Stellenwert der Real-Time Elastografie zur Steuerung der systematischen Prostatabiopsie bei Männern mit unauffälligem digital-rektalen Tastbefund

Zusammenfassung

Hintergrund:

Die vorliegende Studie untersucht den Stellenwert einer systematischen elastografie-gesteuerten Biopsie im Vergleich zur herkömmlichen Biopsie auf Grundlage des Graustufen-Ultraschalls bei Patienten mit unauffälligem digital-rektalen Tastbefund.

Material und Methoden:

Insgesamt wurden 231 Patienten mit Verdacht auf das Vorliegen eines Prostatakarzinom prospektiv randomisiert und anschließend entweder mittels Real-time Elastografie (126) oder Graustufen-Ultraschall (105) transrektal untersucht. Die Untersuchung beschränkte sich auf die periphere Zone unter Einteilung der Prostata in 6 festgelegte Sektoren (Basis, Mitte, Apex). Suspekt verhärtete Areale, die in der Real-time Elastografie, blau zur Darstellung kommen sowie suspekte, hypoechoische Areale im Graustufen-Ultraschalls wurden erfasst. Die Prostatabiopsie erfolgte jeweils nach einem systematischen 10-fach Schema unter Berücksichtigung der entsprechend suspekten Lä­sionen in den bildgebenden Verfahren. Die Karzinom-Vorhersagegenauigkeit und histologische Karzinom-Detektionsrate wurden vergleichend analysiert.

Ergebnisse:

Alter, PSA-Wert und Prostatavolumen in beiden randomisierten Gruppen waren statistisch vergleichbar (p>0,05). Bei 76 von 231 Patienten (32,9%) wurde ein Prostatakarzinom histopathologisch diagnostiziert. Bei Verwendung der Real-time Elastografie war die Karzinom-Detektionsrate signifikant höher (40,5%, p=0,007) als bei Anwendung des Graustufen-Ultraschalls (23,8%). Die Sensitivität und Spezifität zur Vorhersage des Karzinombefalls in insgesamt 1386 Prostatasektoren betrug 53,5% und 70,5% bei Verwendung der Real-time Elastografie verglichen mit 11,7% und 93,7% bei Verwendung des Graustufen-Ultraschalls.

Schlussfolgerung:

Im Rahmen einer systematischen 10-fach Prostatastanzbiopsie verbessert die Anwendung der Real-time Elastografie die Vorhersage und Detektion eines vorliegenden Prostatakarzinoms signifikant im Vergleich zum Graustufen-­Ultraschall.

Abstract

Purpose:

The aim of this study was to evaluate whether real-time elastography-guided biopsy in comparison to grey-scale ultrasound improves prostate cancer detection in patients with an unremarkable digital rectal exam.

Material and Methods:

A total of 231 patients suspicious for prostate cancer were prospectively randomised to transrectal real-time elastography- (126) or grey-scale ultrasound (105)-guided biopsy. The peripheral zone was divided into 6 sectors from base, mid-gland to apex. Lesions with reduced elasticity during real-time elastography and hypoechoic areas during grey-scale ultrasound were defined as suspicious for prostate cancer. Prostate biopsy was guided by real-time elastography (RTE) or grey-scale ultrasound (GSU) using a systematic 10-core approach. Suspicious lesions on RTE or GSU in the corresponding randomised group were targeted within each sector. Accuracy of cancer prediction and histopathological cancer detection rates were evaluated and compared between the 2 imaging modalities

Results:

Baseline characteristics of patients undergoing real-time elastography and grey-scale ultrasound, including age, prostate-specific antigen and prostate volume were not significantly different statistically (p>0.05). Overall, prostate cancer was detected in 76 of 231 cases (32.9%). The cancer detection rate was significantly higher (p=0.007) in patients who underwent a biopsy using real-time elastography (40.5%) compared to the grey-scale-guided group of men (23.8%). Sensitivity and specificity to detect prostate cancer in 1 386 prostate sectors was 53.5% and 70.5% for real-time elastography vs. 11.7% and 93.7% for grey-scale ultrasound, respectively.

Conclusion:

Compared to conventional grey-scale ultrasound, accuracy to detect prostate cancer using a systematic 10-core biopsy approach was significantly improved under the guidance of real-time elastography.

Schlüsselwörter

Real-Time Elastografie - Prostata - transrektale Biopsie - Ultraschall - Prostatakarzinom

Key words

real-time elastography - prostate - biopsy - ultrasound - cancer

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