Accuracy Of Transrectal Ultrasonography Research Articles

Biplane transrectal ultrasonography plus ultrasonic elastosonography and contrast-enhanced ultrasonography in T staging of rectal cancer

BackgroundThe aim of this study is to assess biplane transrectal ultrasonography (TRUS) plus ultrasonic elastosonography (UE) and contrast-enhanced ultrasonography (CEUS) in T staging of rectal cancer.MethodsBetween March 2016 and January 2019, 66 rectal cancer patients who completed biplane TRUS plus UE and CEUS for preoperative workup and were treated by primary total mesorectal excision (TME) were retrospectively analyzed.ResultsThe accuracy of TRUS plus UE and CEUS in all T staging of rectal cancer was 69.7%. The highest accuracy was achieved in the T3 stage (87.5%), while it was 71.4 and 50.0% in the T1 and T2 stage, respectively. The mean sizes of uT1-T2 lesions and uT3-T4 lesions were 30.0 ± 10.6 mm (range, 10.0–55.0) and 40.2 ± 11.2 mm (range, 14.0–57.0), respectively (p < 0.001). According to the receiver operating characteristic (ROC) curve to predict pT stages (pT1,2 vs. pT3), the optimal cut-off value of lesions in greatest dimension was 28.5 mm by TRUS with areas under the curve (AUC) of 0.769, and the optimal cut-off values of peak systolic velocity (PSV) and resistive index (RI) were 18.8 cm/sec and 0.645, respectively. The AUCs of PSV and RI were 0.588 and 0.555, respectively.ConclusionsDiagnostic accuracy of TRUS plus UE and CEUS in T staging of rectal cancer does not reach the excellent published study results, especially for patients with early rectal cancer. Tumor sizes, PSV and RI are useful additions for TRUS in T staging of rectal cancer.

The accuracy of trans rectal ultrasonography (TRUS) in early-stage rectal cancer or benign adenomas

Background: Screening for colorectal cancer in Denmark has resulted in more patients being diagnosed with benign adenomas and early-stage rectal cancer. In general, TRUS is accepted as a good modality for evaluating the above mentioned before deciding on surgery.Objective: To investigate the accuracy of TRUS in a clinical setting at the Region Hospital in Herning, Denmark.Study design: Retrospective cohort study from January 2016 to June 2018.Methods: Quantitative method. The cohort (117 patients) was recruited by searching for specific procedure codes. Data were collected by going through the electronic patient files.Results: TRUS predicted T0, T1, T2 and T3 with an accuracy of 91%, 35%, 43% and 20% respectively and an overall accuracy of 68%. A weighted Cohens kappa value of 0.30 (p .05). TRUS differentiated between T0/T1 with a sensitivity of 70%, specificity of 85% and an accuracy of 85% and kappa value of 0.44 (p .05).Conclusion: TRUS can with great precision establish whether the tumor is benign so correct local treatment can be instituted.

Accuracy of fetal age estimates using transrectal ultrasonography for predicting calving dates in dairy cows in seasonally calving herds in New Zealand

AIM: To describe the accuracy of transrectal ultrasonography for predicting calving dates in dairy cows under typical New Zealand conditions and to assess potential risk factors for differences between predicted and actual calving dates.METHODS: Data were collected from 116 seasonally calving herds over 2 years in a retrospective single cohort study. Transrectal ultrasonography was undertaken by experienced veterinarians (n=12) to determine if cows were pregnant, and if so to estimate fetal age. Predicted calving date was calculated by adding 282 days to the estimated conception date. Accuracy was assessed using differences between predicted and actual calving dates for each animal. Potential risk factors for animals calving >10 days before or after their predicted calving date were assessed using multinomial logistic regression models.RESULTS: The study population comprised 83,104 cows over the 2 years of the study; 75,037 (90.3%) cows calved within 10 days of their predicted calving date, 3,683 (4.4%) calved >10 days earlier, and 4,384 (5.3%) >10 days later, than predicted. Risk factors for calving >10 days before or after the predicted calving date included having >1 artificial insemination (AI) before pregnancy diagnosis (p=0.03), where the cow’s most recent AI was <21 days before the end of the herd’s AI period (p<0.01), and where the diagnosis was made at the second or third herd-visit (p<0.01). The probability of calving being >10 days later than predicted also increased when the fetus was ≥13 weeks old at pregnancy diagnosis (p<0.01).CONCLUSIONS AND CLINICAL RELEVANCE: In this study, >90% of cows diagnosed pregnant by veterinarians using transrectal ultrasonography calved within 10 days of the predicted calving date. In herds where herd reproductive performance is high, it would be expected that more cows would conceive to their first AI, and potentially fewer cows would have AI close to the end of the herd’s AI period, which would increase diagnostic accuracy. Where herd managers rely on accurate predicted calving dates they should be informed about realistic expected accuracy. For greatest accuracy, a complete AI history should be made available to the person performing the pregnancy diagnoses and cows at most risk of having inaccurate predicted calving dates should be identified.

