DOI QR코드

DOI QR Code

Transrectal Real-time Tissue Elastography - An Effective Way to Distinguish Benign and Malignant Prostate Tumors

  • Zhang, Yan (Department of Ultrasound, General Hospital of Chinese PLA) ;
  • Tang, Jie (Department of Ultrasound, General Hospital of Chinese PLA) ;
  • Liang, Hai-Dong (Information Science and Engineering School, Fudan University) ;
  • Lv, Fa-Qin (Department of Ultrasound, General Hospital of Chinese PLA) ;
  • Song, Zhi-Gang (Department of Ultrasound, General Hospital of Chinese PLA)
  • Published : 2014.02.28

Abstract

Background: To investigate the relationship between extracellular matrix parameters and texture of prostatic lesions evaluated by transrectal real-time tissue elastography (TRTE). Methods: 120 patients suspicious for prostate cancer underwent TRTE. Targeted biopsies were carried out after 12-core systematic biopsy. Epithelia were stained with hematoxylin-eosin, and Victoria blue and Ponceau S were used to stain elastic-collagen fibers, and picric acid-sirius red for visualization of collagen type I (Col1) and III (Col3). Smooth muscles were visualized by immunohistochemistry. All image analyses were performed in a blind manner using Image Pro Plus 6.0, and the area ratios of epithelium, elastic fibers, collagen fibers and Col1/Col3 were determined. Results: 42 patients with typical elastograms were included in the final data analysis. Significant differences were detected between the benign and malignant groups in the area ratios of epithelium (P = 0.01), smooth muscles and Col1/Col3 (P = 0.04, P = 0.02, respectively). There were no significant differences in the area ratios of epithelium, smooth muscle and elastic fibers between the stiff and soft lesion groups. The area ratio of Col1 was ($0.05{\pm}0.03$) in the stiff group, and ($0.02{\pm}0.01$) in the soft group (P= 0.00). However, the area ratio of Col3 was ($0.03{\pm}0.02$) in the stiff group, and ($0.05{\pm}0.04$) in the soft group (P = 0.16). Col1/Col3 in the stiff group ($1.99{\pm}1.59$) was greater than in the soft group ($0.71{\pm}0.64$) (P = 0.01). Conclusions: Tissue hardness of prostatic tumors was mainly dependent on the Col1 content, Col1/Col3 being higher in malignant than in benign lesions, so the prostate tissue texture can be used as a target for distinguishing between the two with TRTE.

Keywords

Elastography;ultrasound;prostate cancer;benign/malignant;differential diagnosis;collagen

