Clinical ROC Studies of Digital Stereo Mammography

The objective of this study was to explore and document the diagnostic utility of digital stereo mammography for the detection of localized breast cancer in women. In it we character­ized the ability of experienced mammographers, general radiologists, and non-radiologists to detect three types of tumor masses embedded within a heterogeneous background of normal tis­sue elements in numerically simulated digital mammograms. The simulated mammograms were displayed to the subjects on a high resolution video display, both in stereo mode and in mono mode. Half of the mammograms contained a single tumor, ranging from 0.3 to 0.8 cm in maxi­mal diameter. Each reader rated 120 images (60 in stereo and 60 in mono) as to the probability of abnormality on scale of 1-5. Observer responses were evaluated using receiver operating characteristic (ROC) analysis to characterize any difference in diagnostic performance between the two viewing modes. The synthesized mammograms and the digital display were highly rated by the participant radiologists as promising tools for future research. The results of ROC analysis, however, indicated no significant difference in tumor detection when the same readers utilized the stereo mode versus the mono mode (Az mono = 0.833 versus, Az stereo = 0.826). The results were similar for readers of all 3 experience levels--mammographers, general radiolo­gists, and non-radiologists

Classification of Focal Prostatic Lesions on Transrectal Ultrasound (TRUS) and the Accuracy of TRUS to Diagnose Prostate Cancer

Objective: To improve the diagnostic efficacy of transrectal ultrasound (TRUS)-guided targeted prostatic biopsies, we have suggested the use of a new scoring system for the prediction of malignancies regarding the characteristics of focal suspicious lesions as depicted on TRUS. Materials and Methods: A total of 350 consecutive patients with or without prostate cancer who underwent targeted biopsies for 358 lesions were included in the study. The data obtained from participants were randomized into two groups; the training set (n = 240) and the test set (n = 118). The characteristics of focal suspicious lesions were evaluated for the training set and the correlation between TRUS findings and the presence of a malignancy was analyzed. Multiple logistic regression analysis was used to identify variables capable of predicting prostatic cancer. A scoring system that used a 5-point scale for better malignancy prediction was determined from the training set. Positive predictive values for malignancy prediction and the diagnostic accuracy of the scored components with the use of receiver operating characteristic curve analysis were evaluated by test set analyses. Results: Subsequent multiple logistic regression analysis determined that shape, margin irregularity, and vascularity were factors significantly and independently associated with the presence of a malignancy. Based on the use of the scoring system for malignancy prediction derived from the significant TRUS findings and the interactions of characteristics, a positive predictive value of 80% was achieved for a score of 4 when applied to the test set. The area under the receiver operating characteristic curve (AUC) for the overall lesion score was 0.81. Conclusion: We have demonstrated that a scoring system for malignancy prediction developed for the characteristics of focal suspicious lesions as depicted on TRUS can help predict the outcome of TRUS-guided biopsies.This study was supported by the Seoul National University Bundang Hospital Research Fund (Grant No. 02-2006-031).Mitterberger M, 2007, J UROLOGY, V178, P464, DOI 10.1016/j.juro.2007.03.107Djavan B, 2007, WORLD J UROL, V25, P11, DOI 10.1007/s00345-007-0151-1Shim HB, 2007, TUMORI, V93, P178Toi A, 2007, J UROLOGY, V177, P516, DOI 10.1016/j.juro.2006.09.061Lee HJ, 2006, J ULTRAS MED, V25, P815Elabbady AA, 2006, EUR UROL, V49, P49, DOI 10.1016/j.eururo.2005.08.013Halpern EJ, 2005, CANCER, V104, P2373, DOI 10.1002/cncr.21440Ozden E, 2005, J CLIN ULTRASOUND, V33, P5, DOI 10.1002/jcu.20080Kuligowska E, 2001, RADIOLOGY, V220, P757Lavoipierre AM, 1998, AM J ROENTGENOL, V171, P205Plawker MW, 1997, J UROLOGY, V158, P1853Cornud F, 1997, UROLOGY, V49, P709NEWMAN JS, 1995, RADIOLOGY, V195, P86LITTRUP PJ, 1992, CA-CANCER J CLIN, V42, P198HAMPER UM, 1991, RADIOLOGY, V180, P101LEE F, 1991, CANCER, V67, P1132RIFKIN MD, 1988, RADIOLOGY, V166, P619

