SR2) vs. lesions with no confirmed pathology (SR3)
Fig. 8
Fig. 8
A comparison: cancerous lesions (SR1) vs. postinflammatory and postoperative lesions (SR2) as well as non-pathological lesions within the prostate gland (SR3)
See this image and copyright information in PMC

References

    1. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, Mason MD, et al. Guidelines on prostate cancer. European Association of Urology. 2012.
    1. Ophir J, Céspedes I, Ponnekanti H, Yazdi Y, Li X. Elastography: A quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging. 1991;13:111–134. - PubMed
    1. Cochlin DL, Ganatra RH, Griffiths DF. Elastography in the detection of prostatic cancer. Clin Radiol. 2002;57:1014–1020. - PubMed
    1. König K, Scheipers U, Pesavento A, Lorenz A, Ermert H, Senge T. Initial experiences with real-time elastography guided biopsies of the prostate. J Urol. 2005;174:115–117. - PubMed
    1. Pallwein L, Mitterberger M, Struve P, Pinggera G, Horninger W, Bartsch G, et al. Real-time elastography for detecting prostate cancer: preliminary experience. BJU Int. 2007;100:42–46. - PubMed

LinkOut - more resources