The Evaluation And Application Of Ultrasound Image Score In The Diagnosis Of Prostate Cancer

Part one The Evaluation and Application of Ultrasound Image Score in the Diagnosis of Prostate CancerObjective: To investigate the risk score of transrectal ultrasound image for prostate cancer(PCa)and to evaluate the application value of it.Methods: The clinical data and ultrasonographic characteristics of 279 patients diagnosed by pathology were analyzed retrospectively.The patients’ age,PSA concentration,the result of digital rectal examination(DRE)were collected.All the ultrasonographic features of prostate were reported routinely by 2D and color doppler ultrasonography,After transrectal ultrasound examination,assessing the prostatic diameter,the volume of the whole prostate,recording the shape of prostate,capsule,internal echoes,calcification,internal and external gland boundaries and the surrounding tissue boundaries,the number,location,echo,shape and verge of tubercle,the blood flow of the suspicious lesions.Ultrasound signs with significant efficacy after univariate analysis were evaluated in logistic regression model to predict the malignant risk of prostate lesions.The risk scores that were derived from logistic regression were applied to the validation set who was composed of 60 patients.A receiver operating characteristic(ROC)curve was used to assess the diagnostic value of PCa of the ultrasonic risk score.Results: Twelve ultrasound signs(capsule protruded or interrupted,unidentified with surrounding organizations,unclear boundary between internal and external gland,inhomogeneous echo in peripheral zone,RI≥0.75,blood flow grade≥2,with tubercle located in the peripheral zone,irregular shape,hard text-ure)were included in the final Logistic regression model.Using logistic regression,which created a 5-part score that consisted of inhomogeneous echo in peripheral zone(2 points),unclear boundary of internal and external gland,(2 points),RI ≥ 0.75(1 point),unclear boundary of tubercle(1 point).The risk score in the validation group area under the ROC curve AUC = 0.917,With 95% confidence interval(0.845,0.990).With a total score of 2.5 as a cut-off value,the sensitivity and specificity were 83.9% and 89.7% respectively.Conclusions: The multiparametric risk score based on ultrasonic manifestations can improved the diagnostic accuracy of prostate cancer.Part two Comparison of Analgesic Effects between Infiltration Anesthesia in Local Apical Periprostate and Combined Periprostatic Nerve Block in Transperineal Prostate BiopsyObjective: To compare the analgesic efficiency and safety between local apical periprostate infiltration anesthesia and combined periprostatic nerve block(PPNB)in transperineal prostate biopsy(TPPB).Methods: 80 patients who underwent transperineal prostate biopsy in the Ultrasonic Diagnosis Department of Affiliated Hospital of North Sichuan Medical College were enrolled in during April 2017 to October 2012.After transrectal ultrasound examination,assessing the prostatic diameter,prostate volume,transition zone,capsular and seminal vesicle characteristics,blood flow and the suspicious lesions etc.Two different anesthesia styles were randomly selected between left and right lobe prostate.The first group received local Lidocaine anesthesia onto the capsula of the apex(Group A),meanwhile,the second group received periprostatic nerve block(Group B)besides basal local apical periprostate infiltration anesthesia.Intraoperative and postoperative adverse events as well as complications were recorded detailed to evaluate the safety of the two anesthesia methods.Pain evaluation during anaesthetic and biopsy was explained to the patients,and this assessment was performed using an 10-point linear visual analog scale(VAS).Results: There were no serious adverse events associated with anesthesia during biopsy.The heart rate and blood pressure exhibited mild fluctuation during the operation and showed no significant difference between two groups(P>0.05).Meanwhile,there was no significant difference in VAS scores between two groups during anesthesia(P>0.05).A statistically significant difference was determined in terms of VAS between group A and B during biopsy(P<0.05),PPNB produced superior pain control than TPPB during sampling.Conclusions: The PPNB is a safe and effective analgesic method during transperineal prostate biopsy,showing the better analgesic efficacy than local anesthesia onto the capsula of the apex,which is worthy of clinical application.