The 2 other cases were dense tumors and had volumes of 0.22cm3 and 0.41cm3. This selleck chemicals Volasertib fact was also described by Langer et al. who investigated the outcome of diffusion weighted MRI (DWI) and T2w-MRI in dependence of histological tumor composition [23]. Similar to RTE, DWI assesses tissue information due to cell density: the denser the cancer, the higher the diffusion restriction. All of their ��invisible�� tumors also had predominant Gleason pattern 3 and showed sparse architecture on histology, so that they did not significantly differ from healthy prostate tissue. The authors concluded that this may limit T2w-MRI and DWI in the detection and the assessment of tumor volume of some cancers.Figure 6Outlined sparse cancer lesion PZ base right on whole-mount step section (a), no suspicious changes on macroscopic specimen (b), elastogram (c), and grey-scale ultrasound (d).
Some cancer lesions may be negative on RTE, but positive on CE-TRUS [20]. Maybe this multiparametric way��adding tissue informations about contrast media dynamics to grey-scale ultrasound and RTE��could have detected some of our false negative findings. Brock et al. have shown the usefulness of this approach, whereas Nyg?rd et al. demonstrated the benefit of adding new biomarkers, like PCA-3, to RTE findings for the detection of significant disease [24, 25].Our study has several limitations. (1) We do not have data about intra- and interobserver variability. (2) We have used only one US system for RTE. The reproducibility of our results with other US systems needs to be evaluated in further studies.
(3) We focused this study on correlating tumor sizes; we did not correlate right negative results between RTE and histopathologic specimens. (4) We investigated the PZ only due to the above mentioned reasons. (5) We knew that every patient had PCa, which is a bias. (6) The planes of whole-mount step sections had an orientation of 90�� to the urethra, while an endfire transducer provides images in different angles. Therefore it could be difficult to be sure, whether the identical geographic areas were compared. An investigation with 3D/4D ultrasound would be desirable. 5. ConclusionRTE is capable of detecting significant PCa with high sensitivity, but can have problems when visualizing tumors with sparse architecture. Therefore, adding information about contrast media dynamics in a multiparametric way may decrease the number of false negative cases. In the detection of smaller cancer lesions, RTE is of limited value.Conflict of InterestsThe authors declare that they have no conflict Brefeldin_A of interests.Authors’ ContributionD. Junker, M.D., and G. Sch?fer, M.D., are equally contributing authors.
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