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GENITOURINARY IMAGING Table of Contents   
Year : 2004  |  Volume : 14  |  Issue : 2  |  Page : 155-157
Transrectal ultrasonography for evaluation of various benign and malignant prostatic lesions and their histopathological correlation


Dept. of Radiodiagnosis, Gandhi Medical College, Bhopal, India

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   Abstract 

To study the transrectal ultrasonographic findings in benign and malignant prostatic lesions with respect to its site, echopattern, capsular status, local invasion and their histopathological correlation. Material and Method: A total of 100 patients with clinical suspicion of prostatic disease were examined by transrectal ultrasonography (TRUS) followed by their histopathological correlation to study the sensitivity and specificity of transrectal ultrasonography for diagnosis of carcinoma prostate. Result and conclusion: The sensitivity and specificity of TRUS for diagnosis of carcinoma prostate was found to be 86.96 percent and 71.43 percent respectively. The relative low specificity reflects the difficulty of interpretation of lesion and overlapping echogenic pattern. The percentage of false negative was 13.04 percent and the percentage of false positive was 28.57 percent.

Keywords: Transrectal ultrasonography, Transabdominal ultrasonography, Benign prostatic hyerplasia, Carcinoma Prostate, Prostatitis

How to cite this article:
Malik R, Pandya V K, Naik D. Transrectal ultrasonography for evaluation of various benign and malignant prostatic lesions and their histopathological correlation. Indian J Radiol Imaging 2004;14:155-7

How to cite this URL:
Malik R, Pandya V K, Naik D. Transrectal ultrasonography for evaluation of various benign and malignant prostatic lesions and their histopathological correlation. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Dec 9];14:155-7. Available from: http://www.ijri.org/text.asp?2004/14/2/155/28574

   Introduction Top


Various methods are available for sonographic evaluation of prostate but transrectal ultrasonography (TRUS) has received increasing attention recently because of its potential for early detection of prostate cancer. It provides greater detail of zonal anatomy of prostate and echo pattern of the gland and its various lesion.

Research has centered on the integration of TRUS findings with digital rectal examination (DRE) and PSA levels for diagnosis of prostatic disorders along with histopathological correlation.


   Material and Methods Top


A total of 100 patients with clinical suspicion of prostatic disease were examined by transrectal ultrasonography using US scanner Wipro G.E. with micro convex transrectal ultrasound probe of 6.5 MHz.

Patient is advised to lie in left lateral decubitus position with knees flexed and applied closely to chest. Transrectal ultrasonography (TRUS) was done by micro convex transrectal probe of 6.5 MHz which was wrapped in a sheath. To ensure acoustic contact the sheath contained ultrasound gel. The sheath was coated with gel, then it was inserted into rectum. After imaging the midline, the probe was rotated clockwise and counterclockwise to see all portions of the gland. The prostate gland was evaluated for assessment of the presence of any focal lesion and their echo pattern, capsular integrity, extension of the disease process outside the limits of the gland margin.

Enlarged prostate gland with or without median lobe enlargement with symmetric echogenicity with heterogenous echotexture of inner glandular zone is suggestive of benign prostatic hyperplasia (BPH) [Figure - 1]. Normal or enlarged gland with focal lesion in peripheral zone with or without capsular breach is suggestive of prostate carcinoma [Figure - 2].

The transrectal ultrasonographic diagnosis was correlated with the histopathological examination of the whole mount sections of surgical specimen of prostate.


   Result Top


TRUS diagnosed 42 cases as carcinoma prostate but only 23 (54.76%) cases were positive on histopathology. The sensitivity and specificity of TRUS for diagnosis of carcinoma prostate was found to be 86.96% and 71.43% respectively. The percentage of false negatives was 13.04% and the percentage of false positives was 28.57%.

