Accuracy of transrectal strain elastography in detection of prostate cancer
Main Article Content
Abstract
Background: Elastography has emerged as a boon in aiding diagnosis of various neoplastic conditions Strain elastography helps in differentiating hard lesions from the normal tissue on a real-time basis and targeting biopsies of the same described by other authors in various conditions. We assess a series of cases for the detection of prostate cancer using strain elastography of prostate.
Aims: The aim of this study was to assess the accuracy of transrectal strain elastography in diagnosis of prostate cancer.
Materials and Methods: This is an observational cross-sectional, prospective study. Transrectal strain elastography was performed using a C-10 3 v endocavity probe with elastography software and was compared against biopsy results on 25 adult male patients with raised prostate-specific antigen levels. Statistical significance of qualitative data across two study groups was tested using the Chi-square test or Fisher’s exact test. The entire data were analyzed using SPSS version 16.0, Inc., Chicago, software for Microsoft Windows.
Results: Ten (40%) out of 25 patients demonstrated carcinoma prostate, 14 patients had benign prostatic hyperplasia, and 1 had prostatic abscess. Transrectal real-time elastography scores in patients with carcinoma patient were higher than those of benign conditions, i.e., 3 and 4 scores with accuracy of 92%, sensitivity of 85.7%, and specificity of 94.4%.
Conclusions: The overall accuracy of strain elastography was 92%, which enhanced the diagnostic yield in prostate carcinoma. Real-time strain elastography is a highly sensitive and specific technique for diagnosing prostatic carcinoma and guiding the prostate biopsy.
Downloads
Article Details
Section
How to Cite
References
1. Catalona WJ, Richie JP, Ahmann FR, Hudson MA, Scardino PT, Flanigan RC, et al. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: Results of a multicenter clinical trial of 6,630 men. J Urol 1994;151:1283‑90.
2. Romics I. Ultrasound guided biopsy, a gold standard diagnostical test of the prostate cancer. Acta Chir Iugosl 2005;52:23‑6.
3. Flanigan RC, Catalona WJ, Richie JP, Ahmann FR, Hudson MA, Scardino PT, et al. Accuracy of digital rectal examination and transrectal
ultrasonography in localizing prostate cancer. J Urol 1994;152:1506‑9.
4. Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, et al. EFSUMB guidelines and recommendations on the clinical use
of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med 2013;34:169‑84.
5. Rifkin MD, Zerhouni EA, Gatsonis CA, Quint LE, Paushter DM, Epstein JI, et al. Comparison of magnetic resonance imaging and
ultrasonography in staging early prostate cancer. Results of a multi‑institutional cooperative trial. N Engl J Med 1990;323:621‑6.
6. Beerlage HP, Aarnink RG, Ruijter ET, Witjes JA, Wijkstra H, Van De Kaa CA, et al. Correlation of transrectal ultrasound, computer
analysis of transrectal ultrasound and histopathology of radical prostatectomy specimen. Prostate Cancer Prostatic Dis 2001;4:56‑62.
7. Langer DL, van der Kwast TH, Evans AJ, Trachtenberg J, Wilson BC, Haider MA, et al. Prostate cancer detection with multi‑parametric MRI:
Logistic regression analysis of quantitative T2, diffusion‑weighted imaging, and dynamic contrast‑enhanced MRI. J Magn Reson Imaging
2009;30:327‑34.
8. Xu G, Feng L, Yao M, Wu J, Guo L, Yao X, et al. A new 5‑grading score in the diagnosis of prostate cancer with real‑time elastography.
Int J Clin Exp Pathol 2014;7:4128‑35.
9. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D, et al. Global cancer statistics. CA Cancer J Clin 2011;61:69‑90.
10. Hsing AW, Tsao L, Devesa SS. International trends and patterns of prostate cancer incidence and mortality. Int J Cancer 2000;85:60‑7.
11. Spârchez Z. Real‑time ultrasound prostate elastography. An increasing role in prostate cancer detection? Med Ultrason 2011;13:3‑4.
12. McNeal JE, Redwine EA, Freiha FS, Stamey TA. Zonal distribution of prostatic adenocarcinoma. Correlation with histologic pattern and
direction of spread. Am J Surg Pathol 1988;12:897‑906.
13. Cochlin DL, Ganatra RH, Griffiths DF. Elastography in the detection of prostatic cancer. Clin Radiol 2002;57:1014‑20.
14. Lyshchik A, Higashi T, Asato R, Tanaka S, Ito J, Mai JJ, et al. Thyroid gland tumor diagnosis at US elastography. Radiology 2005;237:202‑11.
15. Garra BS, Cespedes EI, Ophir J, Spratt SR, Zuurbier RA, Magnant CM, et al. Elastography of breast lesions: Initial clinical results. Radiology
1997;202:79‑86.
16. Ophir J, Céspedes I, Ponnekanti H, Yazdi Y, Li X. Elastography: A quantitative method for imaging the elasticity of biological tissues.
Ultrason Imaging 1991;13:111‑34.
17. Kapoor A, Kapoor A, Mahajan G, Sidhu BS. Real‑time elastography in the detection of prostate cancer in patients with raised PSA level.
Ultrasound Med Biol 2011;37:1374‑81.
18. Aigner F, Pallwein L, Junker D, Schäfer G, Mikuz G, Pedross F, et al. Value of real‑time elastography targeted biopsy for prostate cancer
detection in men with prostate specific antigen 1.25 ng/ml or greater and 4.00 ng/ml or less. J Urol 2010;184:913‑7.
19. Ferrari FS, Scorzelli A, Megliola A, Drudi FM, Trovarelli S, Ponchietti R, et al. Real‑time elastography in the diagnosis of prostate tumor. J Ultrasound 2009;12:22‑31.
20. Krouskop TA, Wheeler TM, Kallel F, Garra BS, Hall T. Elastic moduli of breast and prostate tissues under compression. Ultrason Imaging
1998;20:260‑74.
21. Kamoi K, Okihara K, Ochiai A, Ukimura O, Mizutani Y, Kawauchi A, et al. The utility of transrectal real‑time elastography in the diagnosis
of prostate cancer. Ultrasound Med Biol 2008;34:1025‑32.
22. Itoh A, Ueno E, Tohno E, Kamma H, Takahashi H, Shiina T, et al. Breast disease: Clinical application of US elastography for diagnosis.
Radiology 2006;239:341‑50.
23. König K, Scheipers U, Pesavento A, Lorenz A, Ermert H, Senge T, et al. Initial experiences with real‑time elastography guided biopsies of
the prostate. J Urol 2005;174:115‑7.
24. Pallwein L, Mitterberger M, Struve P, Pinggera G, Horninger W, Bartsch G, et al. Real‑time elastography for detecting prostate cancer:
Preliminary experience. BJU Int 2007;100:42‑6.
25. Miyagawa T, Tsutsumi M, Matsumura T, Kawazoe N, Ishikawa S, Shimokama T, et al. Real‑time elastography for the diagnosis of prostate
cancer: Evaluation of elastographic moving images. Jpn J Clin Oncol 2009;39:394‑8.
26. Pelzer AE, Bektic J, Berger AP, Halpern EJ, Koppelstätter F, Klauser A, et al. Are transition zone biopsies still necessary to improve prostate
cancer detection? Results from the Tyrol screening project. Eur Urol 2005;48:916‑21.