Preoperative prediction of papillary thyroid microcarcinoma via multiparameter ultrasound.

Background Accurate diagnosis of papillary thyroid microcarcinoma (PTMC) is important for further management. Ultrasound (US) is the most frequently used imaging modality for PTMC. Purpose To evaluate the diagnostic value of conventional US, contrast-enhanced ultrasound (CEUS) and real-time elastography (RTE) for patients with PTMC. Material and Methods In total, 135 patients with subcentimeter thyroid nodules who underwent conventional US, CEUS, and RTE before surgery were enrolled. A multivariate logistic regression analysis was performed to assess the independent predictors of PTMC. The diagnostic performances of conventional US, CEUS, and RTE were evaluated with a receiver operating characteristic (ROC) curve analysis. Results A taller-than-wide shape was identified as the strongest predictor of PTMC (odds ratio [OR], 25.21), followed by heterogeneous enhancement (OR, 24.03), marked hypoechogenicity (OR, 21.71), poorly defined margin (OR, 5.51), strain ratio (OR, 2.59), and age (OR, 0.92; all P values < 0.05). Heterogeneous enhancement on CEUS showed the highest positive predictive value (PPV; 88.0%) and an accuracy of 83.7%. A logistic regression model was created to predict PTMC using conventional US, CEUS, and RTE. The area under the ROC curve was 0.97, with a sensitivity of 88.6% and a specificity of 94.6%. Conclusion Conventional US combined with CEUS and RTE can improve the diagnostic accuracy of PTMC.

Pharmacokinetic study and clinical evaluation of a slow-release 5-fluorouracil implant in pancreatic cancer patients.

The aim of this research was to study the pharmacokinetic characteristics of a slow-release 5-fluorouracil implant as well as to evaluate the clinical drug activity of this preparation in pancreatic cancer patients. Pharmacokinetic characteristics of the slow-release 5-fluorouracil implant were evaluated by examining the half-life time (T1/2) and apparent volume of distribution (Vd) in pancreatic cancer patients; the slow-release 5-fluorouracil implant was administered through interstitial chemotherapy (tumor interstitium implantation). In the drug activity study, 36 locally advanced unresectable pancreatic cancer patients were divided randomly into an experimental treatment group (n=18) and a standard treatment group (n=18). The experimental treatment group was treated with interstitial chemotherapy of a slow-release 5-fluorouracil implant combined with systemic chemotherapy of gemcitabine; the standard treatment group was treated with systemic chemotherapy of gemcitabine. An internal drainage procedure was used when biliary and/or gastrointestinal tract obstruction occurred in the two groups. Clinical benefit response, including pain (visual analogue scale), analgesic drug use, general conditions (Karnofsky performance score), weight changes, and survival status, was observed. T1/2 of the slow-release 5-fluorouracil implant was 5475.8±136.4 min, whereas Vd was 45275.0±1028.6 l. Clinical benefit response in the experimental treatment group was better than that in the standard treatment group. The experimental treatment group had longer median survival time compared with the standard treatment group. The slow-release 5-fluorouracil implant could deliver drugs mainly in the regional area of the tumor and prolong the drug action time; interstitial chemotherapy of a 5-fluorouracil implant combined with systemic chemotherapy of gemcitabine could improve the quality of life and survival status of pancreatic cancer patients. The method was promising and worthy of in-depth investigations.

Contrast-enhanced gray-scale transrectal ultrasound-guided prostate biopsy in men with elevated serum prostate-specific antigen levels.

