Correlation between three-dimensional ultrasound features and pathological prognostic factors in breast cancer.

OBJECTIVES: To investigate the correlation of three-dimensional (3D) ultrasound features with prognostic factors in invasive ductal carcinoma. METHODS: Surgical resection specimens of 85 invasive ductal carcinomas of 85 women who had undergone 3D ultrasound were included. Morphology features and vascularization perfusion on 3D ultrasound were evaluated. Pathologic prognostic factors, including tumour size, histological grade, lymph node status, oestrogen and progesterone receptor status (ER, PR), c-erbB-2 and p53 expression, and microvessel density (MVD) were determined. Correlations of 3D ultrasound features and prognostic factors were analysed. RESULTS: The retraction pattern in the coronal plane had a significant value as an independent predictor of a small tumour size (P = 0.014), a lower histological grade (P = 0.009) and positive ER or PR expression status (P = 0.001, 0.044). The retraction pattern with a hyperechoic ring only existed in low-grade and ER-positive tumours. The presence of the hyperechoic ring strengthened the ability of the retraction pattern to predict a good prognosis of breast cancer. The increased intra-tumour vascularization index (VI, the mean tumour vascularity) reflected a higher histological grade (P = 0.025) and had a positive correlation with MVD (r = 0.530, P = 0.001). CONCLUSIONS: The retraction pattern and histogram indices of VI provided by 3D ultrasound may be useful in predicting prognostic information about breast cancer. KEY POINTS: Three-dimensional ultrasound can potentially provide prognostic evaluation of breast cancer. The retraction pattern and hyperechoic ring in the coronal plane suggest good prognosis. The increased intra-tumour vascularization index reflects a higher histological grade. The intra-tumour vascularization index is positively correlated with microvessel density.

Contrast-enhanced transrectal ultrasonography: measurement of prostate cancer tumor size and correlation with radical prostatectomy specimens.

OBJECTIVES: To determine the accuracy of contrast-enhanced transrectal ultrasonography for tumor size measurements of hypoechoic prostate cancer foci located in the peripheral zone. METHODS: A total of 55 men scheduled for radical prostatectomy, with biopsy-proven cancer in hypoechoic foci located in the peripheral zone, were consecutively enrolled in the present prospective study. Each patient underwent grayscale ultrasound and contrast-enhanced transrectal ultrasonography of the prostate according to a standardized protocol. The maximum tumor diameter on grayscale imaging and contrast-enhanced transrectal ultrasonography was compared with that determined using histopathology. RESULTS: A mean underestimation was documented to be approximately 3.9 mm and 0.6 mm for grayscale and contrast-enhanced transrectal ultrasonography imaging, respectively. Grayscale and contrast-enhanced transrectal ultrasonography imaging underestimated measurements by 76.67% (46 of 60) and 48.33% (29 of 60), whereas overestimated measurements were 20% (12 of 60) and 26.67% (16 of 60), respectively. A strong correlation was observed between contrast-enhanced transrectal ultrasonography and histopathological measurements (r = 0.91, P < 0.0001). A weak linear correlation was found between grayscale and histopathological measurements (r = 0.59, P < 0.0001). Bland-Altman analysis results were in complete accordance with correlation analysis results. For cases with maximum histopathological tumor diameters ≤10 mm and >10 mm, 40% (6 of 15) and 86.67% (39 of 45) were index tumors, respectively (P < 0.0001). CONCLUSIONS: Contrast-enhanced transrectal ultrasonography is significantly more accurate than conventional grayscale imaging for measuring prostate tumor size, especially for tumors with a diameter >10 mm, and it might have a role in preoperative assessment of prostatic index tumor sizes.

Comparation of the predictive value between ultrasonography and urodynamics for the efficacy of transurethral resection of prostate in benign prostatic hyperplasia patients.

BACKGROUND: Transurethral resection of prostate (TURP) has been widely used as a golden standard therapy of benign prostatic hyperplasia for over 40 years. However, not all patients achieved favorable outcome postoperatively. Since the level of bladder outlet obstruction and the dysfunction of detrusor (overactive and underactive) were both found to affect surgical efficacy, urodynamics was recommended as routine preoperative examination in selecting proper surgical candidates by International Continence Society in spite of its invasiveness and high cost. The aim of this research was to compare the predictive value between ultrasonography and urodynamics for TURP efficacy and determine if preoperative urodynamic test could be replaced by ultrasonography. METHODS: Two hundred and seventy-one patients took part in the retrospective analysis. All the subjects had preoperative evaluation of symptoms, life quality, and combined examination of ultrasonography and urodynamics. Surgical efficacy was measured according to the recovery of international prostate symptom score, quality of life score, and maximal flow rate 6 months after TURP. Fisher's linear discriminant analysis was applied to establish the predictive models of surgical efficacy by choosing parameters from ultrasonography or urodynamics as independent factors. Receiver's operating characteristic curve was then plotted to compare the values between the models. RESULTS: Sensitivity, specificity, positive and negative predictive value of models consisting of parameters from both ultrasonography and urodynamics were favorable. Corresponding models of ultrasonography and urodynamics were found to have non-significant difference in area under curve (P > 0.05). CONCLUSIONS: Preoperative ultrasonography has as strong value as urodynamics does in predicting surgical outcome of patients undergone TURP and might take the place of urodynamics in selecting surgical candidates. Further prospective analysis with larger popularity and longer period of follow up should be launched to verify the result of this research.