In present study it was observed that carcinoma of prostate predominantly involved the peripheral zone and BPH predominantly involved the inner glandular zone. In carcinoma prostate 19 out of 23 (82.61%) patients had lesion in peripheral zone; four (17.39%) patients had lesions in peripheral + inner glandular zone. In BPH 52 of 69 (75.36%) patients showed involvement of inner glandular zone followed by 13.04% in peripheral + inner glandular and 11.59% in peripheral zone.

Hypoechoic lesions were more common in carcinoma of prostate; 14 out of 23 (60.86%) patients had hypoechoic lesion (60.86%), followed by hypoechoic + hyperechoic lesions (13.04%) and mixed echogenic lesions (8.69%). In BPH too, most common echo pattern of the lesion was hypoechoic, observed in 31.88% patients [Table - 1].

In carcinoma prostate capsular breach was observed in 60.87% patients, local invasion of bladder base in 17.39% patients [Figure - 3] and seminal vesicles in 13.04% patients.


   Discussion Top


The sensitivity of TRUS for diagnosis of carcinoma prostate in present study was found to be 86.96% with specificity of 71.43%. The percentage of false positive was found to be 28.57% and percentage of false negative was found to be 13.04%.

Our findings were consistent with the observations made by Fred Lee et al (1986), Mathew D Rifkin et al (1986), Wolfang F Dahnert et al (1987), GJ Griffiths et al (1987).Thus, it was found that TRUS is a superior technique for better visualization of the gland as the transducer is in direct contact with the gland. The visualization of peripheral zone where most carcinoma arises was excellent by TRUS. The characterization of the zonal involvement of the gland, echo pattern, capsular status and adjacent organ invasion was much better by TRUS as compared to transabdominal sonography. The relative low specificity reflects the difficulty in the interpretation of the lesion and the overlapping echogenic pattern of the lesion may be the cause therefore.[8]

 
   References Top

1.Peggy J Fritzolhe, Paul D Oxford, Vieter Ching, Ronald W Rosenquist, Robert J Moore: Corrlation of transrectal sonographic findingsin patients with suspected and unsuspected prostatic disease. J Radiology 1983; 130:272-4.  Back to cited text no. 1    
2.Mathew D Rifkin, Gerald Friedland, Linda Shortiffe: Prostatic evaluation by transrectal endosonography; detection of carcinoma. J Radiology 1986; 158:85-90.  Back to cited text no. 2    
3.Fred Lee and Jerry Gray: Prostatic evaluation by transrectal sonography: criteria for diagnosis of early carcinoma. J Radiology 1986; 158: 91-95.  Back to cited text no. 3    
4.Wolfang F Dahnert, Ulrike M Hamper: Prostatic evaluation by transrectal sonography with histopathological correlation; the echopenic appearance of early carcinoma. J Radiology 1986;158:97-102.  Back to cited text no. 4    
5.GJ Griffiths, R Clements, DR Jones, EE Roberts, WB Peeling, KT Evans: The ultrasound appearances of prostatic cancer with histopathological correlation. Clinical Radiology 1987;38:219-227.  Back to cited text no. 5    
6.Katsuto Shinohara, Thomas M Wheeler, Peter T Scardino; The appearance of prostate cancer on tansrectal ultrasonography; correlation of imaging and pathological examination, J Urol 1989;142:76-82.  Back to cited text no. 6    
7.H Ballentine Carter, Ulrike M Hamper, Sheila Sheth, Roger C Sanders, Johathan I Epstenia, Patrik C Walsh; Evaluation of transrectal ultrasound in the early detection of prostate cancer, J Urol 1989;142:1008-1010.  Back to cited text no. 7    
8.Mona Norberg et al: Transrectal ultrasound and core biopsies for diagnosis of prostate cancer. Acta Radiologica Supplimentum 1994;35:393.  Back to cited text no. 8    

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Correspondence Address:
R Malik
Dept. of Radiodiagnosis, Gandhi Medical College, Bhopal
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

    Tables

[Table - 1]

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Urology. 2007; 70(4): 734-737
[Pubmed]



 

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    Abstract
    Introduction
    Material and Methods
    Result
    Discussion
    References
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