A positive real‐time elastography is an independent marker for detection of high‐risk prostate cancers in the primary biopsy setting

Abstract

Objective• To evaluate the performance of real-time elastography (RTE) in an initial biopsy setting. Patients and Methods• In the period from February 2011 to June 2012, 127 consecutive patients were included in the study.• We used a Hitachi Preirus with Hi-RTE module, a prostate end-fire transrectal probe was used for RTE and for targeted biopsies, and a simultaneous biplane probe was used for the standard systematic biopsies.• The peripheral zone of the prostate was divided into six regions, and each biopsy obtained was referred to a specific region.• All patients were first examined with RTE and, if cancer was suspected, targeted biopsies were taken. A standard systematic 10-core biopsy was then taken in all patients. Results• In all, 64 (50%) patients were diagnosed with prostate cancer in the initial biopsy setting. Three patients were diagnosed solely on RTE-targeted biopsies, 31 were found only in systematic biopsies, and 30 were correctly diagnosed with both methods.• In the RTE-positive group there was a significantly higher frequency of positive cores, a lower prostate volume, a higher Gleason score, and a higher fraction of cancer tissue in each core.• In a multiple regression model RTE was an independent marker for high-risk cancer.• The sensitivity of 42% for all prostate cancers increased to 60% for high-grade prostate cancers.• Similarly, the negative predictive value increased from 79% to 97%. An additional eight patients were diagnosed with prostate cancer during the study period. Conclusions• A positive RTE is an independent marker for detection of high-risk prostate cancer, and a negative RTE argues against such.• RTE with targeted biopsies cannot replace systematic biopsies, but provides valuable additional information about the tumours.

Comparison of meta-analyses among elastosonography (ES) and positron emission tomography/computed tomography (PET/CT) imaging techniques in the application of prostate cancer diagnosis

“…In the process of recognizing and selecting associated studies with 11C-choline PET/CT [5,[8][9][10], 18F-FCH PET/ CT [20,44,[49][50][51][52][53][54][55][56][57][58][59][60][61], 11C-acetate PET/CT [7,13,14,62,63], 18F-FDG PET/CT [64][65][66][67][68], TRTE [11,12,[69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88], and SWE [3,…”

Real-Time Elastography of the Prostate

“…Targeted biopsy under RTE guidance seems to have the advantage of the reliable detection of significant disease [30]. According to Nygård et al the addition of RTE targeted cores to standard SB raised the negative predictive value from 79% to 97% for high-risk PCa.…”

Should Testis Elastography be Performed in All Patients with Scrotal Swelling? A Case Report

“…In recent years, new radiological imaging methods such as Elastography have been described about diagnosis of malign tissue. In previous studies (about prostate and breast cancer) it has been reported that stiffness grade of tumor tissue higher than in normal tissue by Elastographic examination (6,7,8). Aigner et al (3) performed testicular Elastography for 50 patients who have TLs detected with gray-scale US.…”

“…Elastography is a new sonographic method that directly discloses the elasticity features of the tissue and allows examination of changes in tissue hardness (4). Elastography has been proposed with promising results for differentiating benign from malignant lesions in some tissues, such as testis (4,5,6,7,8). Due to increasing stiffness of a mass, the risk of malignancy becomes higher and more sensitive to elasticity evaluation than palpation might obtain with recent sonographic devices (5).…”