Role of transrectal ultrasonography in the prediction of prostate cancer: artificial neural network analysis.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic performance of an artificial neural network (ANN) model with and without transrectal ultrasonographic (TRUS) data. METHODS: Six hundred eighty-four consecutive patients who had undergone TRUS-guided prostate biopsy from May 2003 to January 2005 were enrolled. We constructed 2 ANN models. One (ANN_1) incorporated patient age, digital rectal examination findings, prostate-specific antigen (PSA) level, PSA density, transitional zone volume, and PSA density in the transitional zone as input data, whereas the other (ANN_2) was constructed with the above and TRUS findings as input data. The performances of these 2 ANN models according to PSA levels (group A, 0-4 ng/mL; group B, 4-10 ng/mL; and group C, >10 ng/mL) were evaluated using receiver operating characteristic analysis. RESULTS: Of the 684 patients who underwent prostate biopsy, 214 (31.3%) were confirmed to have prostate cancer; of 137 patients with positive digital rectal examination results, 60 (43.8%) were confirmed to have prostate cancer; and of 131 patients with positive TRUS findings, 93 (71%) were confirmed to have prostate cancer. In groups A, B, and C, the AUCs for ANN_1 were 0.738, 0.753, and 0.774, respectively; the AUCs for ANN_2 were 0.859, 0.797, and 0.894. In all groups, ANN_2 showed better accuracy than ANN_1 (P < .05). CONCLUSIONS: According to receiver operating characteristic analysis, ANN with TRUS findings was found to be more accurate than ANN without. We conclude that TRUS findings should be included as an input data component in ANN models used to diagnose prostate cancer.     

Peripheral zone hypoechoic lesions of the prostate: evaluation with contrast-enhanced gray scale transrectal ultrasonography.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of contrast-enhanced gray scale transrectal ultrasonography (TRUS) for detection of prostate cancer in peripheral zone hypoechoic lesions of the prostate. METHODS: The study involved 66 patients with peripheral zone hypoechoic lesions detected by TRUS. The lesions were evaluated with contrast-enhanced TRUS to differentiate prostate cancer from benign lesions, and the results were compared with color Doppler ultrasonographic findings. RESULTS: Transrectal ultrasonographically guided biopsy of the hypoechoic lesions revealed prostate cancer in 30 patients and benign prostatic diseases in 36. Flow signals within the lesions were classified as no, increased, equal, and decreased flow compared with surrounding peripheral zone tissue as follows: 1, 16, 12, and 1, respectively, in the prostate cancer group and 10, 12, 10, and 4 in the benign disease group. If we considered an increased flow signal within a peripheral hypoechoic lesion as a sign of prostate cancer, color Doppler ultrasonography had low sensitivity and specificity (55.2% and 53.8%, respectively). The enhancement intensity within the lesions was classified as no, increased, equal, and decreased enhancement compared with surrounding peripheral zone tissue as follows: 2, 20, 3, and 5 in the prostate cancer group and 14, 8, 4, and 10 in the benign disease group. The difference was statistically significant (P<.05). Thus, the peak enhancement intensity would be the optimal parameter for discriminatory performance (area under the receiver operating characteristic curve, 0.74; 95% confidence interval, 0.60-0.88). CONCLUSIONS: Contrast-enhanced TRUS could reveal the presence of vasculature within peripheral zone hypoechoic lesions more objectively than color Doppler ultrasonography and could be promising in guidance of prostate biopsy.     

