ISSN:0894-8771    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

There are many misconceptions in the field of ultrasonography. Some are because of poor understanding of anatomy and/or embryological or developmental features of certain organs, which have prevailed over the course of the centuries since the discovery of these entities (e.g., column of Bertin and hypertrophic column of Bertin). Some misconceptions derived from misinterpretation (e.g., double decidual sac sign) or inadequate observation of ultrasonographic findings. (e.g., hyperechoic stroma in polycystic ovarian syndrome).

ISSN:0894-8771    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Maintenance of hemodialysis graft and fistula patency is becoming even more important as the number of patients with end-stage renal disease increases. There are two major categories of dialysis access: native arteriovenous fistula (AVF) and synthetic arteriovenous graft. Arteriovenous fistulas have superior longevity after maturation and are the recommended type of hemodialysis access, if possible. However, AVFs have a higher rate of primary failure as compared with grafts. Close monitoring has been shown to prolong access survival. Ultrasound is a noninvasive means of imaging for access complications. Ultrasound is sensitive in detection of access or draining vein stenosis. Ultrasound is also useful in the evaluation of other graft or fistula abnormalities, such as pseudoaneurysm, steal, or infection. Careful attention to technical detail is required, and avoidance of several diagnostic pitfalls is necessary.

ISSN:0894-8771    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0894-8771    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

During the past 10 years, it has been suggested, and accepted by some, that transrectal ultrasound (TRUS) of the prostate should be used to identify a hypoechoic lesion or, if needed, guide biopsy into nonspecific areas. Retrospectively, the authors attempted to evaluate the need to identify areas that were on pathologic analysis, prostate cancer, but were not hypoechoic, but would require random/systematic biopsy to exclude prostate cancer. Six-hundred fifteen consecutive men were referred to the authors because of a concern found on digital rectal examination or because of increase in prostate-specific antigen. All patients underwent TRUS-guided biopsy of the prostate using either the four-quadrant or sextant biopsy technique. Each area undergoing biopsy was characterized as: 1) normal-appearing; 2) hypoechoic; 3) mixed echogenic (containing both hypoechoic and hyperechoic elements); 4) subtly hyperechoic (containing no calculi); or 5) isoechoic (lesion was seen because of distortion of the normal architecture). A diagnosis of carcinoma was made in 197 patients (32%). Of these, 99 (50.2%) patients had a hypoechoic lesion as the primary site, corresponding to their highest Gleason grade. Twenty-five (12.7%) had mixed echogenicity, nine (4.6%) had hyperechoic foci, and 23 (11.7%) had isoechoic biopsy-proven foci of prostate cancer. Forty-one (20.8%) patients with adenocarcinoma had normal ultrasound findings. The median Gleason grade for cancer in visible mixed echogenic and hyperechoic areas were generally higher than that for cancer in hypoechoic sites. Hypoechoic cancer sites had a Gleason grade range of 2 to 10 (median 5); mixed echogenic foci had a Gleason range of 2 to 10 (median 6); hyperechogenic cancers had a Gleason range of 2 to 8 (median 6); isoechoic cancers had a Gleason range of 2 to 7 (median 5); normal foci had a Gleason range of 2 to 8 (median 5). Results of this study suggest that 50% of clinically significant prostate cancers are not purely hypoechoic, and 37% of all diagnosed cancers contain no hypoechoic elements.

ISSN:0894-8771    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Prostate ultrasound has been accepted as the appropriate tool for prostate biopsy guidance to determine the presence of prostate cancer if the prostate-specific antigen (PSA) level is not normal. Prostate-specific antigen density (PSAD) has been used to determine if an increased PSA level may be because of benign enlargement of the gland or possible presence of cancer. The specific “cutoff” for PSA and PSAD to delineate which patients are at highest risk has been controversial. We attempted to assess which PSA level or PSAD level should be used. A retrospective analysis of 600 consecutive men, referred for prostate ultrasound and possible biopsy because of an abnormal DRE result or increased PSA level was undertaken. All had prostate volume determined by biplanar endorectal ultrasound. One hundred sixty-six men had cancer confirmed by biopsy. This latter group was further analyzed and was divided into PSA <4.0, PSA 4 to 10, or PSA >10.0 ng/ml. Groups were divided according to those with PSAD <0.10, <0.12, and <0.15 ng/ml. Correlation with Gleason grade of the tumor was made. Of the 166 men with cancer, 15 had PSA levels <4 ng/ml (all palpable), and 81 had PSA levels between 4.0 and 10.0 ng/ml (48 were not palpable by digital rectal examination [DRE]). There were 38 (22.8%) of 166 men with cancer who had a PSAD <0.15. Using the Gleason scoring system, 30 of 38 men had mid-grade or high-grade cancers. Twenty-one (12.6%) of 166 men with cancer had a PSAD <0.12. Of these, 17 of 21 men had mid-grade or high-grade cancers. Fifteen (9.0%) of 166 men with cancer had a PSAD <0.10. Of these, 13 of 15 had mid-grade or high-grade cancer. If the PSA level is more than 4.0 ng/ml, even if no palpable lesion is discerned by DRE, suspicion for the presence of cancer should be raised. The use of PSAD threshold of 0.15 is not inclusive enough to identify clinically important cancer, and it should not be used. Our data demonstrate that 7.9% of men with cancer had a PSAD <0.15 and mid-grade or high-grade, i.e., clinically important, cancer. Although more negative biopsy results will be obtained, we recommend the use of a lower PSAD “cutoff” than the literature has suggested. We recommend that those men with PSA levels more than 4 ng/ml and a PSAD higher than 0.10 should undergo a prostate biopsy to detect clinically important cancer.

