Unusual indications for transrectal pelvic ultrasound.
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Transrectal ultrasound (TRUS), routinely performed by urologists to guide prostate biopsy, could be usefully employed in atypical cases. We report our experience in some patients in whom TRUS allowed to obtain a diagnosis in a faster and easier way in comparison to other instrumental procedures usually recommended.Cite
Definitive clinical diagnosis of prostate adenocarcinoma (PCa) requires histopathological confirmation of a tissue sample drawn from a 2D transrectal ultrasound (TRUS) guided biopsy. The prostate biopsy procedure, however, is plagued by high false negative rates (up to 34%) as early-stage PCa is generally not visible on ultrasound. As a result, a negative biopsy does not rule out a diagnosis of PCa, as many tumors are missed on initial biopsy. In such circumstances, patients will undergo multiple repeat prostate biopsy (RPBx) to find undetected PCa. In a repeat biopsy, the physician must either avoid previously biopsied tissue (in cases of prior negative biopsy) or target the same anatomical site for patients with non-diagnostic, atypical small acinar proliferations (ASAP). In cases of ASAP, there is a 40–50% chance of finding PCa on RPBx in the same anatomic location, so accurate targeting of prior biopsy locations is essential. 3D TRUS is hypothesized to be superior to 2D TRUS for accurate guidance and recording of the prostate biopsy procedure. Patients undergoing RPBx might benefit most from the hypothesized improvements, as previous Bx core locations can be viewed in 3D and used to guide a RPBx. Accuracy is also important when suspicious findings exist on other diagnostic imaging modalities, such as MRI or PET, are used to direct a TRUS-guided biopsy. In this paper, we describe a new method to guide prostate biopsy procedures using 3D ultrasound and extend it to prostate therapy. This new approach allows us to guide the biopsy to specific 3D targets in the prostate, record the biopsy locations in 3D, and register the intra-biopsy procedural 3D ultrasound image with an MR image to guide the biopsy to specific locations in the prostate. Learning Objectives: 1. Understand the limitations of conventional TRUS-guided prostate biopsy 2. Understand the methods that can be used to overcome the limitations of TRUS-guided prostate biopsy 3. Understand the advantages of using MR images fused with 3D ultrasound images to guide prostate biopsy
Prostate biopsy
3D ultrasound
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P Pu ur rp po os se e: : To evaluate the usefulness of ultrasound guidance in percutaneous needle biopsy for musculoskeletal tumours.M Me et th ho od ds s: : Forty-five consecutive patients underwent ultrasound-guided needle biopsy.An additional group of 50 patients who underwent needle biopsy without ultrasound guidance was retrospectively selected as historical control.The sample was considered adequate when a diagnosis can be made, and diagnostic when the diagnosis is similar to the final report based on the excised tumour.R Re es su ul lt ts s: : Adequacy of the biopsy samples was 84% in ultrasound-guided group as compared 76% in the group with no ultrasound guidance.Diagnostic accuracy was 64% in the ultrasound-guided group and 52% in the group without ultrasound guidance.Both of these differences were not statistically significant.C Co on nc cl lu us si io on ns s: : Ultrasound guidance did not provide a significant advantage in the biopsy of musculoskeletal tumours.Diagnostic accuracy seems to improve with the use of larger 14 gauge biopsy needle but further evaluation is necessary.
Percutaneous biopsy
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Purpose To explore the diagnostic value of transrectal ultrasound combined with MRI for the detection rate of prostate cancer (PCa) in prostate biopsy. Materials and Methods Transrectal ultrasound and MRI were applied to 168 suspected patients with PCa before puncture, and ultrasound and MRI physician together analyzed the image to determine suspicious lesions. Neither ultrasound nor MRI found the lesion, systematic 6 cores prostate biopsy were used; either of the two imaging found the lesion, the biopsy should be contained puncture one core of both transverse section and longitudinal section of the lesion and then systematic 6 cores biopsy. PCa detection rate was compared for the transrectal ultrasound, MRI and transrectal ultrasound combined with MRI based on the pathological results. Results In the 168 patients, there were 69 cases of PCa (52 cases in peripheral gland, 6 cases in whole gland, and 11 cased in transitional region) and 99 cases of hyperplasia of prostate gland. Transrectal ultrasound combined with MRI before biopsy could effectively improve the sensitivity and specificity (84.5% and 72.7%) compared with transrectal ultrasound (74.0% and 53.4%) or MRI (80.4% and 63.9%) separately. Conclusion Transrectal ultrasound combined with MRI before biopsy is an effective method to improve the detection rate of PCa, and DWI sequence especially contributes to detect the prostate cancer in transitional zones.
Prostate biopsy
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Objective To evaluate the usefulness of ultrasound-guided breast biopsy in clinics. Methods The clinical data of 78 female patients with breast solid lesion detected by ultrasound were retrospectively analyzed. Ultrasound guided breast lesion biopsy was performed in all the cases. The biopsy was carried out with 16 G cutting needle and automatic biopsy gun under percutaneous high frequency ultrasound guidance. The speimens were sent for pathologic examination. Results In the 78 patients,pathological examination revealed benign lesion in 62 cases and malignant lesions in 16 cases. No complications were encountered. Conclusion Ultrasound guided breast biopsy is easily performed and is sutiable for popularization in clinics.
