Alparslan ÜNSAL, Füsun TAŞKIN, İbrahim METEOĞLU, Burçin UZ, Can Zafer KARAMAN

PROSTAT KANSERİ TANISINDA TRANSREKTAL ULTRASONOGRAFİ BULGULARININ GÖZDEN GEÇİRİLMESİ: RADYOLOJİK VE PATOLOJİK BULGULARIN KARŞILAŞTIRILMASI

Amaç:Transrektal ultrasonografi (TRUS) eşliğinde prostat biyopsisi yapılan hastaları gözden geçirmek veprostat kanseri tanısında yardımcı olabilecek ultrasonografik kriterleri değerlendirmek.Yöntem:Ocak 2003-Temmuz 2005 tarihleri arasında TRUS eşliğinde prostat biyopsisi alınan ve PSA değerlerigri zonda yer alan (410 ng/dl; ortalama PSA: 6.9 ± 2.7 ng/dl) 129 hasta retrospektif olarak değerlendirildi. TRUSbulguları patoloji sonuçlarıyla karşılaştırıldı. Periferik zon ekoyapısı (homojen ya da heterojen) ve prostat bezikonturları (düzgün ya da düzensiz) subjektif olarak sınıflandı.Bulgular:44 hasta (% 34) prostat kanseri tanısı aldı. İncelenen kriterlerden periferik zon ekoyapısı ile periferikzonda hipoekoik nodül varlığının patoloji sonuçlarıyla istatistiksel olarak anlamlı biçimde ilişkili olduğusaptandı (p=0.000 ve p=0.007). Prostat kanseri yakalama olasılığının, periferik zonun heterojen olduğu durumda7 kat [Odds Oranı (OO): 7.06 (2.98-16.70) % 95 Güven Aralığı (GA)], periferik zonda hipoekoik nodülvarlığında ise 3 kat [OO: 2.73 (1.18-6.28) % 95 GA] arttığı görüldü.Sonuç:Prostat kanseri tanısında TRUS'nin yeri sınırlıdır ve daha çok biyopsi kılavuzu olarak kullanılır. Bununlabirlikte, bu çalışmanın sonuçları bahsedilen TRUS bulgularının varlığında kanser yakalama olasılığının anlamlıbiçimde arttığını ortaya koymaktadır. Nodüle yönelik biyopsi protokollerine benzer şekilde heterojen periferikzon varlığında alınan biyopsi örneklerinin sayısının artırılmasına dayanan bir çalışma planı ile sunulançalışmanın geçerliliği değerlendirilebilir

Anahtar Kelimeler:

Transrektal ultrasonografi, prostat kanseri, biyopsi, nodül

Review of Transrectal Ultrasonography Findings in the Diagnosis of Prostate Cancer: Radiopathological Correlation

Purpose: To overview transrectal ultrasonography (TRUS) guided prostate biopsy cases and to evaluate the potentially useful sonographic criteria for the diagnosis of prostate cancer. Methods:Between January 2003 and June 2005, TRUS guided prostate biopsy specimens were obtained from 129 patients with a gray zone PSA level (4 - 10 ng/dl; average PSA: 6.9 ± 2.7 ng/dl). TRUS findings were compared with pathology results. Peripheral zone echostructure (homogenous or heterogeneous) and prostate contours (smooth or irregular) were classified subjectively. Presence of a hypoechoic nodule in the peripheral zone was noted, additional samples were obtained from the nodules. Results: 44 patients (34%) were found to have prostate adenocarcinoma. A statistically significant relationship was found between the peripheral zone echostructure - presence of hypoechoic nodule in the peripheral zone and pathological results (p=0.000 and 0.007, respectively). Prostate cancer detection rate increased 7 folds [Odds Ratio (OR): 7.06 (2.98-16.70) 95% Confidence Interval (CI)] when the peripheral zone was heterogeneous and 3 folds [OR: 2.73 (1.18-6.28) 95% CI] when there was a hypoechoic nodule in the peripheral zone. Conclusion:TRUS has a limited role in the diagnosis of prostate cancer and is especially used for biopsy guidance. On the other hand, the results of this study reveal a significant increase in cancer detection rate when the mentioned TRUS findings are present. Similar to the nodule targeted biopsies; the accuracy of the presented study can be evaluated with a prospective study including a larger number of biopsy specimens in case of peripheral zone heterogenity.

Keywords:

Transrectal ultrasography, prostate cancer, biopsy, nodule,

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