-
PloS One 2022To investigate the accuracy of surface-based ultrasound-derived PSA-density (US-PSAD) versus gold-standard MRI-PSAD as a risk-stratification tool.
Evaluation of transabdominal and transperineal ultrasound-derived prostate specific antigen (PSA) density and clinical utility compared to MRI prostate volumes: A feasibility study.
PURPOSE
To investigate the accuracy of surface-based ultrasound-derived PSA-density (US-PSAD) versus gold-standard MRI-PSAD as a risk-stratification tool.
METHODS
Single-centre prospective study of patients undergoing MRI for suspected prostate cancer (PCa). Four combinations of US-volumes were calculated using transperineal (TP) and transabdominal (TA) views, with triplanar measurements to calculate volume and US-PSAD. Intra-class correlation coefficient (ICC) was used to compare US and MRI volumes. Categorical comparison of MRI-PSAD and US-PSAD was performed at PSAD cut-offs <0.15, 0.15-0.20, and >0.20 ng/mL2 to assess agreement with MRI-PSAD risk-stratification decisions.
RESULTS
64 men were investigated, mean age 69 years and PSA 7.0 ng/mL. 36/64 had biopsy-confirmed prostate cancer (18 Gleason 3+3, 18 Gleason ≥3+4). Mean MRI-derived gland volume was 60 mL, compared to 56 mL for TA-US, and 65 mL TP-US. ICC demonstrated good agreement for all US volumes with MRI, with highest agreement for transabdominal US, followed by combined TA/TP volumes. Risk-stratification decisions to biopsy showed concordant agreement between triplanar MRI-PSAD and ultrasound-PSAD in 86-91% and 92-95% at PSAD thresholds of >0.15 ng/mL2 and >0.12 ng/mL2, respectively. Decision to biopsy at threshold >0.12 ng/mL2, demonstrated sensitivity ranges of 81-100%, specificity 85-100%, PPV 86-100% and NPV 83-100%. Transabdominal US provided optimal sensitivity of 100% for this clinical decision, with specificity 85%, and transperineal US provided optimal specificity of 100%, with sensitivity 87%.
CONCLUSION
Transperineal-US and combined TA-TP US-derived PSA density values compare well with standard MRI-derived values and could be used to provide accurate PSAD at presentation and inform the need for further investigations.
Topics: Aged; Feasibility Studies; Humans; Magnetic Resonance Imaging; Male; Prospective Studies; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms; Retrospective Studies
PubMed: 36084119
DOI: 10.1371/journal.pone.0274014 -
Viszeralmedizin Feb 2015Pancreatic cystic lesions (PCL) are common. They are increasingly detected as an incidental finding of transabdominal ultrasound or cross-sectional imaging. In contrast... (Review)
Review
BACKGROUND
Pancreatic cystic lesions (PCL) are common. They are increasingly detected as an incidental finding of transabdominal ultrasound or cross-sectional imaging. In contrast to other parenchymal organs, dysontogenetic pancreatic cysts are extremely rare. In symptomatic patients the most frequent PCL are acute and chronic pseudocysts. The majority of incidental cystic lesions, however, are neoplasias which have different risks of malignancy.
METHODS
PubMed was searched for studies, reviews, meta-analyses, and guidelines using the following key words: ('pancreatic cystic lesions' OR 'cystic pancreatic lesions' OR 'intraductal papillary mucinous neoplasia' OR 'mucinous cystic neoplasia' OR 'pancreatic cyst' OR 'pancreatic pseudocyst') AND (management OR treatment OR outcome OR prognosis OR diagnosis OR imaging OR 'endoscopic ultrasound' EUS-FNA OR EUS OR 'endoscopic ultrasonography' OR CT OR MRI). Retrieved papers were reviewed with regard to the diagnostic and therapeutic management of incidental PCL.