Breast biopsy
Breast ultrasound
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Abnormality
Prostate biopsy
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Objective Using SonoVue to perform transrectal contrast-enhanced ultrasound in prostatic biopsy to discuss the impact of ultrasound on the accuracy and detection rate of biopsy.Methods 65 patients suspected of prostatic carcinoma were underwent TRUS-targeted biopsy.21 patients were randomly selected to perform contrast-enhanced ultrasound before biopsy.All suspected patients were underwent conventional 6+X biopsy.Suspected lesions were the +X according to contrast or conventional ultrasonogram.The pathology diagnosis was considered as the gold standard to compare the positive needles and positive rate between the two groups.Results There was statistical significance on the positive rate between the two groups.Average positive needles and positive rate of contrast examination group were both higher than non-contrast examination group.Conclusion Contrast-enhanced ultrasound has application value in identifying benign and malignant prostatic lesions and could increase the positive rate of biopsy.
Contrast-enhanced ultrasound
Gold standard (test)
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Objective To evaluate the advantages of transrectal contrast-enhanced ultrasound assis-ted prostate biopsy by comparing with systemic prostate biopsy . Methods From Jan.2010 to Dec.2011, 213 cases were selected randomly.Patient’s mean age was 71.0±8.9 （54-83） years.Their PSA level was 22.5±19.4 （4.1-150.0） μg/L.The positive rates of DRE and transrectal ultrasound were 55.9%（ 119/213） and 37.6%（80/213）.This group of patients were biopsied according to transrectal contrast-enhanced ultrasound assisted prostate biopsies （ experimental group ） .During the same period , another 218 cases were selected randomly.Patient′s mean age was 65.0±9.1 （36-94） years.Their PSA level was 23.3±18.9 （4.6-147.0） μg/L.The positive rates of DRE and transrectal ultrasound were 57.3%（ 125/218 ） and 38.1%（83/213）.This group of patients were biopsied according to systemic prostate biopsy （control group）.The data of two groups were compared to find out the advantages and disadvantages of transrectal contrast -en-hanced ultrasound assisted prostate biopsy . Results Comparing these two groups , the positive rates of prostate cancer in experimental group and control group were 38.0%（81/213） and 34.9%（76/218）, with no statistically significance （ P〉0.05）; the numbers of cores were 9.5 and 12.0, with statistically signifi-cance （P〈0.05）;the positive rates of single needle were 18.2%（369/2 025） and 11.5%（301/2 616）, with statistically significance （P〈0.05）; and the mean Gleason scores were 7.1 and 6.6, with statistically significance （P〈0.05）. Conclusions The efficiency of transrectal contrast-enhanced ultrasound assisted prostate biopsy is higher than systemic prostate biopsy .Transrectal contrast-enhanced ultrasound assisted prostate biopsy can be considered as a new option for prostate biopsy .
Key words:
Prostate cancer; Ultrasound; Contrast-enhanced ultrasound; Prostate needle bi-opsy
Contrast-enhanced ultrasound
Prostate biopsy
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OBJECTIVE: To review the role of ultrasound-guided core-needle biopsy (CNB) in the management of breast lesions. METHODS: Review of the most relevant literature on this topic. RESULTS: This technique shows a high sensitivity value of about 97.5% and it offers many advantages over other imaging techniques to guide a biopsy: non-ionising radiation, low cost, full control of the needle in real time, accessibility in difficult locations, multidirectional punctures and excellent comfort for patients and radiologists. All of these advantages have made this technique the most widespread used to perform a biopsy for a suspicious breast lesion. The most important limitation is the failure to perform a biopsy for lesions that are not seen on ultrasound. An adequate radiological-pathological correlation is necessary to minimise the false-negative results. CONCLUSION: Ultrasound-guided CNB has proven to be a reliable technique for performing a biopsy for breast lesions that can be clearly seen on ultrasound.
Interventional radiology
Core biopsy
Neuroradiology
Breast biopsy
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Prostate biopsy
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This study was performed to identify characteristics of suspicious lesions seen on breast MRI that are most likely to have an ultrasound correlate and to determine how often the presumed ultrasound correlate actually corresponds to the MRI finding.From September 2005 through December 2007, targeted ultrasound was performed for 519 suspicious MRI-detected lesions in 361 women. Retrospective review was performed to determine lesion type (mass vs nonmass), lesion descriptors, lesion size, BI-RADS category, indication for MR examination, patient age, and biopsy outcome. The results of 80 follow-up MRI examinations among 154 cases with concordant benign results on ultrasound-guided biopsy were noted.A presumed ultrasound correlate was found in 290 (56%) of the 519 lesions with masses more likely than nonmass lesions to be seen with ultrasound (62% of masses and 31% of nonmass lesions). Increasing lesion size, assessment of BI-RADS category 5 versus BI-RADS category 4, rim enhancement in masses, and clumped enhancement in nonmass lesions were also significantly more likely to have an ultrasound correlate. On follow-up imaging in 80 benign, concordant ultrasound-guided biopsies, the sonographic lesion did not correspond to the MRI finding in 10. Nine of these 10 lesions underwent subsequent MRI-guided biopsy and five cancers were diagnosed.The MR characteristics of lesions most likely to be seen with an ultrasound correlate were mass versus nonmass, increasing size, and increased level of suspicion of the lesion. Clip placement and follow-up imaging after ultrasound-guided biopsy that yields benign concordant results should be performed to detect cases in which the presumed ultrasound correlate is inaccurate to detect unsuspected false-negative biopsies.
Breast ultrasound
Breast MRI
Breast biopsy
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