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Prostate Cancer: Three-dimensional Sonoelastography for in Vitro Detection¹

¹ From the Departments of Biomedical Engineering (L.S.T.) and Electrical and Computer Engineering (B.C.P., Z.W., K.J.P.), University of Rochester, 240 Hutchison Rd, Rm 205, Rochester, NY 14627-0126; Departments of Radiology (D.J.R.), Laboratory Animal Medicine (R.B.B.), Pathology and Laboratory Medicine (P.A.d.S., P.N.), Environmental Medicine, Strong Memorial Hospital (D.P.), and Urology (E.M.M.), University of Rochester School of Medicine and Dentistry, Rochester, NY; and Department of Pathology, Ohio State Medical Center, Columbus, Ohio (G.N.). Received September 10, 2004; revision requested November 14; revision received December 20; accepted January 21, 2005. Supported in part by NIH grant no. 5 R01 AG016317-03. Address correspondence to K.J.P. (e-mail: rcbu{at}ece.rochester.edu).

PURPOSE: To prospectively evaluate the accuracy of three-dimensional (3D) sonoelastographic imaging, relative to that of gray-scale ultrasonography (US), in the in vitro detection of prostate cancer.

MATERIALS AND METHODS: The study was approved by the institutional review board and was HIPAA compliant. Informed consent was obtained from all patients. Nineteen prostatectomy specimens from patients aged 46–70 years with biopsy-proved prostate cancer were scanned in three dimensions by using conventional B-mode US and sonoelastography with vibrations of more than 100 Hz. Step-sectioned whole-mount histologic specimens were used to create a 3D volume of the prostate and the tumors within it. B-mode US scans and regions of low vibration on the sonoelastographic images (hard regions) were formatted in three dimensions. The lesions in the 19 cases were classified into two groups, as follows: G1 lesions were pathologically confirmed tumors with a volume of at least 1.0 cm³, and G2 lesions were pathologically confirmed tumors smaller than 1.0 cm³. G1 lesions were evaluated with B-mode US and sonoelastography and classified as true-positive, false-positive, true-negative, or false-negative; G2 lesions were evaluated only with sonoelastography. Findings at histologic examination were used as the reference standard. True-positive findings necessitated 3D lesion correlation between pathologic and imaging data. Conventional definitions of accuracy and sensitivity were used for statistical analysis.

RESULTS: For G1 lesions (seven lesions with a volume of at least 1.0 cm³), sonoelastography had an accuracy of 55% and a sensitivity of 71% and B-mode US had an accuracy of 17% and a sensitivity of 29%. The mean tumor volume was 3.1 cm³ ± 2.1 (standard deviation). For G2 lesions (22 lesions with a volume of less than 1.0 cm³), the mean tumor volume was 0.32 cm³ ± 0.21. Sonoelastography had an accuracy of 34% and a sensitivity of 41%; there were six false-positive findings.

CONCLUSION: Sonoelastography performed considerably better than did gray-scale US in the depiction of prostate cancer for tumors with volumes of more than 1 cm³.

© RSNA, 2005

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