Transrectal Ultrasonographic Monitoring of Early Pregnancy in Graded Murrah Buffalo Cows (Bubalus bubalis)

The objective of the present study was to evaluate the accuracy of transrectal ultrasonography as a method of pregnancy diagnosis at an early stage in graded murrah buffaloes. 30 inseminated buffaloes were utilized and pregnancy diagnosis was commenced on day 20, 25 and 30 post breeding. Positive diagnosis of pregnancy was based on the presence of an anechoic round area of varying size in the lumen of an echogenic uterine lumen representing the fluid filled allantoic cavity termed as the embryonic vesicle. The presence of an embryo within the embryonic vesicle was confirmed by observing an echogenic area with rhythmic pulsation representing heartbeats. The average lengths of embryonic vesicle on day 20, 25 and 30 were 0.415 ± 0.05, 1.116 ± 0.107 and 1.85 ± 0.068 cm, respectively and the average lengths of embryo on day 25 and 30 were 0.45 ± 0.064 and 1.05 ± 0.086 cm, respectively. Sensitivity was lower on day 20 and 25 being 50 and 75%, respectively when compared to day 30 which was 100%. The overall accuracy increased as the pregnancy advances and was observed to be 100% from day 30 onwards. It was confirmed that early pregnancy diagnosis using ultrasonography can be done effectively from day 25 post insemination.

Optimal post-breeding interval for pregnancy diagnosis in mares by using ultrasonographic technique

The present study was conducted in two different farms, including (256) foaling mares in : AL-Laith equine herd and equestrian club in AL-Ameria, 4-14 years old foaling mares which are situated in areas around Baghdad and extended one calendar from July 2011 until July 2012 . These mares were examined for pregnancy diagnosis by trans-rectal ultrasonography using a 5 MHz lineararray transducer between Days 10 and 40 after breeding (breeding day = Day 0). Criteria to assess the accuracy of trans-rectal sonography were overall accuracy (correct diagnoses/all diagnoses), sensitivity (correct diagnoses "pregnant"/all pregnant animals), and specificity (correct diagnoses "non-pregnant" /all non-pregnant animals. The sensitivity, specificity and accuracy of trans-rectal ultrasonography were 91.4%, 96.2% and 94.7%, respectively, around day (10-40). Accuracy, Sensitivity and Specificity of pregnancy diagnosis were superior (97.8%, 95.2% and 100%), respectively, in (31 - 35) day post breeding (P&lt; 0.01). The results of this study showed a significant difference (P&lt;0.01) in the parameters of sensitivity and various post-breeding intervals. The results of the present study revealed that using trans-rectal ultrasound for pregnancy diagnosis in mares could be used and are reliable under field conditions from day (31) of Gestation onward

Accuracy of transrectal ultrasonography in staging rectal tumors that are clinically eligible for transanal endoscopic microsurgery

Transanal endoscopic microsurgery (TEM) is performed in patients with premalignant or selected stage T1 rectal lesions. Transrectal ultrasonography (TRUS) is an important tool in the preoperative staging of rectal lesions to determine whether lesions are suitable for TEM or not. We analyze the accuracy of TRUS in distinguishing between rectal lesions requiring TEM or more radical excision. From 2006 to 2008 thirty-five patients were included. All patients underwent TRUS. Following TRUS and/or additional imaging, patients underwent surgery. Preoperative TRUS staging was correlated to postoperative pathology findings. In 30 patients TRUS was diagnostic. Postoperative pathologic findings confirmed the preoperative TRUS findings in 29 patients; in 1 patient, a T3 staged tumor was an overstaged lesion biopsied as a tubulovillous adenoma. The accuracy level in the diagnostic TRUS group was 97% (29/30). In 5 patients TRUS was nondiagnostic; in 4 of these patients MRI was performed showing no tumor invasion in all 4 patients, confirmed by pathologic findings. Correct TRUS interpretation was possible in 86% (30/35). Overall accuracy of TRUS was 83% (29/35). TRUS is accurate in distinguishing rectal lesions suitable for TEM from the lesions needing more radical surgery. If TRUS is nondiagnostic or the lesion is of high stage (>or=T2), MRI should be performed.

