Carter H B, Hamper U M, Sheth S, Sanders R C, Epstein J I, Walsh P C
Department of Urology, Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland.
J Urol. 1989 Oct;142(4):1008-10. doi: 10.1016/s0022-5347(17)38971-1.
To determine the ability of transrectal ultrasound to detect early localized prostate cancer, unsuspected (nonpalpable) cancer in the contralateral lobe of patients undergoing radical prostatectomy for clinically localized disease was evaluated. A total of 59 patients with palpable prostate cancer clinically confined to 1 lobe underwent transrectal ultrasound before radical prostatectomy and step-sectioning of the radical prostatectomy specimen. Transrectal ultrasound was performed with 5 or 7 MHz. real-time transrectal units. Pathological findings in these 59 cases revealed no tumor in the contralateral lobe in 34 (58%) and the presence of unsuspected tumor in 25 (42%). Transrectal ultrasound detected 13 of 25 unsuspected cancers for a sensitivity of 52%. Of 34 patients with no contralateral lobe lesion transrectal ultrasound was correct in 23 for a specificity of 68%. The positive and negative predictive values for transrectal ultrasound in this study group were 54 and 66%, respectively. There was no significant difference in the pathological size of the clinically suspected and clinically unsuspected cancers as measured by average largest dimension, and transrectal ultrasound sensitivity did not correlate with the size of the cancer. Based on careful sonopathological analysis, transrectal ultrasound may not be a good method to detect clinically unsuspected prostate cancer and the false positive rate would appear to be high.
为了确定经直肠超声检测早期局限性前列腺癌的能力，我们评估了因临床局限性疾病接受根治性前列腺切除术的患者对侧叶中未被怀疑（不可触及）的癌症情况。共有59例临床上局限于1个叶的可触及前列腺癌患者在根治性前列腺切除术前行经直肠超声检查，并对根治性前列腺切除标本进行连续切片检查。经直肠超声检查使用5或7兆赫的实时经直肠探头。这59例患者的病理检查结果显示，34例（58%）对侧叶无肿瘤，25例（42%）存在未被怀疑的肿瘤。经直肠超声检测出25例未被怀疑癌症中的13例，敏感性为52%。在34例对侧叶无病变的患者中，经直肠超声检查正确判断23例，特异性为68%。该研究组经直肠超声的阳性和阴性预测值分别为54%和66%。通过平均最大直径测量，临床怀疑和临床未怀疑癌症的病理大小无显著差异，且经直肠超声的敏感性与癌症大小无关。基于仔细的超声病理分析，经直肠超声可能不是检测临床未怀疑前列腺癌的好方法，且假阳性率似乎较高。
