Radiation Force Imaging of Prostate Cancer and Guidance of Biopsy Procedures

前列腺癌的辐射力成像和活检程序指导

基本信息

批准号：
8013858
负责人：
Kathryn Radabaugh Nightingale
金额：
$ 40.13万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-01-18 至 2014-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8013858
关键词：
Acoustics Adenocarcinoma Algorithms Ally Benign Benign Prostatic Hypertrophy Biopsy Breast Cancer Detection Cardiovascular system Cessation of life Characteristics Clinical Cold Therapy Core Biopsy Coupled Data Detection Development Diagnosis Digital Rectal Examination Disease Elasticity Europe Gleason Grade for Prostate Cancer Goals Growth Hand Heating Histologic Histology Histopathologic Grade Image Imagery In Situ Inflammation Investigation Laboratories Lesion Liver Malignant Neoplasms Malignant neoplasm of prostate Measures Methods Monitor Needles Newly Diagnosed Pathologic Pathology Patient observation Pattern Physiologic pulse Procedures Process Prostate Prostate Cancer therapy Prostate-Specific Antigen Prostatic Radiation Radiation therapy Radical Prostatectomy Recurrence Reporting Research Resolution Sampling Screening procedure Specimen Staging Stress Structure System Thyroid Gland Time Tissues Transducers Tumor Tissue Ultrasonic Diagnosis Ultrasonic Transducer Ultrasonics Ultrasonography United States Universities Work base cancer recurrence clinical application clinically significant cohort density design imaging modality improved in vivo men public health relevance response standard of care tumor

项目摘要

DESCRIPTION (provided by applicant): Prostate cancer (PCa) is the most common non-cutaneous cancer in men in the United States, with over 185,000 cases newly diagnosed, and over 28,000 deaths annually [1, 2]. Screening methods are now widely used in the United States and Europe to detect PCa, which include digital rectal examination (DRE), and prostate-specific antigen (PSA) analysis. When suspicion is raised through these screening mechanisms, prostate biopsies are performed to diagnose PCa, which depends upon the presence of adenocarcinoma in biopsy cores, with clinical significance being determined by the presence of 50% or more PCa tumor tissue in 3 or more biopsy cores, a Gleason sum (GS, histologic analysis) greater than 6, and a PSA density (PSA divided by ultrasound derived volume of prostate) more than 0.15[3]. The clinical standard for performing prostate biopsy is ultrasound-guided, transrectal, laterally directed 18G needle cores, with the number of cores ranging from 6-12, systematically sampling different regions of the prostate[4]. This standard does not involve targeting needles to suspicious regions since PCa does not have unique B-mode ultrasound image characteristics that can delineate diseased from normal structures and benign pathologies of the prostate (e.g., benign prostatic hyperplasia (BPH) and inflammation). The current standard of care has a dismal sensitivity (only 53% using octant systematic biopsy in a cohort of radical prostatectomy specimens with previously diagnosed, clinically significant disease, [5]), mainly because the sampling grid only randomly intersects the pathologic tissues. Over 1,000,000 prostate biopsies are performed annually in the United States[6], with PCa detection rates being low (25-36%)[6]. PCa detection rates on repeat biopsies (cases with negative first biopsies) are again 10-35% [7, 8]. The fact that these rates are identical suggests that as many cancers are detected as are missed during a single systematic biopsy session. In addition, many of the cancers that are detected with this approach are clinically insignificant[3]. Elastography imaging methods have shown promise for PCa visualization and prostate biopsy guidance based upon stiffness differences between normal and pathologic tissues[9]. However, elastography methods can be limited by an inability to apply uniform compression (stress) to the prostate using a hand-held transrectal ultrasonic transducer. Acoustic Radiation Force Impulse (ARFI) imaging is an elastography imaging method that we have developed at Duke University that overcomes these challenges through the use of focused acoustic beams for the application of stress. We have obtained promising initial ex vivo and in vivo results, in which normal prostatic structures and focal PCa lesions are clearly visualized in ARFI images that are not visualized in matched B-mode images. The in vivo data demonstrate a clear advantage of ARFI imaging over conventional elastography for PCa visualization, in that the acoustic energy is coupled directly into the prostate. We propose to develop and optimize dedicated 2D and 3D transrectal in vivo ARFI imaging methods for the purpose of visualizing PCa and differentiating PCa from benign processes in the prostate; to evaluate the correlation between suspicious regions in ARFI images and tissue histology, to investigate the correlation between local PCa Gleason pattern (measure of histologic aggressiveness) and PCa visibility in ARFI images, and to evaluate the potential increase in biopsy detection rate of clinically significant PCa under ARFI image guidance. If successful, this research has the potential to greatly improve cancer detection rates for clinically significant grade PCa (i.e. GS 7 or more) during first time biopsies, to reduce the number of biopsy cores taken during biopsy, to facilitate longitudinal monitoring of PCa growth or recurrence after in situ therapies, and to provide image guidance for focal PCa therapies. PUBLIC HEALTH RELEVANCE: Prostate cancer (PCa) is the most common non-cutaneous cancer in men in the United States, with over 185,000 cases newly diagnosed, and over 28,000 deaths annually [1]; PCa is currently diagnosed by ultrasonic guided biopsy in which systematic sampling of the prostate is performed because PCa is not generally visualized in ultrasonic images, thus, PCa biopsy is reported to have poor sensitivity (53%)[5]. We propose to develop ultrasonic radiation force based stiffness imaging methods capable of visualizing focal cancers in the prostate, thus providing targeting for biopsy procedures. If successful, this research has the potential to greatly improve the cancer detection yield for clinically significant grade cancers on first time biopsies, to reduce the number of biopsy cores taken during biopsy, to facilitate longitudinal monitoring of PCa growth or recurrence after in situ therapies, and to provide image guidance for focal PCa therapies.

