NEW YORK (Reuters Health) - Compared with conventional grayscale ultrasonography, transrectal real-time elastography (RTE) improves the detection of prostate cancer -- but it's not ready for prime time yet, German researchers say.
"RTE is not ready yet to be the new 'standard' in terms of local staging prostate cancer," Dr. Marko Brock told Reuters Health by email. "But our study appears to show that RTE is a much better tool compared to grayscale ultrasonography when evaluating the preoperative tumor burden."
Grayscale ultrasonography (GSU) is the most frequently used, cost-effective imaging technique, but lesions can appear hypo-, iso- or hyperechoic, as Dr. Brock and colleagues at Ruhr-Universitat Bochum, Herne, note in an August 5 online paper in BJU International.
They say ultrasonically-based RTE can detect the lower elasticity caused by higher cell density in malignant tissue, and its sensitivity reportedly ranges from 57% to 100%, but until now it hasn't been compared to conventional GSU.
In their new study, the authors used both methods to screen for cancer-suspicious areas in the prostate and for extracapsular extension in 229 men with biopsy-proven prostate cancer.
Histology studies were positive in 894 evaluated sectors. RTE correctly detected 594 (66.4%), and GSU found 215 (24.0%). Sensitivity was 51% with RTE and 18% with GSU. Specificity was 72% and 90% with RTE and GSU, respectively.
Forty-seven patients had extracapsular extension. RTE was 38% sensitive and 96% specific; GUS was 15% sensitive and 97% specific.
Overall, lesions with a higher Gleason grade had a higher likelihood of identification on RTE. But the researchers note that because of its low sensitivity and specificity, transrectal ultrasonography is not recommended in the European guidelines for local staging of prostate cancers or extracapsular extension.
They conclude that while adding the attributes of tissue elasticity to current grayscale imaging provides a statistically significant benefit, "improvement is still needed to achieve a clinically meaningful sensitivity."
By David Douglas
Source: http://bit.ly/oQIKIO
BJU Int 2011.
Last Updated: 2011-08-22 17:04:13 -0400 (Reuters Health)
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![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