前列腺癌经直肠超声显像与病理组织学类型的关系

目的:观察前列腺癌的超声声像图特点与病理对照,提高前列腺癌的超声诊断水平。方法:分析21例经术后病理证实为前列腺癌的经直肠超声图像,观察有无异常回声肿块以及肿块的超声回声类型,并分析其与病理组织类型的关系。结果:21例前列腺癌患者经直肠超声诊断正确18例,诊断符合率85.7%,误诊3例,占14.3%。13例表现为低回声结节(占61.9%),8例表现为高回声结节或混合回声结节(占38.1%)。低分化腺癌和中分化腺癌主要表现为低回声(分别占64%和75%)。结论:经直肠超声可以提高前列腺癌的检出率。     

Role of transrectal ultrasound and prostate biopsy

Transrectal ultrasound (TRUS) has revolutionized our ability to image the human prostate. In the present review we, have attempted to present salient observations with respect to this modality. We emphasize its use in combination with biopsy in men who are considered at risk for harboring carcinoma. The relevant English literature is reviewed. In addition, our experience with 2,231 consecutive ultrasound-guided biopsies performed at the University of Washington and the Seattle VA Medical Center is analyzed. TRUS appears to have its primary use in directing the biopsy needle into suspicious areas and in performing the so-called systematic sector approach to biopsy. The role of transrectal ultrasound in staging established malignancy or in monitoring men following therapy remains to be defined. In our experience, carcinoma was detected in 27.2% of the subjects. Carcinoma was found in 30.7% of patients with a hypoechoic sector. Of note, 18.4% of men had their only carcinoma found in isoechoic areas. Failure to biopsy isoechoic sectors would have resulted in missing almost 20% of men with carcinoma. The role of TRUS in men with initially negative biopsy is also discussed. In summary, ultrasound guided biopsy is a useful addition to our armamentarium, particularly with respect to performing biopsy. Future advances in this modality include image enhancement utilizing computer technology as well as the potential additive role of color flow ultrasound. © 1996 John Wiley & Sons, Inc.     

经直肠超声检查在妇科疾病中的初步应用

目的 探讨经直肠法妇科超声检查的适应证及其诊断价值.方法 对39例不宜行经阴道超声检查的患者行经直肠法妇科超声检查,分析其声像图特征.结果 24例阴道异常大量出血患者经直肠超声可清晰显示子宫内膜回声和厚度;6例宫颈癌患者经直肠超声可清晰显示宫颈异常回声和血流表现,其中2例可见低回声占位,边界不清;8例无性生活史者和1例先天性阴道闭锁患者经直肠超声可清晰显示子宫体、宫颈、内膜、双侧卵巢及盆腔情况.结论 经直肠法妇科超声检查是一种安全、无创且可行性强的超声检查方法,对不宜行经阴道超声检查的患者,经直肠法可作为良好的替代方式,有较高的临床应用价值.     

Predictors of testicular sperm retrieval in patients with non-obstructive azoospermia: a review

Azoospermia is divided into two categories of obstructive azoospermia and non-obstructive azoospermia. Before 1995, couples with a male partner diagnosed with non-obstructive azoospermia had to choose sperm donation or adoption to have a child. Currently, testicular sperm aspiration or micro-dissection testicular sperm extraction combined with intracytoplasmic sperm injection allows patients with non-obstructive azoospermia to have biological offspring. The sperm retrieval rate is significantly higher in micro-dissection testicular sperm extraction compared with testicular sperm aspiration. Additionally, micro-dissection testicular sperm extraction has the advantages of minimal invasion, safety, limited disruption of testicular function, a low risk of postoperative intratesticular bleeding, and low serum testosterone concentrations. Failed micro-dissection testicular sperm extraction has significant emotional and financial implications on the involved couples. Testicular sperm aspiration and micro-dissection testicular sperm extraction have the possibility of failure. Therefore, predicting the sperm retrieval rate before surgery is important. This narrative review summarizes the existing data on testicular sperm aspiration and micro-dissection testicular sperm extraction to identify the possible factor(s) that can predict the presence of sperm to guide clinical practice. The predictors of surgical sperm retrieval in patients with non-obstructive azoospermia have been widely studied, but there is no consensus.     