描述（由申请人提供）：前列腺癌（PCA）是美国男性中最常见的非乳腺癌癌症，每年有185,000例新诊断，每年有28,000多人死亡[1，2]。现在，在美国和欧洲广泛使用筛查方法来检测PCA，其中包括数字直肠检查（DRE）和前列腺特异性抗原（PSA）分析。当通过这些筛查机制提出怀疑时，进行前列腺活检以诊断PCA，这取决于活检核心中腺癌的存在，其临床意义是通过30％或更多的PCA肿瘤组织在3或多个活检核心（GS）中（gs，ps，ps a的范围）（PSA）的（PSA）的（PSA）的（PSA）的（PSA）的（PSA）的（PSA）的（PSA）的（PSA）超过6，并且是一个psa（PSA）的临床意义（PSA），并且是一个PSA（PSA），并且是一个PSA（PSA），并且是A的分析（PSA）。前列腺）超过0.15 [3]。进行前列腺活检的临床标准是超声引导的，经直肠，侧向的18G针核的临床标准，其核心数量为6-12，系统地对前列腺的不同区域进行了采样[4]。该标准不涉及将针头靶向可疑区域，因为PCA没有独特的B模式超声图像特性，可以从前列腺的正常结构和良性病理学（例如，良性前列腺增生（BPH）和炎症）中描述患病的疾病。当前的护理标准具有令人沮丧的敏感性（在一系列具有先前诊断为临床意义的疾病[5]的根治性前列腺切除术标本中，只有53％的人使用八次系统活检，主要是因为抽样网格仅随机随机相交病理组织。每年在美国进行超过1,000,000个前列腺活检[6]，PCA检测率较低（25-36％）[6]。重复活检的PCA检测率（阴性第一活检病例）再次为10-35％[7，8]。这些速率是相同的事实表明，由于在一次系统的活检课程中遗漏了许多癌症。另外，这种方法检测到的许多癌症在临床上无关紧要[3]。弹性成像方法已经根据正常组织和病理组织之间的刚度差异显示了PCA可视化和前列腺活检指导的希望[9]。但是，弹性图方法可能会受到无法使用手持式直肠超声传感器对前列腺施加均匀压缩（应力）的限制。声学辐射力冲动（ARFI）成像是我们在杜克大学开发的一种弹性成像方法，它通过使用聚焦的声学束来克服这些挑战，以应用压力。我们已经获得了有希望的初始离体和体内结果，其中正常的前列腺结构和焦点PCA病变在ARFI图像中清楚地可视化，这些图像在匹配的B模式图像中未可视化。体内数据证明了ARFI成像比常规弹性图的明显优势以进行PCA可视化，因为声能直接耦合到前列腺中。我们建议在体内ARFI成像方法中开发和优化专用的2D和3D转直肠直直直直立直直直直鼻，目的是可视化PCA并将PCA与前列腺中的良性过程区分开来；为了评估ARFI图像和组织学中可疑区域之间的相关性，以研究ARFI图像中局部PCA Gleason模式（组织学侵略性的度量）与PCA可见性之间的相关性，并评估ARFI图像指导下临床上重要PCA的活检检测率的潜在增加。如果成功的话，这项研究有可能大大提高第一次活检期间临床意义的PCA（即GS 7或更多）的癌症检测率，以减少活检期间进行的活检核心的数量，以促进对现场疗法后PCA生长或重新培养的纵向监测，并提供图像PCA PCA Terapies。公共卫生相关性：前列腺癌（PCA）是美国男性中最常见的非直觉癌症，每年有185,000例新诊断的病例，每年有28,000多人死亡[1]；当前，PCA是通过超声引导活检诊断的，在超声波检查中，进行了系统采样，因为PCA通常在超声图像中通常不可见，因此据报道，PCA活检的敏感性较差（53％）[5]。我们建议开发基于超声辐射的刚度成像方法，能够可视化前列腺中的焦点癌，从而为活检程序提供靶向。如果成功的话，这项研究有可能大大提高第一次活检中临床意义级癌的癌症检测产量，以减少活检期间进行活检核心的数量，以促进对现场治疗后PCA生长或复发的纵向监测，并为焦点PCA治疗提供图像指导。