Preliminary Application Research Of Transrectal Ultrasound Contrast In Prostate Cancer Diagnosis And Guided Puncture Biopsy

Background: The clinical application of high-resolution imaging method of the prostateis main magnetic resonance imaging (MRI) configuring endorectal coil and transrectalultrasound (TRUS). But lack of specificity of conventional MRI imaging findings ofprostate cancer and non-cancer lesions, such as inflammation, hyperplasia, scarring,calcification may have a similar prostate cancer imaging findings, conventional MRI inthe diagnosis of prostate cancer, especially for early stage prostate cancer,having certaindifficulties. Close to the prostate when checking on, TRUS due to the frequency of therectal probe than abdominal probe frequency, the prostate structure showing has ahigher resolution, but evaluation of neovascularization inside the tumor, the effect is notvery satisfactory. Ultrasound imaging techniques using a new ultrasound contrast agentSonoVue, can better show the tumor microvessel and enhanced the sensitivity ofultrasound exploration to blood flow within the organization, particularly small, lowblood flow. In this study, we use transrectal CEUS and MRI to check the prostate, withpathological findings as the gold standard, preliminary assessment the value oftransrectal CEUS diagnosis of prostate cancer and proceeding preliminary clinicalapplication research to transrectal CEUS positioning prostate ultrasound-guided biopsymethod.Part one The diagnostic value of transrectal ultrasound imaging inprostate cancerObjective：By transrectal CEUS and MRI of prostate lesions imaging performanceanalysis, and comparison surgery or biopsy histopathologic results, we evaluate thediagnostic value of transrectal CEUS in prostate cancer.Methods：Select prostate cases of our hospital from February2008to October2012,with complete examination data of transrectal CEUS and MRI examination, and surgery or biopsy histopathologic results, according to the2012edition of "ChineseUrology disease diagnosis and treatment guidelines "to determine the inclusion criteria:(1) digital rectal examination found nodules, any PSA values;(2) ultrasound found theprostatic hypoechoic nodules or MRI abnormal signal, any PSA value;(3) PSA>10ng/ml, any f/tPSA and PSAD value;(4) PSA4-10ng/ml f/tPSA ratio anomalies orabnormal PSAD value. The study enrolled a total of48cases which were in line withone of the above, and MRI examination was before the transrectal CEUS, and imagingstudies and pathological findings time intervals were less than10days. Received CEUSand MRI images were analyzed and maked a qualitative diagnosis. The results ofcontrol histopathology were statistically analyzed and initial evaluate the diagnosisvalue of transrectal CEUS, MRI, transrectal the CEUS united MRI in the prostatecancer.Results：Pathology confirmed30cases of prostate cancer in the group of48patients(age50to91years old, average age70.3years) by surgery or biopsy of the prostatecases,18cases of benign prostatic hyperplasia. Rectal CEUS diagnosis of the Pcacoincidence, sensitivity and specificity were77.08%,80.00%,72.22%, the MRIdiagnosis Pca coincidence, sensitivity and specificity were79.16%,76.67%,83.33%,transrectal CEUS joint MRI diagnosis of Pca coincidence rate, sensitivity andspecificity were85.42%,86.67%,83.33%. respectively. The differences of Pca diagnosisvia the rectum CEUS and MRI were not statistically significant (P>0.05) betweencoincidence rate and sensitivity, and the difference of specificity were statisticalsignificance (by the rectum CEUS is lower than MRI, P <0.05). Combined applicationof Pca diagnosis coincidence rate, sensitivity were higher than transrectal CEUS andMRI, respectively,and there is a significant difference (P <0.05).Conclusions：Transrectal CEUS and MRI were important imaging methods in clinicalPCa diagnosis, transrectal CEUS and MRI applications can complement each other toimprove the coincidence rate, sensitivity of prostate cancer diagnosis. Part two The application value of guided puncture biopsy of prostatecancer by transrectal ultrasound contrastObjective：Analysis the clinic value of transrectal ultrasound contrast in prostate cancerclinical puncture biopsy.Methods：Collected116cases of clinically suspected prostate cancer from March2008to October2012, patients underwent TRUS or the CEUS joint TRUS guided prostatebiopsy, all patients had pathological results. According to the2012edition of "ChineseUrology disease diagnosis and treatment guidelines " to determine the indications forprostate biopsy:(1) digital rectal examination found nodules, any PSA values;(2)ultrasound found the prostatic hypoechoic nodules or MRI abnormal signal, any PSAvalue;(3) PSA>10ng/ml, any f/tPSA and PSAD value;(4) PSA4-10ng/ml f/tPSAratio anomalies or abnormal PSAD value. Meet more than one of those that wereenrolled in the study. CEUS combined TRUS guided prostate biopsy cases set toangiography group and TRUS guided prostate biopsy cases is set to the normal group,in contrast with the pathological examination results, compared to the Pca-positive ratevia the two puncture methods and the number of puncture needle, analysis andstatistical processing, evaluation the clinic value of transrectal ultrasound contrast inprostate cancer clinical puncture biopsy.Results：Of the group of116patients with clinical suspicion of prostate cancer patients(age50to84years, with an average age of64.3years),the angiography group were48cases,68cases of the general group, the Pca puncture positive rate of62.5%inangiography group was similar to the58.82%in ordinary group and the differencebetween the two groups was not statistically significant (P>0.05). When f/tPSA ratio>0.15, the difference of positive biopsy rate between the two sets was not statisticallysignificant (P>0.05), but when the f/tPSA ratio≤0.15, the patients after ultrasoundcontrast, the puncture-positive rate of Pca was from10.34%to44.83%, the differencebetween the two groups was statistically significant (P <0.05). In this study, theangiography group average puncture was8.21needle, ordinary group average puncturewas11.29needle, each case puncture number of angiography group was less than theordinary group. Compare two sets of positive puncture rate, angiography grouppuncture394-pin,112-pin PCa positive needle number, single needle-positive rate was28.43%; ordinary group puncture768-pin,145-pin PCa positive needle number, the positive rate of single needle was18.88%, the difference between the two groups wasstatistical value (P <0.05).Conclusions：When f/tPSA ratio≤0.15, prostate ultrasound contrast may improve thePca puncture positive rate. The puncture needle of CEUS group was less than ordinarygroup, but the Pca puncture-positive rate was not reduced, and the number of positiveneedle puncture site was significantly higher than the normal group, the positive rate ofsingle needle and puncture accuracy were improved.