Sauvain J L, Palascak P, Nader N, Gomez W, Bloqueau Ph, Bremon J M, Jung L, Maniere Ph, Papavero R
Centre d'Imagerie Médicale, 6 passage Jules Didier, 70000 Vesoul, France.
J Radiol. 2006 Sep;87(9):1063-72. doi: 10.1016/s0221-0363(06)74128-2.
To evaluate the value of power Doppler sonography (PDS) in patients with a serum PSA level greater than 3.5 ng/ml and note the advantages of PDS in management of biopsy cores and staging in prostate cancer.
A group of 579 patients with a serum PSA level greater than 3.5 ng/ml underwent sextant biopsies. PDS of the prostate was performed in all patients before biopsy indication. Patients underwent six initial sextant biopsies without Doppler. In 141 patients who retained an elevated serum PSA level, an additional series of six to eight ultrasound-guided biopsies with Doppler were indicated. A total of 299 cancers were diagnosed (126 palpable) after initial biopsies and 85 (13 palpable) after additional biopsies. One hundred seven patients with localized cancer (48 palpable) underwent a radical prostatectomy.
An echographic or vascular anomaly was detected in 335 patients; after biopsies this anomaly corresponded to 260 cancers, 39 of which were not visible (false-negative Doppler results). The negative predictive value was 84% and there was no significant relation between PSA level and negative predictive value. After initial biopsies, if an abnormal Doppler signal was present the risk of having positive additional biopsies was 83%. Abnormal disoriented irregular vessels were present in 69% of patients with a Gleason score of 7 or higher versus 31% in patients with a Gleason score less than 7 (p<0.01). Twenty out of 39 patients with T1c cancer invisible with PDS and not palpable (13% of all cancers) underwent a radical prostatectomy. Eleven of 16 cancers with a Gleason score of 6 or less were found insignificant, but in two cases the lesion was advanced (p<0.01). Of cancers with a tumor vessel crossing the capsule, 71% presented an extraprostatic extension (Se: 37.5%, Spe: 93%, PPV: 71%, NPV: 78%) (p<0.01).
In prostatic cancer, PDS allows evaluation of aggressiveness features and can optimize the number of useful biopsy cores.
评估能量多普勒超声检查（PDS）在血清前列腺特异抗原（PSA）水平大于3.5 ng/ml患者中的价值，并指出PDS在前列腺癌活检核心组织管理及分期中的优势。
一组579例血清PSA水平大于3.5 ng/ml的患者接受了六分区活检。所有患者在活检前均进行了前列腺的PDS检查。患者首先进行了6次非多普勒引导的六分区活检。在141例血清PSA水平仍升高的患者中，又进行了一系列6至8次多普勒超声引导下的活检。初次活检后共诊断出299例癌症（126例可触及），再次活检后诊断出85例（13例可触及）。107例局限性癌症患者（48例可触及）接受了前列腺根治术。
335例患者检测到超声或血管异常；活检后，该异常对应260例癌症，其中39例不可见（多普勒检查结果为假阴性）。阴性预测值为84%，PSA水平与阴性预测值之间无显著相关性。初次活检后，如果存在异常多普勒信号，再次活检阳性的风险为83%。Gleason评分为7分或更高的患者中69%存在异常的紊乱不规则血管，而Gleason评分小于7分的患者中这一比例为31%（p<0.01）。39例PDS检查不可见且不可触及的T1c期癌症患者中有20例（占所有癌症的13%）接受了前列腺根治术。Gleason评分为6分或更低的16例癌症中有11例被认为不严重，但有2例病变已进展（p<0.01）。肿瘤血管穿过包膜的癌症中，71%出现前列腺外扩展（敏感性：37.5%，特异性：93%，阳性预测值：71%，阴性预测值：78%）（p<0.01）。
在前列腺癌中，PDS可评估侵袭性特征，并能优化有效活检核心组织的数量。