RESULTS
In addition to clinical criteria, transabdominal ultrasonography including contrast-enhanced ultrasonography, cross-sectional radiological imaging, and endoscopic ultrasound (EUS) are used for diagnostic characterization and risk assessment. EUS plays an outstanding role in differential diagnosis and prognostic characterization of incidental PCL. In a single examination it is possible to perform high-resolution morphological description, perfusion imaging, as well as fine-needle aspiration of cyst content, cyst wall, and solid components. An international consensus guideline has defined worrisome and high-risk criteria for the risk assessment of mucinous pancreatic cysts, which are mainly based on the results of EUS and cross-sectional imaging. Nevertheless, despite diagnostic progress and guideline recommendations, differential diagnosis and management decisions remain difficult. This review will discuss problems in and approaches to the diagnosis of incidental PCL.
CONCLUSION
An evidence-based algorithm for the diagnosis of incidental PCL is proposed.
PubMed: 26288611
DOI: 10.1159/000375282 -
Medicine Aug 2021Clinical discovery/staging of gastric cancer (GC) is crucial in designing the treatment strategies and largely decides GC patients' survival. Endoscopic ultrasonography... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Clinical discovery/staging of gastric cancer (GC) is crucial in designing the treatment strategies and largely decides GC patients' survival. Endoscopic ultrasonography (EUS) and computed tomography (CT) are 2 useful GC diagnosis tools. High doses of radiation associated with CT make its use limited, while the process of EUS is stressful, time-consuming, and challenging. Transabdominal ultrasound (TAUS) is a promising candidate to address these shortcomings. This study aimed to meta-analyze the diagnostic accuracy and sensitivity of TAUS in discriminating between advanced and early GCs, as well as compare its utility with other imaging techniques.Methods: Literature searches were conducted using PubMed, Web of Science, Embase, and Cochrane Library databases up to 2019. Data were analyzed using RevMan software (Cochrane Collaboration, Oxford, UK), and pooled estimates of accuracy, sensitivity, and other features were acquired. Seven papers were eventually selected for meta-analysis.
RESULTS
TAUS had distinct diagnostic efficacies for early and advanced GC patients. The accuracy and sensitivity were significantly higher in the advanced group. A high color Doppler vascularity index and a lesion larger than 1 cm were 2 features of advanced GC. Moreover, TAUS had a comparable (but slightly higher) accuracy than CT and EUS.
CONCLUSIONS
TAUS is more accurate and sensitive in diagnosing advanced GC compared to early GC. More features of advanced GC are required to improve the recognition ability. At least, TAUS can be considered as a complementary imaging diagnostic tool to CT and EUS.
Topics: Abdomen; Humans; Reproducibility of Results; Stomach Neoplasms; Ultrasonography
PubMed: 34397938
DOI: 10.1097/MD.0000000000026928 -
Diagnostics (Basel, Switzerland) Dec 2022Image fusion of CT, MRI, and PET with endoscopic ultrasound and transabdominal ultrasound can be promising for GI malignancies as it has the potential to allow for a... (Review)
Review
Image fusion of CT, MRI, and PET with endoscopic ultrasound and transabdominal ultrasound can be promising for GI malignancies as it has the potential to allow for a more precise lesion characterization with higher accuracy in tumor detection, staging, and interventional/image guidance. We conducted a literature review to identify the current possibilities of real-time image fusion involving US with a focus on clinical applications in the management of GI malignancies. Liver applications have been the most extensively investigated, either in experimental or commercially available systems. Real-time US fusion imaging of the liver is gaining more acceptance as it enables further diagnosis and interventional therapy of focal liver lesions that are difficult to visualize using conventional B-mode ultrasound. Clinical studies on EUS guided image fusion, to date, are limited. EUS-CT image fusion allowed for easier navigation and profiling of the target tumor and/or surrounding anatomical structure. Image fusion techniques encompassing multiple imaging modalities appear to be feasible and have been observed to increase visualization accuracy during interventional and diagnostic applications.