TRANSRECTAL ULTRASOUND-GUIDED BIOPSY A PROSPECTIVE STUDY OF PATIENTS TOLERANCE AND COMPLICATIONS

Objectives To determine the morbidity and patient tolerance of TRUS-guided biopsy from suspected malignant prostate or pelvic recurrence after radical cystectomy. Patients and Methods This prospective study comprised 113 patients who underwent TRUS-guided biopsy from the prostate or from pelvic recurrence following radical cystectomy. The patients' tolerance was assessed by scoring the severity of discomfort during the procedure and their acceptance was estimated by questionnaires following it. Results Most patients (56.6%) experienced either no discomfort at all or only mild pain during the procedure. Intravenous sedation was needed in 31% of the patients and general anaesthesia was necessary in two patients. Haematuria was the commonest complication (59.6%) followed by rectal bleeding and haemospermia, which occurred in 36.7% and 17.4% of the patients, respectively. A vasovagal attack occurred in one patient. There was one major complication, a prostatic abscess which resulted in a temporary urethro-rectal fistula. Conclusion TRUS-guided core biopsy is safe with frequent minor but` very rare major complications. The majority of the patients tolerate the procedure with accepted discomfort but a considerable number of patients need sedation to complete the procedure effectively. African Journal of Urology Vol. 7 No. 2 (May 2001): pp 57-61Biopsie Transrectale Echoguidée: Etude Prospective de la Tolérance des Patients et des ComplicationsObjectif Evaluer la tolérance et l'acceptance des patients de la biopsie transrectale échoguidée. Patients et Méthodes Cette étude prospective comprenait 113 patients qui ont bénéficié d'une biopsie transrectale échoguidée de la prostate ou d'une récurrence pelvienne après cystectomie radicale. La tolérance des patients était évaluée en cotant la sévérité du disconfort pendant la procé-dure et leur acceptance était estimée par des questionnaires ensuite. Résultats La plupart des patients (56,6%) ne ressentaient pas du tout de disconfort ou ressentaient seulement une douleur mineure pendant la procédure. Une sédation intraveineuse a été nécessaire chez 31% des patients et une anesthésie générale a été nécessaire dans 2 cas. L'hématurie était la complication la plus fré-quente, suivie de rectorragies et d'hématospermie survenues chez 36,7% et 17,4% des patients, respectivement. Une attaque vaso-vagale est survenue chez un patient. Il y avait une complication majeure: un abcès prostatique ayant évolué à une fistule uréthro-rectale temporaire. Conclusion La biopsie transrectale échoguidée est anodine, ses complications mineures sont fréquentes mais les complications majeures sont très rares. La majorité des patients tolèrent la procédure avec disconfort accepté mais un nombre considérable de patients nécessitent une sédation pour compléter efficace-ment la procédure. African Journal of Urology Vol. 7 No. 2 (May 2001): pp 57-6

Studying the effect of type 2 diabetes mellitus on prostate-related parameters: A prospective single institutional study

Background: To examine the effects of type 2 diabetes mellitus (DM) on the variables associated with prostatic growth including serum prostate-specific antigen (PSA), serum testosterone, and prostate volume, and to correlate these variables with the duration of diabetes treatment. Methods: Our study was conducted over 3 months recruiting 501 men aged≥55 years; of whom 207 had type 2 DM. Exclusion criteria were active urinary tract infection, suspicious rectal examination, urologic cancer, end-organ damage, and recent urological manipulations. Serum PSA and serum testosterone were measured. Prostate volume was determined by abdominal ultrasonography using an ellipsoid formula. Results: The mean patient age was 60.21±5.95 years. The mean PSA, testosterone, and prostate volume for diabetic men were 2.3 ng/mL, 3 ng/mL, and 56 g, respectively. The corresponding values for nondiabetic men were 3.5 ng/mL, 4 ng/mL, and 51 g, respectively (P=0.001, P=0.001, P=0.03, respectively). The mean PSA density was 0.049±0.043 ng/mL/cm3 in diabetics versus 0.080±0.056 ng/mL/cm3 in non-diabetics (P<0.001). Conclusion: Type 2 DM is significantly associated with lower serum PSA and testosterone, and larger prostate volume

Non-contrast computed tomography versus cinefluoroscopy for the assessment of mechanical prosthetic valve leaflet motion

Introduction: valve replacement remains the definitive treatment of most cases with severe valvular heart disease. Mechanical prosthetic valves remain the main option in younger patients. Objective: evaluation of mechanical prosthetic valve function by comparing the feasibility of leaflet motion assessment by cinefluoroscopy vs. CT. Materials and methods: Leaflet motion was assessed in 30 bileaflet mechanical prostheses (21 mitral and 9 aortic) by cinefluoroscopy and non-contrast CT. Assessment was considered feasible when the ‘in profile’ projection (with the radiographic beam parallel to both the valve ring plane and the tilting axis of discs) could be achieved. Results: Overall feasibility of fluoroscopic assessment was 74% (mitral, 66% vs. aortic, 93%; p=0.071), while feasibility of CT assessment was 100% (p=0.003). Among prostheses with unfeasible fluoroscopic assessment, CT suggested an extreme C-arm angulation to achieve the “in profile” projection (RAO: 76.0±5.8°, LAO: 122.7±32.5°, CRA: 51.4±16.0°, CAU: 57.0±18.2°). Among prostheses with feasible assessment by both techniques, fluoroscopy and CT yielded similar opening and closing angles (intraclass correlation coefficient, 0.959 - 0.998) with lower irradiation with CT as compared with fluoroscopy (26.2[21.1-29.3] vs. 289[179-358] mGy, p&lt;0.001). While CT scan took 8.7±0.5 seconds, fluoroscopy required 2.64±1.56 minutes to achieve and record the “in profile” projection