Transrectal Ultrasound Elastography – Evaluating Clinical Implications to Differentiate between Benign and Malignant Lesion of Prostate: A Prospective Observational Study

Introduction: Elastography is a non-invasive imaging to depict relative tissue stiffness or displacement (strain) in response toimpacted force, carcinoma prostate (Ca-P) tissue is stiffer than normal tissue. Shear wave elastography (SWE) is a modifiedreal-time imaging technique that represents a substantial advance in ultrasound elastography. There is no consensus regardingthe cut off value of elastography to differentiate between benign and malignant lesions.Methods: The present study aimed to determine cut off value to differentiate between benign and malignant lesions of prostateand to test sensitivity, specificity, and positive predictive value (PPV) of SWE. It is a prospective observational study, done over6 months at a single tertiary care center. The study included 50 patients. All patients underwent 12 cores prostate biopsies.Elastography of the involved segment compared with histopathology of core biopsy from the same segment.Results: Mean age was 69.12 years. Serum prostate specific antigen ranged from 3.8 to 698 ng/dl. Out of 50, 23 patientshad Ca-P, 27 patients had benign histology. Elasticity in Ca-P group ranged from 76.5 to 161.7 kPa, with mean of 109.39 kPa.Elasticity in the benign group ranged from 19.7 to 134.1 kPa, with mean of 69.94 kPa. Based on these mean elasticity values,we concluded 90 kPa as cut off value as a mean between benign and malignant values to differentiate between benign andmalignant lesions. Sensitivity calculated based on this cut off value is 82.6%, specificity – 55.6%, PPV – 61.3%, and negativepredictive value (NPV) – 78.9%.Conclusions: This study concludes that 90 kPa on SWE can be used as cut off between benign and malignant prostate lesionswith high sensitivity (82.6%) and specificity (55.6%) and PPV of 61.3% and NPV of 78.9%.

Evaluating Neonates With Antenatal Hyderonephrosis Using a Standard Protocol: An Audit of Hospital Records

Aims: To audit the extent of evaluation of neonates with antenatal hydronephrosis. Methods:Records of all neonates with antenatal hydronephrosis between January 2013 andDecember 2016 were audited to look for patient factors and investigation results. Results:290 records were evaluated, 93 (32%) of which had abnormalities detected on voidingcystourethrogram. In the presence of hydroureter, 65% had an abnormality while in theabsence only 11% were abnormal. In the presence of pelvis ?20 mm, 93% had abnormaldiuretic renogram, while with pelvis <20 mm, only 1.5% were abnormal (P=0.001). Numbersneeded to harm calculation revealed 1 in 2 patients would receive an unnecessary voidingcystourethrogram in the absence of hydroureter, and unnecessary diuretic renogram whenpelvis <20 mm. Conclusions: While evaluating neonates with antenatal hydronephrosisinvasive tests can be limited, if evaluation is guided by ultrasonographic criteria.