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31 October 2012

Ultrasound elastography as a tool for imaging guidance during prostatectomy: Initial experience

Ioana Nicolaescu FlemingABCDEF, Carmen KutABCDF, Katarzyna J. MacuraABDEG, Li-Ming SuABD, Hassan RivazABC, Caitlin M. SchneiderABC, Ulrike HamperD, Tamara LotanC, Russ TaylorADG, Gregory HagerADG, Emad BoctorABDEG

DOI: 10.12659/MSM.883540

Med Sci Monit 2012; 18(11): CR635-642

Abstract

Background: During laparoscopic or robotic assisted laparoscopic prostatectomy, the surgeon lacks tactile feedback which can help him tailor the size of the excision. Ultrasound elastography (USE) is an emerging imaging technology which maps the stiffness of tissue. In the paper we are evaluating USE as a palpation equivalent tool for intraoperative image guided robotic assisted laparoscopic prostatectomy.
Material/Methods: Two studies were performed: 1) A laparoscopic ultrasound probe was used in a comparative study of manual palpation versus USE in detecting tumor surrogates in synthetic and ex-vivo tissue phantoms; N=25 participants (students) were asked to provide the presence, size and depth of these simulated lesions, and 2) A standard ultrasound probe was used for the evaluation of USE on ex-vivo human prostate specimens (N=10 lesions in N=6 specimens) to differentiate hard versus soft lesions with pathology correlation. Results were validated by pathology findings, and also by in-vivo and ex-vivo MR imaging correlation.
Results: In the comparative study, USE displayed higher accuracy and specificity in tumor detection (sensitivity=84%, specificity=74%). Tumor diameters and depths were better estimated using USE versus with manual palpation. USE also proved consistent in identification of lesions in ex-vivo prostate specimens; hard and soft, malignant and benign, central and peripheral.
Conclusions: USE is a strong candidate for assisting surgeons by providing palpation equivalent evaluation of the tumor location, boundaries and extra-capsular extension. The results encourage us to pursue further testing in the robotic laparoscopic environment.

Keywords: Phantoms, Imaging, Palpation, Laparoscopy, Elasticity Imaging Techniques - methods, Prostate - ultrasonography, Prostatectomy

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750