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DOI: 10.1055/s-2002-33609
Transrektaler Ultraschall: Mehr als nur eine Punktionshilfe?
Transrectal Ultrasound: More than Aid in Directing Biopsies?Publication History
Publication Date:
25 September 2002 (online)
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Zusammenfassung
Einleitung: Die Prostatasextantenbiopsie gilt als Goldstandard in der invasiven Diagnostik des Prostatakarzinoms. Die Vorhersagekraft des konventionellen transrektalen Ultraschalls bleibt bislang unklar. Dies wird durch die vorliegende Studie prospektiv untersucht. Material und Methodik: Im Universitätsklinikum Benjamin Franklin der FU-Berlin wird eine ultraschallgesteuerte Zehnfachbiopsie der Prostata durchgeführt. Im Rahmen der vorliegenden Studie wurde das Echo im TRUS für jede Biopsie bestimmt und mit dem histologischen Befund korreliert. Unterschieden wurde zwischen folgenden Ultraschallsignalen: homogen, echoreich, echoarm, zystisch und gemischt. Ergebnisse: Zwischen Januar 2000 und Februar 2001 wurden 187 Patienten mit geplanter Zehnfachbiopsie der Prostata in die Studie aufgenommen. In allen Fällen fanden sich auswertbare Ergebnisse. Bei 49/66 (74,2 %) der Karzinompatienten zeigten sich suspekte Signale im TRUS, bei 34/66 (51,5 %) war der digital-rektale Befund klärungsbedürftig, bei 62/66 (93,9 %) bestand ein erhöhtes PSA. Nur bei 2/66 (3 %) Karzinompatienten lagen neben dem nichthomogenen TRUS keine weiteren Hinweise (DRU, PSA) auf eine Malignität vor. Innerhalb der Gruppe der Patienten mit benignen Erkrankungen lag bei 99/122 (81,1 %) ein auffälliger Ultraschallbefund vor. Insgesamt wurden 1841 histologische Befunde mit dem jeweiligen TRUS-Signal in Beziehung gesetzt. Es bestand keinerlei signifikante Korrelation zwischen einem Ultraschallsignal und einem histologischen Ergebnis. Weder eine Malignität, noch eine benigne Erkrankung ließ sich durch das Ultraschallsignal allein vorhersagen. Fazit: Die Sensitiviät des konventionellen TRUS zur Detektion eines Prostatakarzinoms liegt bei 15 %, die Spezifität bei 84 %. Es besteht keinerlei signifikante Korrelation zwischen TRUS-Signal und histologischem Befund. Der konventionelle transrektale Ultraschall ist daher nicht zur Vorhersage der Histologie geeignet.
Abstract
Introduction: The prostate sextant biopsy is regarded as the gold standard of invasive prostate cancer diagnostics. The unclear prognostic value of conventional transrectal ultrasound is examined in this prospective study. Material and Method: Ultrasound-guided 10-core prostate biopsies are performed at the University Hospital Benjamin Franklin of the Free University of Berlin. In this study, the TRUS echo was determined for each biopsy and correlated with the histological findings. The following ultrasound signals were differentiated: homogeneous, hyperechoic, hypoechoic, cystic and mixed. Results: Between January 2000 and February 2001, 187 patients scheduled for a 10-core prostate biopsy were included in the study. Results were assessable in all cases. TRUS signals were suspicious in 49/66 (74.2 %) of the cancer patients, while 34/66 (51.5 %) had unclear digital rectal findings and 62/66 (93.9 %) an elevated PSA. Only 2/66 (3 %) cancer patients had no indications (DRU, PSA) of malignancy other than the nonhomogeneous TRUS. Ultrasound findings were irregular in 99/122 (81.1 %) of the patients with benign diseases. A total of 1841 histological findings were correlated with the respective TRUS signal. No significant correlation was found between an ultrasound signal and a histological result. Neither malignancies nor benign diseases could be predicted by the ultrasound signal alone. Conclusion: Conventional TRUS has a 15 % sensitivity and an 84 % specificity for detecting prostate cancer. There is no significant correlation between the TRUS signal and histological findings. Thus, conventional transrectal ultrasound is not suitable for predicting histology.
Schlüsselwörter
Prostata - Biopsie - TRUS - Histologie
Key words
prostate - biopsy - TRUS - histology
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Dr. med. M. Schostak
Oberarzt der Urologischen Klinik und Poliklinik · Universitätsklinikum Benjamin Franklin · Freie Universität Berlin
Hindenburgdamm 30
D-12200 Berlin
Phone: 030 8445-2577
Fax: 030 8445 4448
Email: martin.schostak@medizin.fu-berlin.de