ISSN:0894-8771    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Prostate cancer originates in the outer gland in 80% of patients and in the transition zone (TZ) in 20%. Transition zone lesions have historically been the most difficult to identify. There have been discrepancies regarding the importance of routinely performing biopsies of the inner gland when performing biopsies of the outer gland. To determine how often TZ tumors were diagnosed as the sole area of cancer, and to determine how frequently TZ tumors contained higher-grade cancer than the outer gland, we attempted to assess the value of including the TZ in routine biopsies of the prostate when no lesions are seen by gray-scale ultrasound (US). A retrospective review of 619 consecutive ultrasound-guided biopsies divided the subjects into: 1) directed biopsies of specific US-identified lesions (N = 140); 2) directed biopsies of specific US-identified lesions and quadrants (N = 165) or sextants (N = 174), including the TZ; and 3) quadrant (N = 46) or sextant (N = 93) biopsies without a focal US-identified lesion. Overall, 185 patients (29.9%) with cancer were identified. Of these, 21.4% (N = 30) of men with US-identified, focal lesion biopsies alone had cancer. Of those men with cancer, 35.8% (N = 59) with US-identified lesions and quadrant biopsies had cancer; 37.4% (N = 65) of those with focal lesions and sextant biopsies had cancer; 23.9% (N = 11) of men without focal lesions but quadrant biopsies had cancer; 21.5% (N = 20) of men without focal lesions but with sextant biopsies had cancer. A total of 267 sextant biopsies were performed: 3.0% (N = 8) of these patients were found to have cancer in the TZ alone without involvement of the outer gland; 12.4% (N = 33) had TZ and outer gland cancers, of which 18.2% (N = 6) had a higher Gleason grade cancer in the TZ than in the outer gland. Routine sextant biopsies in lieu of quadrant biopsies, including the TZ, for men with or without focal lesions will yield a small increase in the number of prostate cancers diagnosed or may identify a higher grade of cancer than would be expected from using quadrant biopsies alone.

ISSN:0894-8771    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The purpose of this article is to evaluate color Doppler imaging (CDI) as an adjunctive tool to gray-scale ultrasound (US) in the diagnosis of prostate cancer and to correlate CDI-positive lesions to cancer grade. We retrospectively analyzed 619 consecutive patients who underwent prostate US, CDI, and biopsy because of abnormal digital rectal examination results or prostate-specific antigen levels. All had directed (into a specific lesion) biopsies or directed biopsies along with systematic four-quadrant or sextant biopsies, or systematic biopsy alone. Color Doppler imaging was compared with gray-scale findings and histologic results. There were 222 (35.9%) biopsy-proven cancers (n = 197) or prostatic intraepithelial neoplasia (n = 25). Of these, 106 (47.7%) had color-flow abnormalities. Of these 106 patients, 26 (24.5%), or 11.7% of all cancer patients, had relatively normal gray-scale US findings but had focal CDI abnormalities as the method of identification. Overall, 76.9% of these were moderate to high Gleason grades and were considered clinically significant lesions. Color Doppler imaging can identify a large number (11.7%) of clinically significant prostate cancers that are poorly seen by gray-scale US. Positive lesions on CDI are of clinical importance because 76.9% are histologically, moderately, or poorly differentiated. We recommend that CDI be used in all diagnostic and biopsy-guided US examinations of the prostate.

ISSN:0894-8771    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The purpose of this article is to assess if the visual inspection of the prostate biopsy specimen can be used as a guide when deciding whether to attempt to sample another core of tissue from the same area if a less than adequate specimen was obtained during the first attempt. Five hundred thirty-seven specimens from 84 patients, referred because of an increased prostate-specific antigen (PSA) level and/or a suspicious result on digital rectal examination (DRE), were sampled and prospectively graded based on the lack of formation and amount of liquid in the specimen (grade I) compared to a highly rigid, solid core (grade V). Specimens were then fixed in formalin and retrospectively compared, and the pathologic diagnosis was compared with the subjective visual grade assigned to the specimen. Receiver–operator curve techniques were used to quantify the results and to test for statistical significance. Rigid biopsy specimens were cancer, and liquid, formless specimens were benign. Most biopsy specimens were solid, with moderate consistency, and could not be diagnosed accurately by visual inspection. Diagnosis of prostate cancer, despite the use of PSA, DRE, or diagnostic endorectal ultrasound, requires biopsy for definitive confirmation. Although the use of spring-loaded biopsy needles routinely yields good-quality cores of tissue for pathologic analysis, there are many occasions when a less than optimal specimen is obtained. The question of whether a repeat biopsy in that region is indicated always arises. These data suggest that if the initial specimen is grade I or II, repeat biopsy is probably not indicated. If the initial specimen is grade IV or V, repeat biopsy is recommended.

ISSN:0894-8771    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0894-8771    

出版商:OVID    

年代:2001

数据来源: OVID