References

  1. Tao KZ, Chen EY, Ding GH (1998). Structure and biomechanics of collagen fibers. Prog Anatom Sci, 4, 289-93.
  2. Zhi YH, Hong WC, Ning W (1995). Immunohistochemical study of the extracellular matrix of prostate cancer. Tumor, 15, 96-7.
  3. Peters N, Armstrong K (2005). Racial differences in prostate cancer treatment outcomes: a systematic review. Cancer Nurs, 28, 108-18.
  4. Shoulders MD, Raines RT (2009). Collagen structure and stability. Annu Rev Biochem, 78, 929-958. https://doi.org/10.1146/annurev.biochem.77.032207.120833
  5. Souchon R, Rouviere O, Gelet A, et al (2003). Visualisation of HIFU lesions using elastography of the human prostate in vivo: preliminary results. Ultrasound Med Biol, 29, 1007-15. https://doi.org/10.1016/S0301-5629(03)00065-6
  6. Sumura M, Shigeno K, Hyuga T, et al (2007). Initial evaluation of prostate cancer with real-time elastography based on step-section pathologic analysis after radical prostatectomy: a preliminary study. Int J Urol, 14, 811-6. https://doi.org/10.1111/j.1442-2042.2007.01829.x
  7. Ushiki T (2002). Collagen fibers, reticular fibers and elastic fibers. A comprehensive understanding from a morphological viewpoint. Arch Histol Cytol, 65, 109-26. https://doi.org/10.1679/aohc.65.109
  8. Wenger MP, Bozec L, Horton MA, et al (2007). Mechanical properties of collagen fibrils. Biophys J, 93, 1255-63. https://doi.org/10.1529/biophysj.106.103192
  9. Zhang Y, Nojima S, Nakayama H, et al (2003). Characteristics of normal stromal components and their correlation with cancer occurrence in human prostate. Oncol Rep, 10, 207-11.
  10. Zhang Y, Tang J, Li YM, et al (2012). Differentiation of prostate cancer from benign lesions using strain index of transrectal real-time tissue elastography. Eur J Radiol, 81, 857-62. https://doi.org/10.1016/j.ejrad.2011.02.037
  11. Zhang Y, Tang J, Li YM, et al (2012). The contribution of strain patterns in characterization of prostate peripheral zone lesions at transrectal ultrasonography. Acta Radiol, 53, 119-26. https://doi.org/10.1258/ar.2011.110504
  12. Hoyta K, Castaneda B, Zhang M, et al (2008). Tissue elasticity properties as biomarkers for prostate cancer. Cancer Biomark, 4, 213-25. https://doi.org/10.3233/CBM-2008-44-505
  13. Gao L, Parker KJ, Lerner RM, et al (1996). Imaging of the elastic properties of tissue - a review. Ultrasound Med Biol, 22, 959-77. https://doi.org/10.1016/S0301-5629(96)00120-2
  14. Gheorghe L, Iacob S, Gheorghe C (2008). Real-time sonoelastography - a new application in the field of liver disease. J Gastrointestin Liver Dis, 17, 469-74.
  15. Greenleaf JF, Fatemi M, Insana (2003). MSelected methods for imaging elastic properties of biological tissues. Annu Rev Biomed Eng, 5, 57-8. https://doi.org/10.1146/annurev.bioeng.5.040202.121623
  16. Konig K, Scheipers U, Pesavento A, et al (2005). Initial experiences with real-time elastography guided biopsies of the prostate. J Urol, 174, 115-7. https://doi.org/10.1097/01.ju.0000162043.72294.4a
  17. Krouskop TA, Wheeler TM, Kallel F, et al (1998). Elastic moduli of breast and prostate tissues under compression. Ultrason Imaging, 20, 260. https://doi.org/10.1177/016173469802000403
  18. Miyanaga N, Akaza H, Yamakawa M (2006). Tissue elasticity imaging for diagnosis of prostate cancer: a preliminary report. Int J Urol, 13, 1514-8. https://doi.org/10.1111/j.1442-2042.2006.01612.x
  19. Moore MA (2013). Overview of cancer registration research in the Asia Pacific from 2008-2013. Asian Pac J Cancer Prev, 14, 4461-84. https://doi.org/10.7314/APJCP.2013.14.8.4461
  20. Pallwein L, Aigner F, Faschingbauer R, et al (2008). Prostate cancer diagnosis: value of real-time elastography. Abdom Imaging, 33, 729-35. https://doi.org/10.1007/s00261-007-9345-7
  21. Pallwein L, Mitterberger M, Struve P, et al (2007). Comparison of sonoelastography guided biopsy with systematic biopsy: impact on prostate cancer detection. Eur Radiol, 17, 2278-85. https://doi.org/10.1007/s00330-007-0606-1
  22. Pallwein L, Mitterberger M, Struve P, et al (2007). Real-time elastography for detecting prostate cancer: preliminary experience. BJU Int, 100, 42-6. https://doi.org/10.1111/j.1464-410X.2007.06851.x
  23. Agliamov SR, Skovoroda AR (2000). Mechanical properties of soft biological tissues. Biofizika, 45, 1137-45.
  24. Aigner F, Pallwein L, Junker D, et al (2010). Value of real-time elastography targeted biopsy for prostate cancer detection in men with prostate specific antigen 1.25 ng/ml or greater and 4.00 ng/ml or less. J Urol, 184, 913-7. https://doi.org/10.1016/j.juro.2010.05.026
  25. Birbach A, Eisenbarth D, Kozakowski N, et al (2011). Persistent inflammation leads to proliferative neoplasia and loss of smooth muscle cells in a prostate tumor model. Neoplasia, 13, 692-703. https://doi.org/10.1593/neo.11524
  26. Fahey BJ, Nightingale KR, Nelson RC, et al (2005). Acoustic radiation force impulse imaging of the abdomen: demonstration of feasibility and utility. Ultrasound Med Biol, 31, 1185-98. https://doi.org/10.1016/j.ultrasmedbio.2005.05.004

Cited by

  1. Laser Induced Fluorescence Studies of Blood Plasma and Tumor Tissue of Men with Prostate Tumors vol.05, pp.11, 2014, https://doi.org/10.4236/jct.2014.511107
  2. Multiparametric ultrasound in the diagnosis of prostate cancer vol.26, pp.1, 2016, https://doi.org/10.1097/MOU.0000000000000245
  3. Comparison of meta-analyses among elastosonography (ES) and positron emission tomography/computed tomography (PET/CT) imaging techniques in the application of prostate cancer diagnosis vol.37, pp.3, 2016, https://doi.org/10.1007/s13277-015-4113-8
  4. Assessment of Tumor Stiffness With Shear Wave Elastography in a Human Prostate Cancer Xenograft Implantation Model vol.36, pp.5, 2017, https://doi.org/10.7863/ultra.16.03066
  5. P2X7R Blockade Prevents NLRP3 Inflammasome Activation and Pancreatic Fibrosis in a Mouse Model of Chronic Pancreatitis vol.46, pp.10, 2017, https://doi.org/10.1097/MPA.0000000000000928