Department of Urology, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Korea.
World J Urol. 2018 Jul;36(7):1059-1065. doi: 10.1007/s00345-018-2224-8. Epub 2018 Mar 5.
Hypoechoic lesions are not included as indicators for prostate biopsy. To discriminate the features of hypoechoic lesions, we investigated the ultrasonographic characteristics of hypoechoic lesions using numerical analysis in image. In addition, we evaluated previously suggested subjective parameters on hypoechoic lesion.
We performed one-core targeted biopsy (TBx) for each hypoechoic lesion in up to two lesions in each patient before the 12-core systemic biopsy was obtained between July 2015 and May 2016. Image analysis data were analyzed using grayscale values and Hounsfield units (HU) to measure heterogeneity. Subjective evaluation of hypoechoic lesions including hypoechoicity, irregularity, vascularity, and microcalcification was also validated.
Of 157 patients (median age = 67.1 years, median prostate-specific antigen = 6.21 ng/mL) included in the study, 77 (49.0%) were diagnosed with prostate cancer (PCa), and 39 (17.0%) diagnoses were confirmed by the results of targeted cores. The existence of hypoechoic lesions was not a final predictor for PCa detection. In multivariate analysis using a combination of clinical and quantitative image analyses, the grayscale value was identified as a significant predictive factor for the presence of PCa and high-grade disease (Gleason score ≥ 7) on target lesions. The combination of clinical and image variables had the highest area under the curve (0.890) for detecting PCa in TBx.
The proposed method for the quantitation of hypoechoic lesions using grayscale images and HU is simple. Combined with the current clinical approaches, quantitative scoring of lesions can be useful for detecting PCa and making more precise diagnoses.
低回声病灶不包括在前列腺活检的指征内。为了区分低回声病灶的特征，我们使用图像的数值分析研究了低回声病灶的超声特征。此外，我们还评估了低回声病灶的先前提出的主观参数。
我们在 2015 年 7 月至 2016 年 5 月期间进行了 12 核心系统活检之前，对每位患者最多两个病灶中的每个低回声病灶进行了 1 核心靶向活检（TBx）。使用灰度值和亨氏单位（HU）分析图像分析数据来测量异质性。还验证了低回声病灶的主观评估，包括低回声、不规则性、血管生成和微钙化。
在研究中包括的 157 名患者（中位年龄为 67.1 岁，中位前列腺特异性抗原为 6.21ng/ml）中，77 名（49.0%）被诊断为前列腺癌（PCa），39 名（17.0%）通过靶向核心的结果得到确诊。低回声病灶的存在不是 PCa 检测的最终预测指标。在使用临床和定量图像分析相结合的多变量分析中，灰度值被确定为靶病灶中存在 PCa 和高级别疾病（Gleason 评分≥7）的显著预测因素。临床和图像变量的组合在 TBx 中检测 PCa 的曲线下面积最高（0.890）。
使用灰度图像和 HU 对低回声病灶进行定量的方法很简单。与当前的临床方法相结合，对病变进行定量评分有助于检测 PCa 并做出更精确的诊断。
