Contribution of Color Doppler Sonography to the Diagnosis of Prostatic Pathologies

Objective: The aim of this study was to investigate the ability of color Doppler ultrasonography to determine prostate cancer, to evaluate the contribution of color Doppler ultrasonography to a conventional greyscale transrectal ultrasonography (TRUS) examination, and to assess the efficacy of prostate-specific antigen (PSA) values in the detection of prostate cancer in combination with sonographic imaging methods. Methods: A total of 78 patients who presented at the Radiology Department of Taksim Training and Research Hospital and were diagnosed with benign prostate hyperplasia or prostate cancer were included in the study. The age range of the patients was 49 to 90 years. A Diasonic VST Master color Doppler ultrasonography system with a 7-Mhz transrectal probe (Diasonic Technology Co. Ltd., Gyeonggi-do, South Korea) was used to assess the patients. The presence and number of nodules; the size, shape, and echo structure of the lesion; the loss of peripheral zone and inner gland border; capsular invasion; seminal vesicle thickening; and obliteration or patency of the prostate seminal vesicle angle as observed in the TRUS examination were noted. A vascularization map of different regions of the prostate gland was evaluated by section. The color flow was graded using a 3-point scale and the findings were compared with the pathology results. Results: Based on the results of a histopathological examination, 28 cases (36%) were malignant and the remaining 50 cases (64%) were benign. The mean PSA density (PSAD) value was 0.41 in the malignant cases and 0.23 in the benign cases. The best results for the diagnosis of prostate cancer were obtained with the combined use of TRUS, color Doppler ultrasound, and PSAD. The sensitivity, specificity, positive, and negative predictive value was 64%, 80%, 64%, and 80%, respectively. Conclusion: The addition of color Doppler ultrasound to TRUS increased the specificity and decreased the sensitivity (from 78% to 51%) of the findings. Though RDUS does not provide a significant advantage in the diagnosis of cancer, the color flow grading better determines the areas to be biopsied. Due to the poor sensitivity of a color Doppler examination, it should be evaluated with grayscale and PSA findings. The best specificity (80%) was observed with the combined use of these 3 methods.

Prostat Patolojilerinde Renkli Doppler İncelemenin Yeri

Amaç: Çalışmamızın amacı renkli Doppler ultrasonografinin kanser belirleme yeteneğinin araştırılması transrektal gri skala ultrason incelemeye katkısı ve PSA değerlerinin sonografik görüntüleme yöntemleri ile birlikte kulanımının prostat kanseri saptamadaki etkinliğinin değerlendirilmesidir. Gereç ve Yöntem: Çalışmaya Taksim Eğitim ve Araştırma Hastanesi Radyoloji Bölümü’ne benign prostat hiperplazisi ya da prostat kanseri ön tanısı ile başvuran ve yaşları 49–90 arasında değişen 78 hasta alındı. Araştırmada Diasonic VST master renkli Doppler USG aracı ve 7 Mhz’lik transrektal prob kullanıldı. TRUS incelemede nodüllerin varlığı ve sayısı, lezyonun boyutu, şekli, eko yapısı, tutulan zon, peripheral zondaki nonkitlesel eko farklılığı, periferik zon ve inner gland sınırının kaybı, kapsüler invazyon, seminal vezikül kalınlaşması, prostat seminal vezikül açısının obliterasyonu ya da açıklığı not edildi. Damarlanma haritası ise bezin değişik alanlarından geçen kesitlerde değerlendirildi. Renkli akım 3 puan skalası ile gradelendi ve bulgular patoloji sonuçları ile karşılaştırıldı. Bulgular: Histopatolojik inceleme sonucunda 28 olgu (%36) malign, geri kalan 50 olgu ise (%64) benign olarak değerlendirildi. Malign olguların ortalama prostat spesifik antijen dansitesi (PSAD) değeri 0.41 olarak kaydedildi, benign olgularda 0.23 olarak saptandı. Prostat kanseri belirleme açısından en iyi sonuçları transrektal gri skala ultrason, renkli Doppler ultrason ve PSAD’nin birlikte kullanımı ile elde edildi. Bu koşulda sensitivite, spesifite, pozitif ve negatif prediktif değerler sırası ile %64, %80, %64 ve %80 olarak kaydedildi. Sonuç: Çalışmamızda RDUS’ninn TRUS’ye eklenmesi spesifiteyi artırsa da sensitiviteyi (%78 den %51’e) düşürmektedir. Sonuçlarımıza göre RDUS’nin kanser tanısında belirgin bir avantaj sağladığını iddia edemesek de renkli akım gradelemesi biyopsiye aday yerleri daha iyi belirlemektedir. Renkli Doppler incelemesinin spesifitesinin kötü olması nedeni ile gri skala ve PSA bulguları ile birlikte değerlendirilmelidir. Nitekim çalışmamızda da en iyi spesifite (%80) üç yöntemin birlikte kullanılması ile elde edildi.

Kaynakça

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Kaynak Göster

Southern Clinics of Istanbul Eurasia
  • ISSN: 2587-0998
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2017

1b345

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