Transrectal quantitative shear wave elastography in the detection and characterisation of prostate cancer (original) (raw)

Abstract

Background

Shear wave imaging (SWI) is a new ultrasound technique whose application facilitates quantitative tissue elasticity assessment during transrectal ultrasound biopsies of the prostate gland. The aim of this study was to determine whether SWI quantitative data can differentiate between benign and malignant areas within prostate glands in men suspected of prostate cancer (PCa).

Methods

We conducted a protocol-based, prospective, prebiopsy quantitative SWI of prostate glands in 50 unscreened men suspected of prostate cancer between July 2011 and May 2012. The ultrasound image of whole prostate gland was arbitrarily divided into 12 zones for sampling biopsies, as is carried out in routine clinical practice. Each region was imaged by grey scale and SWI imaging techniques. Each region was further biopsied irrespective of findings of grey scale or SWI on ultrasound. Additional biopsies were taken if SWI abnormal area was felt to be outside of these 12 zones. Quantitative assessment of SWI abnormal areas was obtained in kilopascals (kPa) from abnormal regions shown by SWI and compared with histopathology. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios were calculated for SWI (histopathology was a reference standard).

Results

Fifty patients, with a mean age of 69 ± 6.2 years, were recruited into the study. Thirty-three (66 %) patients were diagnosed with PCa, while an additional 4 (8 %) had atypia in at least one of the 12 prostate biopsies. Thirteen (26 %) patients had a benign biopsy. Data analysed per core for SWI findings showed that for patients with PSA <20 μg/L, the sensitivity and specificity of SWI for PCa detection were 0.9 and 0.88, respectively, while in patients with PSA >20 μg/L, the sensitivity and specificity were 0.93 and 0.93, respectively. In addition, PCa had significantly higher stiffness values compared to benign tissues (p <0.05), with a trend toward stiffness differences in different Gleason grades.

Conclusion

SWI provides quantitative assessment of the prostatic tissues and, in our preliminary observation, provides better diagnostic accuracy than grey-scale ultrasound imaging.

