Prostatic cancer: role of color Doppler imaging in transrectal sonography.

Abstract

OBJECTIVE. Theaimof thisstudywastoassess therolesof transrectal colorDoppler andgray-scale sonography in revealing prostatic cancer,using biopsy as the referencestandard. SUBJECTSAND METHODS. Twohundred fifty-sixpatients referred forurologic studies underwent transrectal sonography using gray-scale and color Doppler scanning. All abnor mal areas shown on gray-scale or color Doppler sonography or both were targeted and biopsies were performed. The patients also underwent random sextant biopsies. All biopsies were mdi viduallycorrelatedwith histopathologic findingsandall resultswereanalyzed. RESULTS.Cancer wasfoundonbiopsyin 100patients (39%),andequivocal sonographicresults or prostatic intraepithelial neoplasia was found in 22 other patients (9%). In 16 of the patients in whom cancer was detected, the tumors were correctly revealed only with color Dop pIer sonography.These 16patients had a meanGleason scoreof 6.4 (range, 5â€"8). Biopsy find ings in these 16 patients showed eight patients with extensive lesions, three with moderate lesions, and five with minimal lesions. However, in nine other patients with cancer (9% of can cers detected), both gray-scale and color Doppler sonography failed to reveal lesions that were found on sextant biopsy. An analysis showed that, although highly sensitive, color Doppler sonography wassomewhatlessspecificthangray-scalesonography. CONCLUSION. ColorDopplersonography should become a routinepartof transrectalsonography of theprostateglandto improvedetectionandtargetingoflesions.The practiceof performing random sextant biopsies should also continue. P rostatic cancer is the most common malignancy in the American male population. Although widely ac ceptedand usedin the diagnosisof prostatic cancer, transrectal sonography has limitations.Prostaticcarcinomasmay be isoechoicI 1] and consequently not visualized on gray-scale sonography. Conversely, the most common sonographic appearance for prostate carci nomaâ€"theperipheral zone hypoechoic le sionâ€"canalso, on histopathologic examination of biopsy specimens, be found to represent a be nign lesion [2, 31.Limitations such as these may be partly over come by advances in technique. Several reports To evaluate the role of color Doppler transrectal sonography in detecting prostatic cancer in referred urologic patients, we pro spectively compared its usefulness with that of gray-scale imaging (keeping in mind the role of sextant biopsies) and correlated the results with biopsy findings. Subjects and MethodsThe population in this study consisted of 256 consecutive patients referred by urologists during theperiodbetween April andSeptember 1996. The patientswere40â€"84 yearsold (meanage,64years). Forty-threepatients(17%) were referredbecauseof an abnormality found on digital rectal examination, I 17 (46%) because of a raised (or rising) level of prostate-specific antigen (PSA), 90 (35%) because of botha raisedlevelof PSAandanabnormality on

Peripheral Hypoechoic Lesions of the Prostate: Evaluation with Color and Power Doppler Ultrasound

“…If the echogenicity of the lesion is similar to that of the remainder of the prostate, it may be very difficult to detect the lesion on gray–scale TRUS images alone, especially for less experienced examiners [3]. CDUS may detect and guide biopsy sites in such isoechoic lesions with abnormal flow signals, otherwise the lesion may not be sampled even at systematic sectant biopsies [2, 3, 11, 17]. However, this study was focused on the CDUS findings of the peripheral hypoechoic lesions that were detected on gray–scale US.…”

A comparison of the diagnostic performance of systematic versus ultrasound-guided biopsies of prostate cancer

“…Only three out of every 10 areas with increased colour Doppler flow were proven to be prostate cancer. Lavoipierre et al [71] even had more falsepositive than true-positive cases, achieving a sensitivity and PPV of 76% and 44%, respectively.…”

Contemporary issues in the diagnosis of prostate cancer for the radiologist

“…Hypervascular foci on colour Doppler may be sought during a TRUS scan and sampled. Use of colour Doppler does not, however, obviate a systematic biopsy [59]. In the author's experience, colour Doppler may be useful in the patient undergoing repeat biopsy after previous negative systematic biopsies, where it may focus attention to an area that might otherwise be overlooked.…”