超音波A-スコープ方式応用による前立腺疾患の診断法(前立腺癌の鑑別診断法の価値についての研究)

Abstract

Among senile diseases in the field of urology, establishment of differential diagnostic means between benign and malignant prostatic tumors was evaluated by application of ultrasonic A-scope method, The apparatus used in the study was SSD-2B model A-scope indication manufactured by Japan Radio Co, with a transducer which was specifically designed for diagnosis of prostatic diseases, Using three kinds of special transducers, 5 MC and 10 mm¢ for transrecta1 method, 5 MC and 3 mm¢ for transurethral method and 5 MC and 10 mm¢ of P.PJ. form designed by Takahashi for prostatic use, experiments were carried out on its basic and clinical applications. 1) The most appropriate scanning condition of the apparatus was searched in order to differentiate malignant prostatic tumors from benign tumors. The main conditions, such as at 100V for power, 10 ≒75dB for gain and 10 for rejection, were fixed and then the marker was settled so as to shows about 7.7µs per time mark at about 130 KC of oscillating frequency of distance mark on the Brown tube surface (by the preliminary study one distance mark on the Brown tube surface was settled to correspond about 1 cm distance of the test piece). The pulse L 'was set on 1.0 or 2.0 for transrecta1 method and 0 or 1.0 for transurethral method, and ultrasonic diagnosis was made by analysis of the observed echo-patterns and the representative patterns were drawn. 2) For the basic experiments, operatively extripated prostatic tumor specimens, including 7 hypertrophy and 1 cancer confirmed by histological examination, were provided. i) Echo-pattern of prostatic hypertrophy: The height of the echo showed (÷) to (+) levels of my own classification and the echo itself revealed a tendency of single-peaked and solitary simple pattern. ii) Echo-pattern of prostatic cancer: The height of the echo showed (x) to () levels of my own classification and the echo itself revealed a tendency of multiple-peaked and fused irregular pattern. 3) For clinical experiments, a total of 63 cases was provided including 19 subjects with normal prostate, 6 patients with prostatic stone and 38 with prostatic tumors (in histologically, 21 with hypertrophy, 13 with cancer or suspected cancer and 4 with others), all of which diagnosis was established by urological examinations. i) In normal prostatic subjects, the thickness of the prostatic part from its rectal part to pubic part, determined by the observed values of the distance markes in 17 subjects, was 2.7 ±0.4 marks as an average. ii) In 17 patients with prostatic hypertrophy, the average thickness of the prostatic part was 3.9±0.5 marks, which was significantly different from that in normal subjects. The observed values in the patients with hypertrophy were worth in differentiating the enlarged thickness of the prostatic gland from normal. iii) No specific echo-pattern was observed in normal prostatic gland. The height of echo at the prostatic part was approximately in grade of (÷). iv) In patients with prostatic stone, the height of echo ranged (÷) to () levels with markedly sharp and single-peaked or 2- to 3-peaked echo-patterns. v) In patients with prostatic hypertrophy, the height of echo was () to ( +) with single, double or tripple peaks, and the echo-pattern was not specific. vi) In patients with prostatic cancer, the height of echo was (+) to (), and showed multiple-peaked and fused irregular specific echo-pattern. 4) The comparative study 9n analysis of echo-pattern at the prostatic part for ultrasonic diagnosis and histological diagnosis resulted as follows. i) Among 21 cases of prostatic hypertrophy diagnosed by histological examination 17 cases, 80.9%" agreed to the diagnosis made by ultrasonic method. ii) All of 15 cases who were diagnosed as prostatic cancer or possible prostatic cancer by histological examination concurred with the ultrasonic diagnosis. iii) In two patients who were suspected to have prostatic cancer but were not confirmed histologically due to unsuccessful biopsy, the ultrasonic examination revealed echo-patterns of cancer or possible cancer. iv) Out of 19 cases in which diagnosis of cancer or possible cancer of the prostatic gland was made by ultrasonic examination, histological study revealed prostatic hypertrophy in 4 cases, among which complication of cancer of the bladder neck was found in 1 case. 5) The ultrasonic diagnostic means of this kind gave neither direct nor indirect side effects to patients under study, not like prostatic biopsy or X-ray examination.