Hypoehoic lesions on Transrectal Ultrasound and its correlation to Gleason grade in the diagnosis of Clinically Significant Prostate Cancer: A Prospective Study

Context The importance of hypoechoic lesions on transrectal ultrasound (TRUS) merits re-assessment in the present era of widespread prostate-specific antigen (PSA) testing. Aims We aimed to investigate the predictive accuracy of hypoechoic lesions on TRUS of prostate in the diagnosis of prostate cancer and to examine the association of hypoechoic lesions with the aggressiveness of prostate cancer. Settings and Design This prospective study was conducted in a tertiary care center in South India from November 2017 to December 2019. Methods and Material We included 151 patients undergoing TRUS-guided 12-core prostate biopsy in view of raised serum PSA with or without suspicious digital rectal examination (DRE) findings in the study. Age, DRE findings, serum PSA level, TRUS findings, and histopathology reports were documented. These were compared between patients with and without hypoechoic lesions on TRUS. Statistical Analysis Used The statistical analysis for this study was performed using SPSS v20.0 software. Results Among 151 men, prostate cancer was diagnosed in 68 (45.03%) with mean age at presentation 69.81 ± 6.49 years. Fifty-eight cases (38.41%) had hypoechoic lesion on TRUS and the cancer detection rate (68.96%) amongst this group was significantly higher than in those without hypoechoic lesion (p <0.0001). Patients with hypoechoic lesion were more likely to have higher grade cancer. Abnormal DRE findings and hypoechoic lesion on TRUS were independent predictors of a clinically significant cancer (p <0.05). Conclusion Hypoechoic lesion on TRUS can be considered as an indicator of clinically significant prostate cancer.

PREDICTION OF HYPOECHOIC LESIONS ON ULTRASOUND OF PROSTATE CANCER BASED ON PSA INTERVAL AND GLEASON GROUP

Objective: To evaluate hypoechoic lesion in transrectal ultrasonography of prostate (TRUS-P) predictive value on prostate cancer based on PSA Interval and Gleason Group. Material & Methods: An observational analytic study with a cross-sectional design take place from January 2015 to December 2018 analyzing patients who had undergone TRUS-P Biopsy at Hasan Sadikin Hospital. Patients are divided into several subgroups according to different PSA levels. A p-value < 0.05 was considered statistically significant. PPV, NPV, and Youden’s index were all indexes reflecting the performance of a diagnostic test. Results: There were 35 cases (49.3%) with a visible hypoechoic lesion in TRUS and 36 cases (41.7%) without a visible hypoechoic lesion. In our study, 23.9% of the patients with hypoechoic lesions were diagnosed with prostate cancer on TRUSP-Biopsy. The results of the analysis with Youden’s index show that PSA at intervals of 10-20 is the best predictor of diagnostic values. Then we analyzed the overall detection rate based on PSA interval. Patients with PSA > 20 ng/ml, hypoechoic lesions were significantly associated with Gleason Group. Conclusion: We concluded in our study that the hypoechoic lesion in transurethral ultrasonography of prostate could improve the predictive efficacy for diagnosing prostate cancer.

Jejunojejunal Intussusception in an Adult- Secondary to Lipoma

Gastric lipomas are very rare Tumours of Gastrointestinal Tract (GIT) accounting for about 2-3% of all benign gastric tumours. They are asymptomatic and discovered incidentally, most lipomas being submucosal. Authors hereby discuss a case of 50-year- old female patient who presented with abdominal pain and vomiting since four days. Transabdominal Ultrasound (TAUS) revealed long segment jejunojejunal intussusception and a hypoechoic lesion in the distal end of intussusception which was successfully treated by removing the lipoma along with the intussuscepted loop. Histopathological features revealed normal jejunal mucosa with a segment of intussusception and edematous submucosa which was thought to be submucosal lipoma or subserosal lipoma. As these lesions present at later dates, proper follow-up and early intervention is needed.

Ultrasonography and Atypical Sites of Endometriosis

In the present pictorial we show the ultrasonographic appearances of endometriosis in atypical sites. Scar endometriosis may present as a hypoechoic solid nodule with hyperechoic spots while umbilical endometriosis may appear as solid or partially cystic areas with ill-defined margins. In the case of endometriosis of the rectus muscle, ultrasonography usually demonstrates a heterogeneous hypoechogenic formation with indistinct edges. Inguinal endometriosis is quite variable in its ultrasonographic presentation showing a completely solid mass or a mixed solid and cystic mass. The typical ultrasonographic finding associated with perineal endometriosis is the presence of a solid lesion near to the episiotomy scar. Under ultrasonography, appendiceal endometriosis is characterized by a solid lesion in the wall of the small bowel, usually well defined. Superficial hepatic endometriosis is characterized by a small hypoechoic lesion interrupting the hepatic capsula, usually hyperechoic. Ultrasound endometriosis of the pancreas is characterized by a small hypoechoic lesion while endometriosis of the kidney is characterized by a hyperechoic small nodule. Diaphragmatic endometriosis showed typically small hypoechoic lesions. Only peripheral nerves can be investigated using ultrasound, with a typical solid appearance. In conclusion, ultrasonography seems to have a fundamental role in the majority of endometriosis cases in “atypical” sites, in all the cases where “typical” clinical findings are present.

Intense Therapeutic Ultrasound for Pain Relief in the Treatment for Chronic Plantar Fasciopathy

Background: Intense therapeutic ultrasound (ITU) is an innovative ultrasound-based therapy where sound waves are concentrated into select musculoskeletal tissue. These focused waves generate thermal coagula at a controlled depth and space while preserving surrounding tissues. A multicenter study was conducted evaluating the efficiency, safety, and patient tolerance of ITU for the treatment of chronic plantar fasciitis (CPF) pain. Methods: Seventy-four CPF patients, having failed conservative and/or minimally invasive treatment, participated in the study. Randomized participants either received 2 ITU treatments or 2 sham ITU treatments in addition to standard-of-care therapy. Plantar fascia pain was assessed pretreatment and at 4, 8, 12, and 26 weeks after treatment. Diagnostic ultrasonographic images were analyzed to examine hypoechoic, perifascial lesions whose volumes were calculated until week 12. Function and patient satisfaction were measured using self-reported outcome measures. Results: The treated group reported significant average pain reduction (–26%, –33%, –43%) and hypoechoic lesion volume (–33%, –53%, –68%) at weeks 4, 8, and 12 compared to baseline. Although the control/sham group reported insignificant pain changes at the same time points (–5%, +8%, and +2%) and increased hypoechoic lesion volume (+15%, +28%, +58%). Treated patients reported a significant increase in daily living activities (+28%, +42%, +47%, +40%) compared to the sham/control group (+0.12%, +12%, +3%, +21%). Patient satisfaction remained more than 80% at weeks 8, 12, and 26 for all treatment groups. Conclusion: ITU is an effective pain relief treatment for CPF, which is refractory to either conservative measures or minimally invasive treatments. Level of Evidence: Level II.