Dergiler / Türk Üroloji Dergisi/Turkish Journal of Urology / 2004 / Cilt: 30 - Sayı: 2
Prostat iğne biyopsisinde power Doppler ultrasonografinin yeri
- Sayfa
- 182–186
- DOI
- —
Özet
Prostat kanserlerinin çoğunda hipervaskülarizasyon izlendiği Renkli Doppler Ultrasonografi (RDUS) ve PDUS ile yapılan çalışmalarda gösterilmiştir. Bu çalışmanın amacı, sistemik 10 kadran biyopsiye ek olarak PDUS ile saptanan şüpheli alanlardan alınan biyopsilerin prostat kanseri teşhisine katkısını saptamak idi. Temmuz 2002 - Nisan 2003 tarihleri arasında kliniğimizde görülen serum PSA değeri 2.5 ng/mL’nin üzerinde olan yada parmakla rektal incelemesinde (PRİ) nodul yada sertlik bulunan 52 hasta çalışmaya dahil edildi. Tüm hastalara PDUS’da artmış akım gösteren bölgelere ek olarak sistematik 10 kadran transrektal prostat iğne biyopsisi yapıldı. Sistematik olarak 10 kadrandan alınan biyopsilere ek olarak PDUS’da artmış akım gösteren 73 alandan biyopsi yapıldı. Toplam 11 hastadan alınan 65 biyopsi alanında tümör tespit edildi. PDUS kullanımı ile tümör tespit oranı %10,2 den %11,0’a çıktı. Bu artış istatistiksel olarak anlamlı değildi (p=0,75). İki hastada sadece PDUS ile alınan alanlarda tümör tespit edildi. PDUS’un birey bazında katkısı da istatistiksel olarak anlamlı değildi (p=0,80).PDUS ile tümör şüphesi olan alanlardan alınan biyopsilerin sistematik olarak 10 kadrandan alınan biyopsilere katkısının olmadığını, serum PSA düzeyleri yüksek olan yada PRİ’leri tümör lehine değerlendirilen hastalardan alınan biyopsilerde tümör tespit edilememesi durumlarında sistematik biyopsilerin tekrarlanmasının halen en geçerli yöntem olduğunu düşünmekteyiz.
Abstract
Introduction: Transrectal ultrasound guided prostate biopsy is the method of choice for prostate biopsy guidance. It was demonstrated that most prostate cancers in peripheral zone showed hypervascularization, in contrasts to hypovascularization of the normal peripheral zone. Color Doppler ultrasonography or power Doppler sonography may be of help in differentiating prostate cancer from benign prostatic disease by demonstrating local blood flow changes in the lesion compared to signals from surrounding tissue. Power Doppler is more sensitive to slow flow and is less angle-dependent than color Doppler imaging. In this prospective study, the role of power Doppler ultrasonography in addition to systematic 10 cores biopsy for the detection of prostate cancer was assessed. Materials and Methods: Between July 2002 and April 2003, 52 patients who have serum PSA level greater than 2.5 ng/mL or abnormal digital rectal examination included the study. All patients were examined with the 7.5 MHz end-firing probe (Hitachi EUB 525, Tokyo, Japan). Biopsies were directed into hypervascularized area detected by power doppler ultrasonography before systematic 10 cores needle biopsies were performed. No major complication during or after the procedure was seen. The impact of power Doppler, directed biopsies to prostate cancer detection rate, was analyzed using chi-square test. Mean age of patients was 63.1 (42-82). Results: In addition to 520 systematic biopsy sites from 52 patients, 73 suspicious areas detected by power Doppler ultrasonography were also biopsied. A total of 65 biopsy sites in 11 patients turned out to be adenocarcinoma of the prostate. With the use of power Doppler ultrasonography, cancer detection rate was increased to 11.0% (65/593) from 10.2% (53/520). This increase was statistically insignificant (p=0.75). In 2 patients, prostate cancer was diagnosed only in the suspicious areas detected by power Doppler ultrasonography. The contribution of power Doppler ultrasonography in that regard was also statistically insignificant (p=0.80). In a patient with prostate cancer diagnosed with systematic 10 cores needle biopsy, power Doppler ultrasonography could not detect any suspicious areas. In contrasts to suspicious areas detected with power Doppler ultrasonography, prostate cancer was diagnosed in a patient in the areas taken by systematic 10 cores needle biopsy technique. Conclusion: Targeted biopsy performed on the basis of power Doppler ultrasonography findings does not increase the detection rate of prostate cancer compared to systematic 10 cores needle biopsy technique. A second set systematic 10 cores needle biopsy seems the most reliable method in patients with high serum PSA level or suspicious digital rectal examination and negative biopsy result in the first set of biopsy.