经直肠超声检查在血精病因分析中的价值

目的探求经直肠超声检查在血精病因诊断中的价值。方法对53例血精患者经直肠超声检查前列腺、精囊及射精管。结果53例血精患者中47例(88.7%)伴有射精管囊肿、苗勒氏管囊肿、精囊炎、前列腺病变;9例患者在前列腺、精囊及射精管囊肿内发现结石或钙化。炎症是本组血精最常见的病因(26例,39.6%)。结论经直肠超声检查对确定血精的局部性病因具有较高的价值,是血精首选的影像学诊断方法。     

Transrectal ultrasonography in the diagnosis of urethral diverticula in women

The diagnosis of urethral diverticula in women can be difficult. Several imaging modalities have been described for evaluating this entity: urethrography; transabdominal, transrectal, transvaginal, and transperineal ultrasonography; computed tomography (CT); and magnetic resonance (MR) can be helpful in evaluating a diverticulum and its relationship to the urethra. We report on four women aged 36 to 42 years with urethral diverticula. Transrectal ultrasonography (TRU) was the most useful diagnostic test in our series. TRU showed 7 urethral diverticula and provided information about its shape, volume, and content as well as its spatial relationship about its shape, volume, and content as well as its spatial relationship to the urethra. In two cases, multiple diverticula were detected when only a single lesion was clinically suspected. Transabdominal sonography failed to demonstrate small diverticula. CT examination did not provide additional information except for the passage of the contrast from the urethra to the diverticulum in one of the cases. Voiding cystourethrogram was positive in only one patient. © 1997 John Wiley & Sons, Inc.     

经直肠腔内三维超声在肛瘘诊断中的价值

目的分析经直肠腔内三维超声对肛瘘的检出情况。方法 57例临床和术后证实的肛瘘患者,应用三维超声探查肛瘘并推注过氧化氢超声造影。结果 57例肛瘘患者,三维超声检出率100%。除去9例内盲瘘,内口检出率为33.3%(16/48),瘘道超声造影后检出率提高到60.4%(29/48);继发瘘道检出率为29.2%(14/48),继发瘘道超声造影后检出率提高到37.5%(18/48)。结论经直肠腔内三维超声结合瘘道过氧化氢超声造影可为外科手术提供更多的信息,指导手术。     

经直肠超声检查预测药物流产结局的研究

目的 探讨经直肠超声在预测药物流产结局方面的临床应用价值。方法 选择120例无任何合并症和并发症的药物流产妇女,于药物流产后第3天经直肠超声观察宫腔情况。根据宫腔内容物血流信号特征,分为Ⅰ、Ⅱ、Ⅲ型;根据宫腔内容物最大前后径,分为A(<10.0mm)、B(11.0~30.0mm)和C(>30.0mm)三组;并随访各组药物流产结局。结果 Ⅰ、Ⅱ、Ⅲ型患者药流成功率依次为95.83%、31.03%、0;清宫率依次为0、17.24%及100%;A、B、C三组患者药流成功率依次为94.67%、3.03%、0;清宫率依次为0、24.24%、100%,且各组间比较差异有统计学意义(P<0.05)。此外,随着血流信号丰富程度的增加,宫腔内容物大小呈逐渐上升趋势,差异有统计学意义(P<0.01)。结论 应用直肠超声观测宫腔情况对预测药物流产结局有一定的指导意义。对于宫腔内容物血流信号丰富且体积较大的药物流产患者,应加强监测,可积极行清宫术。     

Role of transcutaneous perianal ultrasonography in evaluation of fistulas in ano.

OBJECTIVE: The purpose of this study was to evaluate the role of transcutaneous perianal ultrasonography in evaluation of fistulas in ano and to assess its possible role as a first-line investigation, for follow-up, and as a possible substitute for magnetic resonance imaging. METHODS: Transcutaneous perianal ultrasonography was performed in 30 patients with fistulas in ano with the use of a 3- to 6-MHz sector probe, a 7- to 11-MHz linear probe, and a 5- to 7-MHz endocavitary probe. Patients were followed clinically and at surgery to assess the accuracy of transcutaneous perianal ultrasonography. RESULTS: A total of 43 fistulas, sinus tracts, or both were found in 26 patients. They appeared as hypoechoic tracts. Eleven of 30 patients had the presence of a collection or abscess, which appeared as hypoechoic areas. Twenty-four of 29 patients with positive findings underwent surgery. In these, 35 of 39 tracts were surgically confirmed (positive predictive value, 90%). The positive predictive value for demonstration of an internal opening was 85% (22/26) when compared with direct visualization or probing. Sensitivity for detection of tracts was 100%, and that for demonstration of an internal opening was 96% (26/27). The negative predictive value for sinus/fistulous tracts was nearly 100%. Transcutaneous perianal ultrasonography could not adequately evaluate suprasphincteric-type fistulas. However, it is a good, inexpensive modality in the evaluation of patients with fistulas in ano and also helps in follow-up of these patients. It can also be used to select patients who need magnetic resonance imaging. CONCLUSIONS: Transcutaneous perianal ultrasonography has the potential to become the first investigation in patients with perianal fistulas and abscesses.     