Utility of the transition zone index for identification of prostate cancer in Chinese men with intermediate PSA levels.

PURPOSE: We aimed to investigate the utility of the transition zone index (TZI) for identification of prostate cancer (PCa) in Chinese men with prostate-specific antigen (PSA) levels of 4-10 ng/mL. METHODS: In this retrospective cohort study, results of transrectal ultrasonography (TRUS)-guided biopsy were assessed in 616 consecutive Chinese men; all subjects had intermediate serum PSA levels and normal digital rectal examination findings. The prostate and transition zone volumes were determined by TRUS. A TZI cutoff value of 0.47 produced the best sensitivity and specificity rates in receiver operating characteristic (ROC) curve analysis and thus was used to classify the study subjects into two subgroups: group 1 with TZI ≤ 0.47 and group 2 with TZI > 0.47. Logistic regression analysis was used to predict outcomes. The variables that were statistically significant in the stepwise logistic regression analysis were assessed using the ROC curve and the area under the curve. RESULTS: Overall, 166 of the 616 patients (26.9%) had histologically confirmed PCa. A total of 238 (38.6%) patients were classified into group 1, of whom 97 (40.8%) exhibited a positive biopsy; and 378 (61.4%) patients were classified into group 2, of whom 69 (18.3%) exhibited a positive biopsy. The stepwise logistic regression analysis revealed that PSA density (PSAD) exhibited the strongest predictive value in the overall population and in group 1, whereas PSA transition zone density (PSATZD) was the optimal predictor in group 2. The ROC curve analysis revealed that when using the TZI-specific 100% sensitivity cutoffs, 17.7% and 25% of the biopsies were unnecessary and could be avoided in the overall patient population prior to and following the division into groups, respectively (P = 0.002). Using an individually generated 95% sensitivity cutoff of 0.12 ng/mL(2) for PSAD and a cutoff of 0.179 ng/mL(2) for PSATZD for TZI-stratified cohorts of TZI ≤ 0.47 and TZI > 0.47, a more consistent specificity of 44% and 46.9%, respectively, for each cohort was observed. CONCLUSIONS: The optimal predictor for PCa differs between various TZI levels. The combination of PSAD in patients with TZI ≤ 0.47 and PSATZD in patients with TZI > 0.47 helps to identify potentially unnecessary biopsies compared to the use of a single PSAD for the entire patient population. The discrepancies regarding an optimal predictor in published reports are most likely due to the differing TZI levels among the cases. In this study, we demonstrated improved identification of PCa using TZI-adjusted cutoffs for PSAD and PSATZD.

Predictive value of resistive index, detrusor wall thickness and ultrasound estimated bladder weight regarding the outcome after transurethral prostatectomy for patients with lower urinary tract symptoms suggestive of benign prostatic obstruction.

OBJECTIVES: To evaluate the value of three parameters from preoperative ultrasonography in predicting the outcome of transurethral prostatectomy in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction. METHODS: A total of 239 patients with lower urinary tract symptoms suggestive of benign prostatic obstruction entering our department for surgical therapy were prospectively recruited. All of them underwent both ultrasound and urodynamics before receiving standard transurethral prostatectomy by the same team of surgeons. For 202 patients, 6-month follow-up data were available after the surgery, including the International Prostate Symptom Score, the Quality of Life score and the maximum flow rate. Preoperative data stratified by different degree of recovery were compared and the influence of ultrasound parameters on the surgical outcome was analyzed by using logistic regression and receiver-operator characteristic curve analyses. RESULTS: Baseline transitional zone index, intravesical prostatic protrusion, resistive index, detrusor wall thickness and ultrasonic estimation of bladder weight were significantly different between patients with an effective outcome and those with an ineffective outcome (P < 0.05). Resistive index, detrusor wall thickness and ultrasonic estimation of bladder weight were selected as independent factors correlated with the efficacy of transurethral prostatectomy by logistic regression (P < 0.05). All three factors had adequate area under receiver-operator characteristic curve with resistive index having the largest area (0.816, 95% CI 0.759-0.874). The combined positive predictive value in effective surgical outcome of resistive index, detrusor wall thickness and ultrasonic estimation was 96.3%. CONCLUSIONS: Resistive index, detrusor wall thickness and ultrasonic estimation adequately predict the outcome of transurethral prostatectomy. Measuring these parameters by preoperative ultrasound might aid in determining the need for surgical intervention.