RATIONALE AND OBJECTIVES: Our goal was to evaluate the role of contrast-enhanced gray-scale transrectal ultrasound (CETRUS)-guided prostate biopsy in patients with elevated serum prostate-specific antigen (PSA) levels. MATERIALS AND METHODS: A total of 115 men (mean age, 70 years; range, 47-85) with serum PSA levels of greater than 4.0 ng/ml were assessed using gray-scale transrectal ultrasound (TRUS), power Doppler ultrasound (PDU), and CETRUS. Subsequently, these patients underwent systematic sextant transrectal biopsy and additional biopsies for positive sites on gray-scale TRUS, PDU, and CETRUS. The cancer detection rates of the three techniques were compared. RESULTS: Cancer was detected in 63 of the 115 patients (55%). CETRUS was positive in 50 patients, 35 of whom (70%) had prostate cancer; CETRUS had a higher sensitivity, specificity, and accuracy of 65% (41/63), 83% (43/52), and 73% (84/115), respectively. CETRUS could have saved a significant number of patients from undergoing unnecessary biopsies, compared to TRUS and PDU. However, no significant correlation was found between the Gleason score and CETRUS grade. CONCLUSIONS: The use of CETRUS in detecting prostate cancer might reduce the number of unnecessary needle biopsies of the prostate in patients with abnormally high serum PSA levels and increase the detection rate of clinically significant prostate cancer.

Contrast-enhanced transrectal ultrasound for assessing vascularization of hypoechoic BPH nodules in the transition and peripheral zones: comparison with pathological examination.

The purpose of this study was to investigate the vascularization of zonal location of hypoechoic benign prostatic hyperplasia (BPH) nodules and to evaluate the clinical value of contrast-enhanced transrectal ultrasound (CETRUS) for assessing vascularity of hypoechoic BPH nodules. Sixty-two patients with hypoechoic biopsy-proven BPH nodules in transition zone (TZ) (32 patients) or peripheral zone (PZ) (30 patients) of the prostate gland underwent CETRUS examination between January 2006 and September 2006. The enhancement characteristics of hypoechoic BPH nodules were observed and time to enhancement (AT), time to peak intensity (TTP) and peak intensity (PI) were measured with ACQ time-intensity curve analysis software. In addition, microvessel density (MVD) and vascular endothelial growth factor (VEGF) immunoreactivity were determined in the biopsy specimens. Microvessels were identified by immunohistochemical staining of endothelial cells for CD34. Findings were compared between hypoechoic BPH nodules located in PZ and TZ. The most common enhancement characteristic of hypoechoic BPH nodules in PZ was nonenhanced area inside (21/30), while most of hypoechoic BPH nodules in TZ appeared homogeneous enhancement (28/32). The average AT and TTP were significantly longer, the average PI was significantly lower in hypoechoic BPH nodules located in PZ than TZ (p < 0.01). The VEGF expression and MVD were significantly higher in hypoechoic BPH nodules located in TZ than PZ (p < 0.01). PI was found to be an important parameter strongly correlated with degree of vascularity of hypoechoic BPH nodules. Hypoechoic BPH nodules located in PZ and TZ showed significant difference in vascularization, which indirectly verified our finding that BPH nodule could occur in the peripheral zone. CETRUS could afford information on the vascularity of hypoechoic BPH nodules in a noninvasive manner and this could be used to improve selection of nodules for biopsy.

[An autopsy specimen study of benign hyperplastic nodules in the peripheral zone of the prostate].

OBJECTIVE: To investigate the correlation and anatomic association of benign hyperplastic nodules in the peripheral zone (PZ) with those in the transition zone (TZ) of the prostate, and to compare the histological components of the two kinds of nodules. METHODS: We obtained benign hyperplastic nodules specimens from the PZ and TZ by autopsy, measured the distance between the outer surface of the nodules and the inner gland, observed the integrity of the surgical envelope of the prostate, and determined the histological components of the two kinds of nodules by HE staining, immunohistochemistry and automatic quantitative image analysis. RESULTS: The surgical envelope of the prostate was integrated and the distance between the nodules of the PZ and the outer surface of the inner gland was about 2.5 to 5 mm ([3.9 +/- 0.8] mm), with no signs of anatomic connection in between. The stromata and epithelia in the nodules accounted for (69.32 +/- 8.35)% and (16.08 +/- 5.36)% in the PZ and (74.58 +/- 8.95)% and (15.82 +/- 6.41)% in the TZ. CONCLUSION: Benign hyperplastic nodules may originate from the PZ of the prostate and not correlate with the inner gland hyperplasia in the TZ, but with no statistical difference between the histological components of the two kinds of nodules.