2118 Accuracy of TransRectal UltraSonography (TRUS) in the preoperative staging of rectal lesions suitable for Transanal Endoscopic Microsurgery (TEM)

2118 Accuracy of TransRectal UltraSonography (TRUS) in the preoperative staging of rectal lesions suitable for Transanal Endoscopic Microsurgery (TEM)

Automated detection of prostatic adenocarcinoma from high-resolution ex vivo MRI

Prostatic adenocarcinoma is the most commonly occurring cancer among men in the United States, second only to skin cancer. Currently, the only definitive method to ascertain the presence of prostatic cancer is by trans-rectal ultrasound (TRUS) directed biopsy. Owing to the poor image quality of ultrasound, the accuracy of TRUS is only 20%-25%. High-resolution magnetic resonance imaging (MRI) has been shown to have a higher accuracy of prostate cancer detection compared to ultrasound. Consequently, several researchers have been exploring the use of high resolution MRI in performing prostate biopsies. Visual detection of prostate cancer, however, continues to be difficult owing to its apparent lack of shape, and the fact that several malignant and benign structures have overlapping intensity and texture characteristics. In this paper, we present a fully automated computer-aided detection (CAD) system for detecting prostatic adenocarcinoma from 4 Tesla ex vivo magnetic resonance (MR) imagery of the prostate. After the acquired MR images have been corrected for background inhomogeneity and nonstandardness, novel three-dimensional (3-D) texture features are extracted from the 3-D MRI scene. A Bayesian classifier then assigns each image voxel a "likelihood" of malignancy for each feature independently. The "likelihood" images generated in this fashion are then combined using an optimally weighted feature combination scheme. Quantitative evaluation was performed by comparing the CAD results with the manually ascertained ground truth for the tumor on the MRI. The tumor labels on the MR slices were determined manually by an expert by visually registering the MR slices with the corresponding regions on the histology slices. We evaluated our CAD system on a total of 33 two-dimensional (2-D) MR slices from five different 3-D MR prostate studies. Five slices from two different glands were used for training. Our feature combination scheme was found to outperform the individual texture features, and also other popularly used feature combination methods, including AdaBoost, ensemble averaging, and majority voting. Further, in several instances our CAD system performed better than the experts in terms of accuracy, the expert segmentations being determined solely from visual inspection of the MRI data. In addition, the intrasystem variability (changes in CAD accuracy with changes in values of system parameters) was significantly lower than the corresponding intraobserver and interobserver variability. CAD performance was found to be very similar for different training sets. Future work will focus on extending the methodology to guide high-resolution MRI-assisted in vivo prostate biopsies.

The Safety of Endosonography-Guided FNA and/or Trucut Biopsy in Patients on Aspirin, NSAIDs or Prophylactic Low Molecular Weight Heparin

