Nelson Eric D, Slotoroff Craig B, Gomella Leonard G, Halpern Ethan J
Kimmel Cancer Center, Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Urology. 2007 Dec;70(6):1136-40. doi: 10.1016/j.urology.2007.07.067.
To compare detection of prostate cancer and distribution of Gleason scores with gray-scale, color Doppler, and elastographic imaging.
Prostate biopsy patients were evaluated with gray-scale, color Doppler, and elastographic imaging. Targeted biopsy cores were obtained along with six laterally directed systematic sextant cores. Pathologic results were correlated with imaging findings.
Prostate cancer was detected in 60 of 137 patients (43.8%). Cancer was detected in 241 (14%) of 1703 biopsy cores, including 90 (20%) of 448 targeted cores, 106 (13%) of 818 sextant cores, and 45 (10%) of 437 transition zone cores. Sonographic abnormality was associated with cancer: gray-scale odds ratio (OR) = 3.19, P = 0.011; color Doppler OR = 1.86, P = 0.041; elastography OR = 2.53; P = 0.007. Although targeted cores were more likely than sextant cores to detect cancer (OR = 1.82, P = 0.004), no sonographic abnormality was found in 57 (53.8%) of 106 of positive sextant sites. A linear trend for increasing Gleason score was present with gray-scale (P <0.001) imaging, color Doppler imaging (P <0.005), and elastography (P <0.001). Abnormal color flow was strongly associated with Gleason score 8 to 10 lesions but not with lower-grade lesions. Elastography demonstrated a positive association with Gleason scores of 5 to 10.
Targeted cores based on gray-scale, color Doppler, and elastographic imaging are more likely to return positive biopsy results as compared with systematic biopsy cores. Although color Doppler imaging and elastography are encouraging adjuncts to improve cancer detection, targeted biopsy alone is not sufficient to replace the traditional sextant biopsy technique.
比较灰阶成像、彩色多普勒成像和弹性成像对前列腺癌的检测以及Gleason评分分布情况。
对前列腺活检患者进行灰阶成像、彩色多普勒成像和弹性成像评估。获取靶向活检组织芯以及六个侧向系统六分区组织芯。将病理结果与影像学表现进行关联分析。
137例患者中有60例（43.8%）检测出前列腺癌。在1703个活检组织芯中有241个（14%）检测出癌症，其中包括448个靶向组织芯中的90个（20%）、818个六分区组织芯中的106个（13%）以及437个移行区组织芯中的45个（10%）。超声异常与癌症相关：灰阶成像优势比（OR）=3.19，P = 0.011；彩色多普勒成像OR = 1.86，P = 0.041；弹性成像OR = 2.53，P = 0.007。尽管靶向组织芯比六分区组织芯更有可能检测出癌症（OR = 1.82，P = 0.004），但在106个阳性六分区部位中有57个（53.8%）未发现超声异常。灰阶成像（P <0.001）、彩色多普勒成像（P <0.005）和弹性成像（P <0.001）均呈现Gleason评分升高的线性趋势。异常血流与Gleason评分8至10分的病变密切相关，但与低级别病变无关。弹性成像显示与Gleason评分5至10分呈正相关。
与系统活检组织芯相比，基于灰阶成像、彩色多普勒成像和弹性成像的靶向组织芯更有可能获得阳性活检结果。尽管彩色多普勒成像和弹性成像作为辅助手段有助于提高癌症检测率，但单纯靶向活检不足以取代传统的六分区活检技术。
