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Targeted Biopsy With Color Doppler and Elastography: A Comparison Of Gleason Scores
Eric Nelson, Craig Slotoroff, Leonard Gomella, Ethan Halpern*
Thomas Jefferson University, Philadelphia, PA
Introduction: Both color Doppler imaging and real time elastography may be useful to identify cancer within the prostate. We evaluated the distribution of Gleason scores found by systematic biopsy as well as targeted biopsy of the prostate with color Doppler and elastography.
Methods: One hundred and thirty-seven patients referred for prostate biopsy were evaluated with gray scale, color Doppler, and elastography. Targeted core biopsy specimens were obtained from areas of increased color flow and decreased elasticity. Six sextant biopsies specimens were then obtained. Abnormalities on Doppler or elastography were tabulated as a function of Gleason score and analysis was performed with a Chi-square for linear trend.
Results: Prostate cancer was established in 60/137 (43.8%) of subjects, 90/448 (20%) of targeted cores and 106/818 (13%) of sextant cores. A significant trend for increasing Gleason score was present with color Doppler (χ2 = 7.69, p < 0.005) and elastography (χ2 = 28.89, p < 0.001). Abnormal color flow was strongly associated with Gleason 8 (OR=4.12) and Gleason 9/10 (OR=10.61) lesions, but was minimally associated with Gleason 5/6 (OR=0.96) and Gleason 7 (OR=0.85) lesions. Elastography also demonstrated a stronger association with higher Gleason scores (Gleason 8 - OR=3.36 and Gleason 9/10 - OR=4.11), but was more strongly associated with Gleason 5/6 (OR=1.71) and 7 (OR=3.36) lesions.
Conclusions: Positive color Doppler and elastography findings are associated with higher Gleason scores. Positive color Doppler findings are strongly associated with high grade cancer, whereas positive elastography findings are associated with both moderate and high grade cancer.
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