Role of Color Doppler Sonography in Transrectal Ultrasound Guided Biopsy of Prostate

Jeon, Sung Hyun; Lee, Sun Ju; Lee, Choong Hyun; Chang, Sung Goo; Kim, Jin Il; Lim, Joo Won

Abstract

PURPOSE: The aim of this study is to correlate the findings at prostate CDS (Color doppler sonography) with those of site specific transrectal ultrasound (TRUS) guided biopsy for determining the role of CDS in detection of prostate cancer.
MATERIALS AND METHODS
Forty-nine patients underwent TRUS guided biopsy because of palpable hard nodule of prostate, abnormal prostate specific antigen, or hypoechoic lesion of TRUS. CDS was performed at all biopsy sites before TRUS guided biopsy. Color flow at CDS was prospectively graded on a scale of 0, I, II (0=no or minimal, I=moderate, II=markedly increased color flow at peripheral zone). CDS results were correlated with histologic findings from 491 separate biopsy sites of 49 patients.
RESULTS
Cancer was found on biopsy in 153 sites, prostatitis was found in 95 sites, and benign prostatic hyperplasia (BPH) was found in 243 sites. CDS had a sensitivity of 30.1%, specificity of 98.2%, positive predictive value of 88.5%, and negative predictive value of 75.6%. Of 52 grade II color flow biopsy sites, 46 were prostate cancer, prostatitis and BPH were 3 each other. Of 153 biopsy sites in prostate cancer, 46 sites were grade II, 62 sites were grade I, 45 sites were grade 0 color flow. CDS depicted cancer in 43 sites of 5 patients without gray scale abnormality. Of 16 patients with hypoechoic lesion, eight patients had cancer, but CDS did not assist to differentiate the cancer from benign lesion.
CONCLUSIONS
Grade II color flow in peripheral zone is highly associated with prostate cancer. In case of no gray scale abnormality, CDS may help identify appropriate sites for biopsy. But, negative CDS do not exclude biopsy because of low sensitivity.