The Safety of Endosonography-Guided FNA and/or Trucut Biopsy in Patients on Aspirin, NSAIDs or Prophylactic Low Molecular Weight Heparin John Meenan, Laura Doig, Charles Vu Background: Endoscopic ultrasound (EUS)-FNA is classified as a high risk procedure for gastrointestinal bleeding under the American Society of Gastrointestinal Endoscopy guidelines. Limited data suggest that aspirin and other non-steroidal anti-inflammatory drug (NSAIDs) in standard doses do not increase the risk of significant bleeding after EGD or colonoscopy with biopsy, polypectomy or biliary sphincterotomy. Because of the paucity of data, the same recommendation is extrapolated to EUS-FNA. Aim: To compare the safety of EUS-guided FNA or trucut biopsy (TCB) in patients who are taking aspirin, NSAIDs or prophylactic low molecular weight heparin (LMWH) and those who are not. Methods: Consecutive patients undergoing EUS FNA or TCB were prospectively analyzed for all complications. We excluded patients on non-aspirin antiplatelet drugs from EUS-FNA or TCB because of their profound effect on platelets. Cystic aspirate cases were given routine antibiotic prophylaxis. All patients were assessed for evidence of immediate and late (by a phone call within 48hours for outpatient or by review as inpatient) complications after the procedure. Bleeding was considered significant if there was: hematemesis, melena, continuous intraluminal oozing requiring hemostatic procedures or EUS evidence of an expanding hypoechoic area extraluminally. Results: 224 patients underwent EUS-FNA or TCB on 243 sites (153 pancreatic, 55 intraabdominal, 34 mediastinal, 1 rectal), of which 194 were solid, 46 cystic and 3 ascites. One (3.6%) of 28 patients taking potentially risky drugs (23 aspirin/NSAIDs and 5 LMWH) developed extraluminal bleeding compared to 5 (2.6%) of the remaining 196 patients (p Z 0.263). None of these patients developed any clinically significant sequel. One patient from the low-risk group developed intraluminal bleeding requiring injection therapy and hemoclipping. Two patients (one from each group) reported self limiting mild hematemesis. One patient (0.65%) developed pancreatitis. There was no difference in the bleeding complications between the FNA and TCB group (p Z 0.246). Conclusion: EUS-FNA or TCB appears to be safe in patients taking aspirin, NSAIDs or prophylactic LMWH. W1256 Transrectal Ultrasound (TRUS) Helps Select Patients for Transanal Excision (TAE) of Early (T1) Rectal Cancers and Large Polyps Girish Mishra, Saulette Roberson, John Sweeney, Edward Levine, Russell Howerton, Greg Waters Background and Significance: TAE is an extremely effective and attractive surgical approach in patients with T1 rectal cancers and polyps that are not amenable to endoscopic removal. T2 rectal cancers have a higher local recurrence rate and may be selected for more invasive surgery with either a low anterior resection,or an abdomino perineal resection. Thus, accurate staging is critical in selecting patients for a TAE. TRUS is highly sensitive in T and N-staging for rectal cancer, but its diagnostic accuracy for distinguishing T1 and T2 rectal cancers has been challenged. Study Aims: To determine the accuracy of TRUS in determining resectability by TAE for T1 rectal cancers and polyps too large to be resected endoscopically. Methods: 183 TRUS were performed at our institution between August 2001 and October 2004. 21 TAE were performed for either T1 lesions by TRUS or for large polypoid masses localized to the mucosa by TRUS, but technically challenging to remove endoscopically. Results: The mean age of patients staged either T1 or T2 was 62 (33-80). 13 of 15 patients (87%) were accurately classified as having T1 disease. 2 lesions were understaged. 6 polypoid lesions (100%) that were either tubulovillous or villous adenomas were accurately classified as being localized to the mucosa. All patients (nZ11) staged T2 by TRUS were confirmed to be T2 at pathology. No difference was noted in the predictive value of TRUS for T1 vs T2 lesions (pZ.4923, exact test). Correlation between TRUS and pathology was kZ.85.Conclusions: TRUS is highly accurate in delineating depth of invasion for T1 rectal cancers and large, polypoid lesions unamenable to polypectomy. The ability to accurately delineate T1 vs T2 rectal cancer by TRUS allows for the appropriate selection of patients for TAE and thus, avoidance of more invasive surgery with higher morbidity and mortality.

Transrectal Ultrasound (TRUS) Helps Select Patients for Transanal Excision (TAE) of Early (T1) Rectal Cancers and Large Polyps

Transrectal Ultrasound (TRUS) Helps Select Patients for Transanal Excision (TAE) of Early (T1) Rectal Cancers and Large Polyps Girish Mishra, Saulette Roberson, John Sweeney, Edward Levine, Russell Howerton, Greg Waters Background and Significance: TAE is an extremely effective and attractive surgical approach in patients with T1 rectal cancers and polyps that are not amenable to endoscopic removal. T2 rectal cancers have a higher local recurrence rate and may be selected for more invasive surgery with either a low anterior resection,or an abdomino perineal resection. Thus, accurate staging is critical in selecting patients for a TAE. TRUS is highly sensitive in T and N-staging for rectal cancer, but its diagnostic accuracy for distinguishing T1 and T2 rectal cancers has been challenged. Study Aims: To determine the accuracy of TRUS in determining resectability by TAE for T1 rectal cancers and polyps too large to be resected endoscopically. Methods: 183 TRUS were performed at our institution between August 2001 and October 2004. 21 TAE were performed for either T1 lesions by TRUS or for large polypoid masses localized to the mucosa by TRUS, but technically challenging to remove endoscopically. Results: The mean age of patients staged either T1 or T2 was 62 (33-80). 13 of 15 patients (87%) were accurately classified as having T1 disease. 2 lesions were understaged. 6 polypoid lesions (100%) that were either tubulovillous or villous adenomas were accurately classified as being localized to the mucosa. All patients (nZ11) staged T2 by TRUS were confirmed to be T2 at pathology. No difference was noted in the predictive value of TRUS for T1 vs T2 lesions (pZ.4923, exact test). Correlation between TRUS and pathology was kZ.85.Conclusions: TRUS is highly accurate in delineating depth of invasion for T1 rectal cancers and large, polypoid lesions unamenable to polypectomy. The ability to accurately delineate T1 vs T2 rectal cancer by TRUS allows for the appropriate selection of patients for TAE and thus, avoidance of more invasive surgery with higher morbidity and mortality. Abstracts