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References

  1. Frauscher F, Gradl J, Pallwein L (2005) Prostate ultrasound–for urologists only? Cancer Imaging 5 Spec No A:S76–82
    Google Scholar
  2. Aigner F, Pallwein L, Schocke M, Lebovici A, Junker D, Schafer G, Mikuz G, Pedross F, Horninger W, Jaschke W, Halpern EJ, Frauscher F (2011) Comparison of real-time sonoelastography with T2-weighted endorectal magnetic resonance imaging for prostate cancer detection. J Ultrasound Med 30:643–649
    PubMed Google Scholar
  3. Ginat DT, Destounis SV, Barr RG, Castaneda B, Strang JG, Rubens DJ (2009) US elastography of breast and prostate lesions. Radiographics 29:2007–2016
    Article PubMed Google Scholar
  4. Spârchez Z (2011) Real-time ultrasound prostate elastography. An increasing role in prostate cancer detection? Med Ultrason 13:3–4
    PubMed Google Scholar
  5. Oehr P, Bouchelouche K (2007) Imaging of prostate cancer. Curr Opin Oncol 19:259–264
    Article PubMed Google Scholar
  6. Krouskop TA, Wheeler TM, Kallel F, Garra BS, Hall T (1998) Elastic moduli of breast and prostate tissues under compression. Ultrason Imaging 20:260–274
    Article PubMed CAS Google Scholar
  7. Zhai L, Polascik TJ, Foo WC, Rosenzweig S, Palmeri ML, Madden J, Nightingale KR (2012) Acoustic radiation force impulse imaging of human prostates: initial in vivo demonstration. Ultrasound Med Biol 38:50–61
    Article PubMed Google Scholar
  8. Curiel L, Souchon R, Rouviere O, Gelet A, Chapelon JY (2005) Elastography for the follow-up of high-intensity focused ultrasound prostate cancer treatment: initial comparison with MRI. Ultrasound Med Biol 31:1461–1468
    Article PubMed CAS Google Scholar
  9. Evans A, Whelehan P, Thomson K, McLean D, Brauer K, Purdie C, Jordan L, Baker L, Thompson A (2010) Quantitative shear wave ultrasound elastography: initial experience in solid breast masses. Breast Cancer Res 12:R104
    Article PubMed Google Scholar
  10. Barr RG, Memo R, Schaub CR (2012) Shear wave ultrasound elastography of the prostate: initial results. Ultrasound Q 28:13–20
    Article PubMed Google Scholar
  11. Bercoff J, Chaffai S, Tanter M, Sandrin L, Catheline S, Fink M, Gennisson JL, Meunier M (2003) In vivo breast tumor detection using transient elastography. Ultrasound Med Biol 29:1387–1396
    Article PubMed CAS Google Scholar
  12. Bercoff J, Pernot M, Tanter M, Fink M (2004) Monitoring thermally-induced lesions with supersonic shear imaging. Ultrason Imaging 26:71–84
    Article PubMed CAS Google Scholar
  13. Nelson ED, Slotoroff CB, Gomella LG, Halpern EJ (2007) Targeted biopsy of the prostate: the impact of color Doppler imaging and elastography on prostate cancer detection and Gleason score. Urology 70:1136–1140
    Article PubMed Google Scholar
  14. Sebag F, Vaillant-Lombard J, Berbis J, Griset V, Henry JF, Petit P, Oliver C (2010) Shear wave elastography: a new ultrasound imaging mode for the differential diagnosis of benign and malignant thyroid nodules. J Clin Endocrinol Metab 95:5281–5288
    Article PubMed CAS Google Scholar
  15. Sarvazyan A, Hall TJ, Urban MW, Fatemi M, Aglyamov SR, Garra BS (2011) An overview of elastography—an emerging branch of medical imaging. Curr Med Imaging Rev 7:255–282
    Article PubMed Google Scholar
  16. Urban MW, Alizad A, Aquino W, Greenleaf JF, Fatemi M (2011) A review of vibro-acoustography and its applications in medicine. Curr Med Imaging Rev 7:350–359
    Article PubMed Google Scholar
  17. Parker KJ, Doyley MM, Rubens DJ (2011) Imaging the elastic properties of tissue: the 20 year perspective. Phys Med Biol 56:R1–R29
    Article PubMed CAS Google Scholar
  18. Krouskop TA, Dougherty DR, Vinson FS (1987) A pulsed Doppler ultrasonic system for making noninvasive measurements of the mechanical properties of soft tissue. J Rehabil Res Dev 24:1–8
    PubMed CAS Google Scholar
  19. Garra BS (2011) Elastography: current status, future prospects, and making it work for you. Ultrasound Q 27:177–186
    Article PubMed Google Scholar
  20. Ophir J, Cespedes I, Ponnekanti H, Yazdi Y, Li X (1991) Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging 13:111–134
    PubMed CAS Google Scholar
  21. Ophir J, Garra B, Kallel F, Konofagou E, Krouskop T, Righetti R, Varghese T (2000) Elastographic imaging. Ultrasound Med Biol 26(Suppl 1):S23–S29
    Article PubMed Google Scholar
  22. Varghese T (2009) Quasi-static ultrasound elastography. Ultrasound Clin 4:323–338
    Article PubMed Google Scholar
  23. Tanter M, Bercoff J, Athanasiou A, Deffieux T, Gennisson JL, Montaldo G, Muller M, Tardivon A, Fink M (2008) Quantitative assessment of breast lesion viscoelasticity: initial clinical results using supersonic shear imaging. Ultrasound Med Biol 34:1373–1386
    Article PubMed Google Scholar
  24. Delahunt B, Miller RJ, Srigley JR, Evans AJ, Samaratunga H (2012) Gleason grading: past, present and future. Histopathology 60:75–86
    Article PubMed Google Scholar
  25. Aigner F, Mitterberger M, Rehder P, Pallwein L, Junker D, Horninger W, Frauscher F (2010) Status of transrectal ultrasound imaging of the prostate. J Endourol 24:685–691
    Article PubMed Google Scholar
  26. Kuligowska E, Barish MA, Fenlon HM, Blake M (2001) Predictors of prostate carcinoma: accuracy of gray-scale and color Doppler US and serum markers. Radiology 220:757–764
    Article PubMed CAS Google Scholar
  27. Barr RG, Destounis S, Lackey LB 2nd, Svensson WE, Balleyguier C, Smith C (2012) Evaluation of breast lesions using sonographic elasticity imaging: a multicenter trial. J Ultrasound Med 31:281–287
    PubMed Google Scholar
  28. Garg S, Fortling B, Chadwick D, Robinson MC, Hamdy FC (1999) Staging of prostate cancer using 3-dimensional transrectal ultrasound images: a pilot study. J Urol 162:1318–1321
    Article PubMed CAS Google Scholar
  29. Aboumarzouk OM, Ogston S, Huang Z, Evans A, Melzer A, Stolzenberg JU, Nabi G (2012) Diagnostic accuracy of transrectal elastosonography (TRES) imaging for the diagnosis of prostate cancer: a systematic review and meta-analysis. BJU Int 110(10):1414–1423; discussion 1423
    Google Scholar
  30. Evans A, Whelehan P, Thomson K, McLean D, Brauer K, Purdie C, Baker L, Jordan L, Rauchhaus P, Thompson A (2012) Invasive breast cancer: relationship between shear-wave elastographic findings and histologic prognostic factors. Radiology 263:673–677
    Article PubMed Google Scholar

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Acknowledgments

The authors thank SuperSonic Imagine (Aix-en-Provence, France) for an equipment grant to support this work.

Disclosures

The authors have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Academic Section of Urology, Division of Cancer, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, DD1 4HN, UK
    Sarfraz Ahmad, Rui Cao & Ghulam Nabi
  2. Clinical Research Imaging Facility, Division of Imaging and Technology, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, DD1 4HN, UK
    Luc Bidaut
  3. Department of Medical Physics, University of Wisconsin–Madison, Madison, WI, 53705, USA
    Tomy Varghese
  4. Division of Imaging and Technology, Medical Research Institute, Medical School, University of Dundee, Dundee, DD1 9SY, UK
    Ghulam Nabi

Authors

  1. Sarfraz Ahmad
  2. Rui Cao
  3. Tomy Varghese
  4. Luc Bidaut
  5. Ghulam Nabi

Corresponding author

Correspondence toGhulam Nabi.

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Ahmad, S., Cao, R., Varghese, T. et al. Transrectal quantitative shear wave elastography in the detection and characterisation of prostate cancer.Surg Endosc 27, 3280–3287 (2013). https://doi.org/10.1007/s00464-013-2906-7

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