az4peaks
Regular
Joined: 23 Oct 2009
Posts: 17
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 Posted: Thu Oct 29, 2009 4:59 pm Post subject: Color Doppler Clarification |
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To all interested:
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> Although, it is generally acknowledged that, when properly used, Color Doppler (CDU) can be another helpful AID in Prostate Cancer (PCa) diagnosis, some overzealous proponents bestow attributes to it, that are sometimes grossly overstated.
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> In simple terms, Color Doppler is a color-enhanced version of traditional gray-scale Ultrasound Imaging. It measures blood flow and by variations in intensity can identify "suspicious" areas of increased blood activity. It is used to guide what is known as a "targeted"biopsy. Without the accompanying biopsy samples being examined by a Pathologist, its images alone cannot diagnose or determine disease type.
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> Its most valuable use MAY be in the evaluation of the extent of disease proliferation in cases of an already identified PCa tumor, or in disease recurrence. As with other imaging techniques, results are not always definitive and indeterminate findings are not uncommon.
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> Some enthusiasts suggest, or at least imply, that CDU is so accurate that it can substitute for the more traditional patterned Biopsy. Numerous Studies have found that NOT to be the case. It is generally acknowledged that it can be an adjunct to, BUT DOES NOT REPLACE, the need for the traditional 10-12 core patterned Biopsy.
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> For those interested, I can furnish abstracts of numerous Studies stating that conclusion. - John@newPCa.org (aka) az4peaks |
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az4peaks
Regular
Joined: 23 Oct 2009
Posts: 17
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| Posted: Sat Oct 31, 2009 12:33 pm Post subject: Color Doppler use |
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Hi johnT, - [b]The requested Study conclusions, follow this message.[/b]
I understand your own enthusiasm, because of the personal experience you describe. However, after 11 years of educating and counseling men with Prostate Cancer, I don't believe that your experience is TYPICAL of most CDU results. If it was, I assure you, it would be far more widely available and more regularly used, than it is today.
As I stated in my previous Post, when used properly, it can sometimes be a beneficial AID in the diagnostic process, but in my opinion, it is NOT something every Prostate Cancer (PCa) patient needs or should necessarily have administered. Grossly over-stating its capabilities, unfairly raises the patient's expectations to a level that could discourage his acceptance of other equally valuable diagnostic tools.
I believe my original assessment to be a fair and balanced representation of CDU capabilities, in general use. Respectfully, - John@newPCa.org (aka) az4peaks
Urology. 2007 Dec; 70(6):1136-40.
Targeted biopsy of the prostate: the impact of color Doppler imaging and elastography on prostate cancer detection and Gleason score.
Nelson ED, Slotoroff CB, Gomella LG, Halpern EJ.
Kimmel Cancer Center, Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. eric.nelson@mail.tju.edu
Conclusion:
[b]“Although color Doppler imaging and elastography are encouraging adjuncts to improve cancer detection, targeted biopsy alone is not sufficient to replace the traditional sextant biopsy technique.” [/b]
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Radiology. 2002 Apr;223(1):282-3; author reply 283-4.
Predictors of prostate carcinoma: accuracy of gray-scale and color Doppler US and serum markers.
Kuligowska E, Barish MA, Fenlon HM, Blake M.
Department of Radiology, Boston University School of Medicine, 88 E Newton St, Boston, MA 02118, USA. ewa.kuligowska@bmc.org
[b]“CONCLUSION: Gray-scale transrectal US, even coupled with color Doppler US, is inadequate for prostate carcinoma screening; therefore, targeted biopsy should always be accompanied by complete sextant biopsy sampling.”
[/b]
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Comparison Between Vascular Density and Total Vascularity
Peter H. Arger, MD, S. Bruce Malkowicz, MD, Keith N. VanArsdalen, MD, Chandra M. Sehgal, PhD, Anson Holzer, BA and Susan M. Schultz, RDMS
Departments of Radiology (P.H.A., C.M.S., A.H., S.M.S.) and Urology (S.B.M., K.N.V.), University of Pennsylvania Medical Center, Philadelphia, Pennsylvania USA.
[b]“Conclusions. Pathologic categories were not separable by apparent vascular measurement. All pathologic categories showed low, moderate, or high vascularity; thus vascular areas by themselves did not distinguish cancer types, nor did focal hypervascular hypoechoic areas increase the likelihood of cancer. These imaging techniques provided no further resolution of tumor discrimination over multiple biopsies of the prostate.[/b]
AJR 2000; 175:1161-1168
© American Roentgen Ray Society
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Endorectal Color Doppler Sonography and Endorectal MR Imaging Features of Nonpalpable Prostate Cancer
Correlation with Radical Prostatectomy Findings
F. Cornud1, K. Hamida1, T. Flam2, O. Hélénon1, Y. Chrétien2,3, N. Thiounn2, J. M. Correas1, J. M. Casanova4 and J. F. Moreau1
1 Service de Radiologie, Hôpital Necker, 149 rue de Sèvres, 75015 Paris, France.
2 Service d'Urologie, Hôpital Cochin, 24 Rue du Faubourg saint Jacques, 75014 Paris, France.
3 Service d'Urologie, Hôpital Necker, 75015 Paris, France.
4 Service d'Uro-Gynécologie, Hôpital Notre Dame de Bon Secours, 14 rue des volontaires, 75014 Paris, France.
[b]“CONCLUSION. Endorectal sonography and color Doppler sonography are useful to differentiate low-risk invisible and hypovascular tumors from high-risk visible and hypervascular tumors. However, MR imaging has a poor sensitivity for the detection of extraprostatic spread and is accurate only in a minority of highly selected high-risk hypervascular tumors.”[/b]
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2007 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 26:1671-1679 • 0278-4297
Peripheral Zone Hypoechoic Lesions of the Prostate
Evaluation With Contrast-Enhanced Gray Scale Transrectal Ultrasonography
Jie Tang, MD, Jing Chun Yang, MD, Yanmi Li, MD, Junlai Li, MD and Huaiyin Shi, MD
Departments of Ultrasound (J.T., J.C.Y., Y.L., J.L.) and Pathology (H.S.), Chinese People’s Liberation Army General Hospital, Beijing, China.
[b]“Conclusions. Contrast-enhanced TRUS could reveal the presence of vasculature within peripheral zone hypoechoic lesions more objectively than color Doppler ultrasonography and could be promising in guidance of prostate biopsy.”[/b]
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Reviews in Urol. 2003; 5(Suppl 6): S17–S22.
Conclusion:
[b] “Optimal cancer detection, however, requires targeted and standard systematic techniques. Given the obvious increased cost of contrast-enhanced color Doppler imaging, larger studies in different populations will be needed before this can be recommended for widespread use.[/b]” |
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