Transrectal ultrasound versus magnetic resonance imaging for detection of rectal wall invasion by prostate cancer

This study compared the accuracy of transrectal ultrasound (TRUS) versus magnetic resonance imaging (MRI) in the detection of rectal wall involvement by prostate cancer in patients undergoing salvage total pelvic exenteration (TPE) or cystoprostatectomy. We identified 16 patients who underwent TPE and 24 patients who underwent cystoprostatectomy for locally advanced prostate cancer as salvage procedures with palliative intent. Patients were examined by TRUS, MRI, or both within the month preceding surgery. Histologic evidence of rectal involvement with prostate cancer was considered the gold standard diagnostic criterion in patients undergoing TPE. Among patients undergoing cystoprostatectomy, posterior prostatic surgical margins and clinical evidence of rectal wall recurrence during a median follow-up duration of 18.6 months were considered the gold standard. The sensitivity, specificity, and overall accuracy with which TRUS and MRI detected rectal wall involvement were compared. Fifteen (93.7%) of the patients who underwent TPE had histologically-proven rectal wall involvement with prostate cancer. Rectal and perineal recurrence developed 10 months after surgery in 1 (4.1%) patient in the cystoprostatectomy group. The sensitivity, specificity, and overall accuracy of TRUS were: 92.9 (66.1-99.8), 87.0 (66.4-97.2), and 89.2 (74.6-97.0), respectively. The sensitivity, specificity, and overall accuracy of MRI were: 54.6 (23.4-83.3), 100 (76.8-100.0), and 80 (59.3-93.2), respectively. TRUS is a highly sensitive diagnostic modality for rectal wall involvement in patients with locally advanced prostate cancer. Although MRI is very specific, it cannot reliably rule out rectal involvement in the presence of a positive TRUS.

Accuracy of transrectal ultrasound in predicting pathologic stage of rectal cancer before and after preoperative radiation therapy.

Transrectal ultrasound (TRUS) and CT scan staging of rectal cancers before, and TRUS staging after, 45 Gy of irradiation were compared with the pathologic stage of the resected specimen in 19 patients. Accuracy of TRUS before and after irradiation, and of CT scan before irradiation, was 32 percent, 63 percent, and 53 percent, respectively. CT scan before and TRUS after irradiation predicted lymph node involvement in 79 percent and 68 percent of cases, respectively. Positive predictive value for lymph node involvement before irradiation was 60 percent for CT scan and 37.5 percent for TRUS; after irradiation, it was 50 percent for TRUS. Negative predictive value was 100 percent for CT scan and TRUS before radiation and 88 percent for TRUS after irradiation. Preoperative radiation therapy makes TRUS and CT scan less effective as staging techniques. The absence of lymph nodes on TRUS and CT scan before and after irradiation is reliable.

Analysis of Sonographic Pattern in Prostatic Cancer: Comparison of Longitudinal and Transversal Transrectal Ultrasound with Subsequent Radical Prostatectomy Specimens

In this study the diagnostic accuracy of transrectal ultrasonography (TRUS) in identifying prostatic cancer has been investigated. Attention was paid to the localization of tumor, capsular penetration and involvement of seminal vesicles. TRUS was performed with a 5-mHz linear array longitudinal probe as well as with a 5-mHz rotating transverse scanner. 23 patients underwent radical prostatectomy. The histological results were compared with the sonographic patterns. Transverse TRUS and longitudinal TRUS were comparable with regard to all the investigated parameters. The sensitivity and specificity for the presence or absence of tumor were 70-75 and 54%, respectively. When suspicion of capsular involvement was estimated in a prostatic lobe, a sensitivity of 89% and a specificity of 21% was found. When every separate ultrasonographically suspicious area of capsular breach was considered, there was a positive correlation of 63%. Seminal vesicle infiltration is hard to identify and TRUS has a sensitivity of only 65-74% with a specificity of 40-57%.