PubMed: 36553225
DOI: 10.3390/diagnostics12123218 -
Journal of Clinical Medicine Mar 2021The diagnostic process for biliary strictures remains challenging in some cases. A broad differential diagnosis exists for indeterminate biliary strictures, including... (Review)
Review
The diagnostic process for biliary strictures remains challenging in some cases. A broad differential diagnosis exists for indeterminate biliary strictures, including benign or malignant lesions. The diagnosis of indeterminate biliary strictures requires a combination of physical examination, laboratory testing, imaging modalities, and endoscopic procedures. Despite the progress of less invasive imaging modalities such as transabdominal ultrasonography, computed tomography, and magnetic resonance imaging, endoscopy plays an essential role in the accurate diagnosis, including the histological diagnosis. Imaging findings and brush cytology and/or forceps biopsy under fluoroscopic guidance with endoscopic retrograde cholangiopancreatography (ERCP) are widely used as the gold standard for the diagnosis of biliary strictures. However, ERCP cannot provide an intraluminal view of the biliary lesion, and its outcomes are not satisfactory. Recently, peroral cholangioscopy, confocal laser endomicroscopy, endoscopic ultrasound (EUS), and EUS-guided fine-needle aspiration have been reported as useful for indeterminate biliary strictures. Appropriate endoscopic modalities need to be selected according to the patient's condition, the lesion, and the expertise of the endoscopist. The aim of this review article is to discuss the diagnostic process for indeterminate biliary strictures using endoscopy.
PubMed: 33802525
DOI: 10.3390/jcm10051048 -
Journal of Gastroenterology Jan 2019Accumulated evidence has revealed that endoscopic ultrasonography (EUS) has had a great impact on the clinical evaluation of pancreatic cancers. EUS can provide... (Review)
Review
Accumulated evidence has revealed that endoscopic ultrasonography (EUS) has had a great impact on the clinical evaluation of pancreatic cancers. EUS can provide high-resolution images of the pancreas with a quality regarded as far surpassing that achieved on transabdominal ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI). EUS is particularly useful for the detection of small pancreatic lesions, while EUS and its related techniques such as contrast-enhanced EUS (CE-EUS), EUS elastography, and EUS-guided fine needle aspiration (EUS-FNA) are also useful in the differential diagnosis of solid or cystic pancreatic lesions and the staging (T-staging, N-staging, and M-staging) of pancreatic cancers. In the diagnosis of pancreatic lesions, CE-EUS and EUS elastography play a complementary role to conventional EUS. When sampling is performed using EUS-FNA, CE-EUS and EUS elastography provide information on the target lesions. Thus, conventional EUS, CE-EUS, EUS elastography, and EUS-FNA are essential in the clinical investigation of pancreatic cancer.
Topics: Diagnosis, Differential; Elasticity Imaging Techniques; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Humans; Magnetic Resonance Imaging; Neoplasm Staging; Pancreatic Diseases; Pancreatic Neoplasms; Tomography, X-Ray Computed
PubMed: 30406288
DOI: 10.1007/s00535-018-1519-2 -
Journal of Ultrasound Dec 2020Contrast-enhanced ultrasonography (CEUS) is increasingly being performed in Italy and Europe, particularly in the field of hepato-gastroenterology. Initially, it was...
Contrast-enhanced ultrasonography (CEUS) is increasingly being performed in Italy and Europe, particularly in the field of hepato-gastroenterology. Initially, it was mainly carried out to characterize focal hepatic lesions, but, since then, numerous studies have demonstrated its efficacy in the differential diagnosis of focal pancreatic pathologies (D'Onofrio et al. in Expert Rev Med Devices 7(2):257-273, 2010; Vidili et al. in J Ultrasound 22(1):41-51, 2019). The purpose of this paper is to provide Italian Medical Doctors with recommendations and thereby practical guidelines on the management of these patients. The present paper reports the final conclusions reached by the SIUMB guideline commission. This paper addresses particularly percutaneous ultrasound (US) examination (transabdominal US) and is drawn up specifically for publication.
