Brock M, Eggert T, Löppenberg B, Braun K, Roghmann F, Palisaar R J, Noldus J, von Bodman C
Urologische Klinik, Marienhospital Herne, Ruhr-Universität Bochum.
Aktuelle Urol. 2013 Jan;44(1):40-4. doi: 10.1055/s-0032-1333257. Epub 2013 Jan 16.
The aim of this study was to evaluate whether real-time elastography-guided biopsy in comparison to grey-scale ultrasound improves prostate cancer detection in patients with an unremarkable digital rectal exam.A total of 231 patients suspicious for prostate cancer were prospectively randomised to transrectal real-time elastography- (126) or grey-scale ultrasound (105)-guided biopsy. The peripheral zone was divided into 6 sectors from base, mid-gland to apex. Lesions with reduced elasticity during real-time elastography and hypoechoic areas during grey-scale ultrasound were defined as suspicious for prostate cancer. Prostate biopsy was guided by real-time elastography (RTE) or grey-scale ultrasound (GSU) using a systematic 10-core approach. Suspicious lesions on RTE or GSU in the corresponding randomised group were targeted within each sector. Accuracy of cancer prediction and histopathological cancer detection rates were evaluated and compared between the 2 imaging modalitiesBaseline characteristics of patients undergoing real-time elastography and grey-scale ultrasound, including age, prostate-specific antigen and prostate volume were not significantly different statistically (p>0.05). Overall, prostate cancer was detected in 76 of 231 cases (32.9%). The cancer detection rate was significantly higher (p=0.007) in patients who underwent a biopsy using real-time elastography (40.5%) compared to the grey-scale-guided group of men (23.8%). Sensitivity and specificity to detect prostate cancer in 1 386 prostate sectors was 53.5% and 70.5% for real-time elastography vs. 11.7% and 93.7% for grey-scale ultrasound, respectively.Compared to conventional grey-scale ultrasound, accuracy to detect prostate cancer using a systematic 10-core biopsy approach was significantly improved under the guidance of real-time elastography.
本研究的目的是评估与灰阶超声相比，实时弹性成像引导下的活检能否提高直肠指检无异常的患者前列腺癌的检出率。共有231例疑似前列腺癌的患者被前瞻性随机分为经直肠实时弹性成像引导活检组（126例）和灰阶超声引导活检组（105例）。外周区从基底部、腺体中部到尖部分为6个扇区。实时弹性成像时弹性降低且灰阶超声时为低回声区的病变被定义为疑似前列腺癌。采用系统的10针活检方法，在实时弹性成像（RTE）或灰阶超声（GSU）引导下进行前列腺活检。在每个扇区内，对相应随机分组中RTE或GSU上的可疑病变进行靶向活检。评估并比较两种成像方式之间癌症预测的准确性和组织病理学癌症检出率。接受实时弹性成像和灰阶超声检查的患者的基线特征，包括年龄、前列腺特异性抗原和前列腺体积，在统计学上无显著差异（p>0.05）。总体而言，231例中有76例（32.9%）检测出前列腺癌。与灰阶超声引导组男性（23.８%）相比，接受实时弹性成像活检的患者癌症检出率显著更高（p=0.007）（40.5%）。在1386个前列腺扇区中，实时弹性成像检测前列腺癌的敏感性和特异性分别为53.5%和70.5%，而灰阶超声分别为11.7%和93.7%。与传统灰阶超声相比，在实时弹性成像引导下，采用系统的10针活检方法检测前列腺癌的准确性显著提高。
