Prostate cancer is a malignant tumor of the prostate. 2004 "WHO of urinary system and male genital organs of tumor pathology and genetics" in prostate cancer pathological types including adenocarcinoma (acinar adenocarcinoma), ductal adenocarcinoma, urothelial carcinoma, squamous cell carcinoma, adenosquamous carcinoma. Prostate adenocarcinoma accounted for more than 95%, therefore, we usually refer to prostate cancer refers to prostate cancer [1]. Prostate cancer is one of the most common malignant tumors in men. After 55 years of age, the incidence of the disease increases with age. The peak age is 70-80 years old, which seriously affects the physical and mental health of middle-aged and elderly male patients. [2]. In recent years, with the rapid development of ultrasound technology, the diagnostic accuracy rate of prostate cancer has been significantly improved.
1, general information
45 cases of prostate cancer patients from 2012 to 2015 in our hospital confirmed by surgery and pathology, aged 53-84 years old, the average age of 67 years, the duration of 1.5-4.5 years, an average of 2 years, all patients with rectal examination can touch the hard nodules have different degrees of retention of urine, blood, urine, urinary frequency of the clinical symptoms such as dysuria.
2, inspection method
Ask the patient to check before emptying stool, cleaning enema when necessary, patients take the left lateral position, legs buckling, the frequency of transrectal 7.5MHz, condoms in probe sets, asked the patients mouth breathing couplant coat, the probe gently inserted into the patient's anus, the prostate for longitudinal and transverse, oblique, coronal, measure and record the prostate size, inner gland size, outer gland thickness, area and perimeter, observe the prostate shape, internal echo, internal and external gland has no abnormal echo area, key observation of abnormal echo, blood flow distribution and signal characteristics of recording its position, size and shape and sonographic features and inside and around, can probe the appropriate pressure, displacement and deformation observation of the prostate and abnormal echo and feel the hardness of abnormal echo area.
3, results
The postoperative pathology, 45 cases diagnosed by transrectal ultrasonography correctly in 39 cases (86.67%), 6 cases were misdiagnosed (13.33%), the masses showed low echo in 36 cases, 5 cases, 4 cases of mixed echo echo, see table 1:
Table 1 Comparison of echo and case type
4, discussion
4.1, transrectal ultrasound features of prostate cancer
Prostate cancer is more common in the outer gland, especially in the peripheral area. Typical sonographic features of prostate cancer, prostate or prostate irregular shape complete capsule, internal and external gland has no clear boundary, even not clear, outer gland is markedly thickened and the peripheral zone of the probe and nodules, lumps or irregular protrusions are substantial limitations, low echo, only a few showed high echo, echo or etc. mixed echo [3] lesions in the probe and rich color flow, in dot, strip or into shape. (1) prostate cancer nodules: non hypoechoic nodule ultrasound visible outer gland, around the probe and blood flow, blood flow and scarce; (2) nodules - invasive prostate carcinoma: ultrasound probe and morphology of irregular hypoechoic nodules, the boundary is not clear, the internal probe and may be more blood flow. The peripheral zone only detectable and multi strip blood flow; (3) invasive prostate cancer, prostate ultrasound shows were isoechoic, boundaries are not clear, no nodular change, does not have the obvious spaceoccupying swelling characteristics, damage to the surrounding tissue and tumor infiltration, which is suggestive of the diagnosis of prostate cancer [4] changes.
4.2, different pathological types of prostate cancer by transrectal ultrasonography
Clinical studies have shown that the different ultrasonographic features of prostate cancer are related to different histological types and histological structure. Poorly differentiated and undifferentiated carcinoma in the cancer tissue differentiation, nests and cords arranged to have around interstitial infiltration tendency, therefore, the ultrasound examination of the probe and lobulated hypoechoic nodule, irregular peripheral; high differentiation carcinoma and atypical hyperplasia (precancerous lesions) from cancer well differentiated tissue, showed adenoid distribution, ultrasound to probe and hypoechoic nodules and mixed nodular hyperplasia of the prostate, the echo intensity is not the same, ultrasonography is complex.
4.3, prostatic hyperplasia and prostate cancer by transrectal ultrasound
Benign prostatic hyperplasia is common, multiple, often need to identify the clinical and prostate cancer. The sonographic features of benign prostatic hyperplasia: the prostate shape plump, often protruding into the bladder, but the internal and external gland clear demarcation, outer gland often show compression thinning, uneven internal echo, some patients in the gland could be detected and unclear boundary slightly lower or near or slightly isoechoic nodules, but the nodular morphology rules; cystic nodules is rare; hyperplasia of prostate gland or outside the junction often be detected and larger light group, namely calcification and strong echo.
4.4, prostate cancer by transrectal ultrasound and transabdominal ultrasound
Although the conventional transabdominal ultrasound examination of the prostate, but for some of the drawbacks of screening for prostate cancer, mainly for the resolution and clarity of the image is susceptible to obesity, bladder excessive or too little, scar, prostate hypertrophy, pubis and rectal sound shade many factors such as interference, and the resolution and definition of the image of transrectal ultrasound the interference of these factors.
In summary, transrectal ultrasonography not only clear image, high resolution, can be observed in blood vessels, can provide a reliable basis for clinical treatment, but also has no trauma, low cost, simple operation, easy to accept patients and other advantages, is worthy of clinical application.
Reference material
[1] Han. Relationship between transrectal ultrasonography and pathological types of prostate cancer [J]. Chinese Journal of modern medicine, 2013, 51 (13): 78