经腹联合经直肠超声在前列腺中线囊肿诊断中的应用

目的探讨经腹超声(TAS)联合经直肠超声(TRUS)对前列腺中线囊肿的诊断价值。方法根据检查方法将71例前列腺中线囊肿患者的资料分成两组,TRUS探查为对照组(30例),TAS+TRUS联合探查为观察组(41例),均经穿刺或病理证实,回顾分析并对比两组诊断符合率。结果观察组对是否与精道相通、伴随征象及并发症的检出能力高于对照组,两组的超声诊断符合率差异有统计学意义(P﹤0.05)。结论 TAS+TRUS联合探查较单纯使用TRUS在前列腺中线囊肿诊断时更加准确、全面。     

经直肠超声在前列腺囊肿诊断中的价值

目的探讨经直肠超声前列腺检查对前列腺囊肿的早期诊断价值。方法全部病例均行经腹超声(TAS)及经直肠超声(TRUS)对比检查。结果110例前列腺疾患者,TAS检出7例(6%)前列腺囊肿,TRUS检出24例(22%)前列腺囊肿,两种方法的检出率及不同年龄组的患病率有明显差异。结论TRUS对前列腺囊肿的探测敏感性高于TAS,而且可进一步帮助定性诊断,是诊断前列腺囊肿的理想方法。     

Role of ultrasound in the assessment of male infertility

The use of ultrasonography has become an important component in the evaluation and treatment of male reproductive tract disorders. From the use of color flow Doppler ultrasonography for the assessment of varicoceles to transrectal ultrasonography combined with seminal vesiculography for the evaluation of ejaculatory duct obstruction, ultrasonography has practical clinical applications. In this article, the authors review the indications and use of ultrasonography in the assessment and treatment of the infertile male. The recent advances in diagnostic transrectal ultrasonography for ejaculatory duct obstruction, in particular, are emphasized. © 1996 John Wiley & Sons, Inc.     

Seminal vesicle masses detected incidentally during transrectal sonographic examination of the prostate

PURPOSE: The aim of this study was to review the incidence and type of seminal vesicle (SV) masses discovered during transrectal sonography (TRUS) of the prostate. METHODS: Patients were a consecutive series of men referred for TRUS of the prostate because of lower urinary tract symptoms or elevated prostate-specific antigen levels, who were found on TRUS to have SV masses. Patients with prostate cancer involving the SVs were excluded. Cystic lesions were sampled by fine-needle aspiration and solid lesions by core biopsy, all under sonographic guidance. RESULTS: Of the 450 patients who underwent TRUS between January 1997 and December 2001, 10 (2%) were found to have SV masses; 5 masses were cystic and 5 were solid. Cytologic evaluation of aspirated specimens revealed benign findings in all 5 cysts. Four of the 5 patients with solid SV masses had chronic schistosomiasis, and the mass in the fifth patient was a metastatic deposit from a renal cell carcinoma. CONCLUSIONS: SV masses may be responsible for lower urinary tract symptoms in a small fraction of cases. A cystic mass is presumptively benign, whereas a solid lesion has a small probability of being malignant, especially if the patient has a primary neoplasm elsewhere. Schistosomiasis should always be considered when making a differential diagnosis in patients who live in areas where infestation is endemic.     

