Sauvain J L, Palascak P, Bourscheid D, Chabi C, Atassi A, Bremon J M, Palascak R
Medical Imaging Center, 6 passage Jules Didier, Vesoul 70000, France.
Eur Urol. 2003 Jul;44(1):21-30; discussion 30-1. doi: 10.1016/s0302-2838(03)00204-5.
To compare the value of Power Doppler Sonography (PDS) and B mode sonography in the diagnosis of prostate cancer and to assess the value of PDS to specify capsular effraction of the cancer.
323 patients were investigated: 41 control subjects allowed the establishment of normal vascular semiology and 282 patients with suspected cancer (PSA >4ng/ml). Power Doppler Sonography with 3D reconstruction was used to describe Power Doppler Sonography features of normal or abnormal vessels. Three types of blood supply(a: regular avascular posterior peripheral margin, b: irregular avascular posterior peripheral margin, c: vessels crossing the posterior peripheral margin) were described as a function of the presumed stage of cancer (a: intraprostatic, b: undetermined, c: extraprostatic). Comparison with histology was performed on random biopsies without Doppler (282 cases) (median PSA level = 15.8ng/ml), on second biopsies indicated with PDS (72 cases), and radical prostatectomy specimens (63 cases).
A cancer was diagnosed in 157 of the 282 patients (55.7%) with suspected cancer. The overall sensitivity of PDS in the initial diagnosis of prostatic cancer was 92.4% and its specificity was 72% (versus 87.9% and 57.6% for sonography alone respectively). The negative predictive value of PDS was elevated to 80.6% (p<0.0001). Targeting area presenting abnormal blood flow in any part of the prostate was useful to detect isoechoic or lesions in patients with first negative biopsy results (in 41 of 72 targeted patients with first negative biopsies with PDS a cancer was diagnosed: 58% of these cancers had less than 3 positive biopsies and 34% only one positive biopsy). The 3 vascular types a, b, c were evaluated prospectively in the detection of capsular effraction. The presence or absence of vessels crossing the capsule to determine an extracapsular extension was a significant sign (p<0.0001). Capsular effraction was detected in 3 of the 27 cases (11%) of type a cancer and in 16 of the 18 cases (87%) of type c cancer.
PDS improves the accuracy of echographic imaging in the diagnosis of cancer. Combining first sextant biopsies and targeted areas presenting abnormal blood flow using PDS can increase cancer detection with an optimized number of biopsy cores. The risk of extracapsular involvement can be evaluated by the presence of vessels perforating the capsule.
比较能量多普勒超声（PDS）和B型超声在前列腺癌诊断中的价值，并评估PDS对明确癌症包膜侵犯的价值。
对323例患者进行了研究：41例对照者用于建立正常血管影像学特征，282例疑似癌症患者（前列腺特异抗原[PSA]>4ng/ml）。采用三维重建的能量多普勒超声来描述正常或异常血管的能量多普勒超声特征。根据推测的癌症分期描述三种血液供应类型（a：规则的无血管后外周缘，b：不规则的无血管后外周缘，c：血管穿过后外周缘）（a：前列腺内，b：未确定，c：前列腺外）。对随机的未行多普勒检查的活检标本（282例）（PSA中位数水平=15.8ng/ml）、PDS引导下的二次活检标本（72例）以及前列腺根治性切除标本（63例）与组织学结果进行比较。
282例疑似癌症患者中有157例（55.7%）被诊断为癌症。PDS在前列腺癌初始诊断中的总体敏感性为92.4%，特异性为72%（单独超声检查分别为87.9%和57.6%）。PDS的阴性预测值提高到80.6%（p<0.0001）。针对前列腺任何部位出现异常血流的区域进行靶向活检，有助于检测首次活检结果为阴性的患者中的等回声或病变（在72例首次活检结果为阴性且接受PDS靶向活检的患者中，有41例诊断为癌症：这些癌症中有58%的阳性活检标本少于3个，34%仅有1个阳性活检标本）。前瞻性评估了三种血管类型a、b、c在检测包膜侵犯方面的情况。血管是否穿过包膜以确定包膜外侵犯是一个重要征象（p<0.0001）。在27例a型癌症中有3例（11%）检测到包膜侵犯，在18例c型癌症中有16例（87%）检测到包膜侵犯。
PDS提高了超声成像在癌症诊断中的准确性。将首次六分区活检与PDS引导下出现异常血流的靶向区域相结合，可在优化活检针数的情况下增加癌症检出率。可通过血管穿破包膜的情况评估包膜外侵犯的风险。