Topics: Contrast Media; Diagnosis, Differential; Humans; Image-Guided Biopsy; Pancreatic Cyst; Pancreatic Neoplasms; Ultrasonography
PubMed: 32886345
DOI: 10.1007/s40477-020-00522-2 -
Journal of Ultrasonography Mar 2017The paper discusses the rules of the proper performing of the ultrasound examination of the prostate gland. It has been divided into two parts: the general part and the... (Review)
Review
The paper discusses the rules of the proper performing of the ultrasound examination of the prostate gland. It has been divided into two parts: the general part and the detailed part. The first part presents the necessary requirements related to the ultrasound equipment needed for performing transabdominal and transrectal examinations of the prostate gland. The second part presents the application of the ultrasound examination in benign prostatic hyperplasia, in cases of prostate inflammation and in prostate cancer. Ultrasound examinations applied in the diagnostics of benign prostatic hyperplasia accelerated the diagnosis, facilitated the qualification to surgery and the selection of the treatment method. The assessment of the size of the prostate gland performed using the endorectal ultrasound examination is helpful in making the choice between transurethral electroresection and adenomectomy. In prostate inflammation this examination should be performed with particular gentleness due to pain ailments. The indication for performing the examination in acute inflammation is the suspicion of prostate abscess. In chronic, exacerbating prostatitis it is possible to perform an intraprostatic antibiotic injection. In the recent years increased morbidity and detectability of prostate gland cancer is observed among men. In Poland it ranks second (13%) among diseases occurring in men. The indication for an endorectal examination is the necessity to assess the size of the prostate gland, its configuration, the echostructure in classical ultrasonography, the vascularization in an ultrasound examination performed with power doppler and, if possible, the differences in the gland tissue firmness (consistency) in elastography. The ultrasound examination is used for performing the mapping biopsy of the prostate gland - from routine, strictly defined locations, the targeted biopsy - from locations suspected of neoplastic proliferation and the staging biopsy - from the neurovascular bundles, the seminal vesicles, from the apex of the prostate and from the periprostatic tissue - this type of biopsy is supposed to help in determining local staging of the neoplastic disease. The ultrasound examination is also helpful during the treatment of the neoplasm performed using brachytherapy or using the method of ultrasonic ablation which is still in the phase of clinical trials.
PubMed: 28439429
DOI: 10.15557/JoU.2017.0007 -
Deutsches Arzteblatt International Dec 2014Fibroids are the most common benign tumors in women. One-third of all women of reproductive age undergo treatment for symptomatic fibroids. In recent years, the spectrum... (Review)
Review
BACKGROUND
Fibroids are the most common benign tumors in women. One-third of all women of reproductive age undergo treatment for symptomatic fibroids. In recent years, the spectrum of available treatments has been widened by the introduction of new drugs and interventional procedures.
METHODS
Selective literature review on the treatment of uterine fibroids, including consideration of several Cochrane Reviews.
RESULTS
Fibroids can be treated with drugs, interventional procedures (uterine artery embolization [UAE] and focused ultrasound treatment [FUS]), and surgery. The evidence regarding the various available treatments is mixed. All methods improve symptoms, but only a few comparative studies have been performed. A meta-analysis revealed that recovery within 15 days is more common after laparoscopic enucleation than after open surgery (odds ratio [OR], 3.2). A minimally invasive hysterectomy, or one performed by the vaginal route, is associated with a shorter hospital stay and a more rapid recovery than open transabdominal hysterectomy. UAE is an alternative to hysterectomy for selected patients. The re-intervention rates after fibroid enucleation, hysterectomy, and UAE are 8.9-9%, 1.8-10.7%, and 7-34.6%, respectively. The main drugs used to treat fibroids are gonadotropin-releasing hormone analogs and selective progesterone receptor modulators.
CONCLUSION
Multiple treatment options are available and enable individualized therapy for symptomatic fibroids. The most important considerations in the choice of treatment are the question of family planning and, in some cases, the technical limitations of the treatments themselves.
Topics: Antineoplastic Agents; Combined Modality Therapy; Evidence-Based Medicine; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Leiomyoma; Minimally Invasive Surgical Procedures; Organ Preservation; Treatment Outcome; Ultrasonography; Uterine Neoplasms
PubMed: 25597366
DOI: 10.3238/arztebl.2014.0877 -
Fertility and Sterility May 2021
Topics: Oocyte Retrieval; Oocytes; Ultrasonography, Interventional
PubMed: 33933178
DOI: 10.1016/j.fertnstert.2021.02.038