Role of systematic ultrasound-guided staging biopsies in predicting extraprostatic extension and seminal vesicle invasion in men with prostate cancer

PURPOSE: To assess the presence of extraprostatic extension and seminal vesicle invasion in men with prostate cancer, we performed systematic staging biopsies targeting neurovascular bundles, seminal vesicles, and other extraprostatic tissues before the men underwent radical prostatectomy. We retrospectively evaluated the clinical efficacy of these systematic staging biopsies compared with digital rectal examination (DRE) and transrectal sonography (TRUS). METHODS: Two hundred forty-four candidates for prostatectomy who had a diagnostic biopsy Gleason score of 8 or higher and/or indications of extraprostatic extension (eg, seminal vesicle invasion) by DRE or TRUS underwent staging biopsies using an 18-gauge Tru-Cut needle under real-time TRUS guidance between June 1997 and March 2000. We determined the number of staging biopsy cores to be taken based on the Gleason score of the diagnostic biopsy as well as abnormal DRE and/or TRUS findings. The chi-square test was used to evaluate the statistical significance of differences. RESULTS: There were no complications of staging biopsy. In 75 (31%) of the 244 patients, results of the staging biopsies were positive. The clinical stage was upgraded by staging biopsy in 18 (24%) of these 75 patients. After the staging biopsies, 90 patients underwent radical prostatectomy. Among these 90 patients, staging biopsy specimens were positive for cancer in 20 (47%) of the 43 patients who received neoadjuvant therapy and in 1 (2%) of the 47 patients who did not receive neoadjuvant therapy. There were no false-positive staging biopsies in either group. Among the 90 patients who underwent radical prostatectomy, the false-negative rate for the prediction of organ-confined disease was 43% (30/69) for staging biopsies compared with 29% (10/34) for TRUS. The diagnostic accuracy of staging biopsies (67%; 60/90) was higher than that of DRE (52%; 47/90; p < 0.05) but lower than that of TRUS (79%; 71/90; p = 0.066). CONCLUSIONS: Staging biopsies can reliably sample extraprostatic tissue, including the seminal vesicles and neurovascular bundles. Positive staging biopsy results can aid in the selection of treatment options and in the prediction of outcome for individual patients by providing definitive histologic confirmation of locally advanced disease. Conventional predictive variables for staging can be applied when the results of staging biopsies are negative.     

腔内超声在直肠癌术前分期中的价值

目的评价腔内超声在直肠癌术前分期中的价值。方法对48例直肠癌患者术前行腔内超声检查,与手术及病理结果对比,观察腔内超声对直肠癌浸润深度和区域淋巴结转移判断的准确性。结果腔内超声术前分期T分期的准确率为83.3%(40/48),N分期的准确率为66.7%(32/48),评价肿瘤侵犯外膜的敏感性和特异性分别为97.7%(43/44)和75.0%(3/4),评价淋巴结转移的敏感性为73.3%(22/30),特异性为61.1%(11/18)。结论腔内超声对直肠癌术前判断肿瘤侵犯层次、淋巴结转移等情况有重要价值。     

经直肠彩色多普勒超声在前列腺疾病中的诊断价值

目的探讨经直肠超声检查（TRUS）在良性前列腺增生症（BPH）和前列腺癌（PCa）鉴别诊断中的作用。方法应用TRUS对78例前列腺患者进行检查，包括63例BPH和15例PCa。对前列腺体积、内腺体积及内外腺比值。前列腺和结节之形态、边界、内部回声、血流形态分布及血流动力学参数进行分析。结果设立“前列腺体积增大、形态不规则、前列腺内血流增多（≥Ⅱ级）、血流分布不对称”和“外腺结节、形态不规则，边界不清，结节内部较密集血流信号，PSV增高（〉20cm／s）”两组征象，符合每组≥2项者为PCa诊断标准，良恶性鉴别诊断总符合率为96．2％（75／78例）。结论综合分析TRUS的征象，对于鉴别BPH和PCa极有帮助。