Peripheral zone hypoechoic lesions of the prostate: evaluation with contrast-enhanced gray scale transrectal ultrasonography.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of contrast-enhanced gray scale transrectal ultrasonography (TRUS) for detection of prostate cancer in peripheral zone hypoechoic lesions of the prostate. METHODS: The study involved 66 patients with peripheral zone hypoechoic lesions detected by TRUS. The lesions were evaluated with contrast-enhanced TRUS to differentiate prostate cancer from benign lesions, and the results were compared with color Doppler ultrasonographic findings. RESULTS: Transrectal ultrasonographically guided biopsy of the hypoechoic lesions revealed prostate cancer in 30 patients and benign prostatic diseases in 36. Flow signals within the lesions were classified as no, increased, equal, and decreased flow compared with surrounding peripheral zone tissue as follows: 1, 16, 12, and 1, respectively, in the prostate cancer group and 10, 12, 10, and 4 in the benign disease group. If we considered an increased flow signal within a peripheral hypoechoic lesion as a sign of prostate cancer, color Doppler ultrasonography had low sensitivity and specificity (55.2% and 53.8%, respectively). The enhancement intensity within the lesions was classified as no, increased, equal, and decreased enhancement compared with surrounding peripheral zone tissue as follows: 2, 20, 3, and 5 in the prostate cancer group and 14, 8, 4, and 10 in the benign disease group. The difference was statistically significant (P<.05). Thus, the peak enhancement intensity would be the optimal parameter for discriminatory performance (area under the receiver operating characteristic curve, 0.74; 95% confidence interval, 0.60-0.88). CONCLUSIONS: Contrast-enhanced TRUS could reveal the presence of vasculature within peripheral zone hypoechoic lesions more objectively than color Doppler ultrasonography and could be promising in guidance of prostate biopsy.

Does benign prostatic hyperplasia originate from the peripheral zone of the prostate? A preliminary study.

OBJECTIVE: To compare the histological characteristics, cell proliferation, apoptosis and biological features in benign prostatic hyperplasia (BPH) in the peripheral (PZ) and transition zone (TZ) of the prostate. PATIENTS AND METHODS: Tissue from BPH in TZ and PZ was obtained from 68 patients undergoing transrectal ultrasonography-guided biopsy and used for both morphometric analysis and immunohistochemical studies. The epithelial, stromal and luminal composition of the tissue was determined using a computer-assisted method for quantitative morphometric analysis. Apoptosis was detected as the apoptotic index (AI) using the TdT dUTP nick-end labelling assay. Cell proliferation was determined as the proliferation index (PI) using Ki-67 immunostaining. The expression of epidermal growth factor receptor (EGFR), transforming growth factor beta1 (TGFbeta1), androgen receptor (AR) and bcl-2 were assessed immunohistochemically. RESULTS: There was no difference in the stroma/epithelium ratio between PZ and TZ hyperplastic nodules (P > 0.05). The mean AI in epithelium was almost identical to the corresponding PI. In stroma, no apoptotic cells were detectable. There was a significantly higher PI and AI in the glandular epithelial cells in PZ hyperplastic than in TZ hyperplastic nodules, but no difference in PI of the stromal cells between PZ and TZ hyperplastic nodules. There was significantly higher expression of TGFbeta1 and lower expression of EGFR and bcl-2 in PZ than TZ hyperplastic nodules (P < 0.05). There was no difference in AR expression between PZ and TZ hyperplastic nodules (P > 0.05). CONCLUSIONS: These results indicate that some hyperplastic nodules in PZ might originate from the PZ, and the formation of these nodules might be modulated in a different way from that in the TZ.