Clinical value of transrectal ultrasound in the diagnosis of suspected neoplasia in the small pelvis

Purpose: In daily clinical practice, it is challenging to accurately diagnose suspected neoplasias in the small pelvis by minimal invasive means, and CT-guided biopsy is often limited in its feasibility. The aim of our study was to evaluate whether transrectal ultrasound (TRUS)-guided biopsy can verify suspected neoplasias in the small pelvis histologically. Material and Methods: The study population consisted of 12 patients who underwent biopsy of suspected malignancy in the pelvis by TRUS. All patients had clinical signs of an advanced tumour stage and in all cases, biopsy utilising computerised tomography (CT scan) had been unsuccessful despite of a documented lesion on CT scan or magnetic resonance imaging. For the TRUS guided biopsy, a commercially available 3-dimensional 7.5-MHz-probe was used (Combison 530 D, GENERAL ELECTRIC, Milwaukee, USA). The probe was armed with an 18 G biopsy gun. Results: In all patients, the suspected lesion was easily detectable by TRUS, and tissue for verification of the malignant origin of the lesions could be collected under real-time TRUS with only 2 patients needing anaesthesia. The biopsy cores were of excellent quality and adequate for conclusive pathological diagnosis. 6 cases of lymph node metastases of a transitional cell carcinoma were detected. 1 case of extended node metastasis in prostate cancer, 1 paravesical manifestation of recurrent cervical cancer, 1 metastasis of a paravesically infiltrating colon cancer and 2 cases of paravesical metastases of a gastric cancer were also diagnosed. In one case, extragenital endometriosis could be diagnosed. Conclusion: Based on our experience it can be stated that TRUS-guided biopsy is a reliable diagnostic tool for verification of the neoplastic origin of suspected masses in the small pelvis. In all cases with a history of unsuccessful CT guided biopsy, sufficient tissue cores for conclusive histology could be collected with our technique, and surgical exploration could be avoided. This technique is minimally invasive, without radiation exposure, well tolerated under analgesia, time efficient and cheap. Key words TRUS - endorectal biopsy - pelvic neoplasias

- 1 Hatch K. Pelvic exenteration. Berek JSHN Practical Gynecolic Oncology Philadelphia; Lippincott, Williams and Wilkins 2000: 829-845 - 2 Malmstrom H. Fine-needle aspiration cytology versus core biopsies in the evaluation of recurrent gynecologic malignancies. Gynecol Oncol. 1997; 65 69-73 - 3 Rodriguez L V, Terris M K. Risks and complications of transrectal ultrasound. Curr Opin Urol. 2000; 10 111-116 - 4 Sailer M, Bussen D, Fein M. et al . Endoscopic ultrasound-guided transrectal biopsies of pelvic tumors. J Gastrointest Surg. 2002; 6 342-346 - 5 Arulampalam T H, Costa D C, Loizidou M. et al . Positron emission tomography and colorectal cancer. Br J Surg. 2001; 88 176-189 - 6 Yamashita Y, Harada M, Torashima M. et al . Dynamic MR imaging of recurrent postoperative cervical cancer. J Magn Reson Imaging. 1996; 6 167-171 - 7 Weber T M, Sostman H D, Spritzer C E. et al . Cervical carcinoma: determination of recurrent tumor extent versus radiation changes with MR imaging. Radiology. 1995; 194 135-139 - 8 Seitz K. New goals for contrast-enhanced sonography. Ultraschall in Med. 2005; 26 455-457 - 9 Konopke R, Kersting S, Saeger H D. et al . Detection of liver lesions by contrast-enhanced ultrasound - comparison to intraoperative findings. Ultraschall in Med. 2005; 26 107-113 - 10 Drudi F M, Giovagnorio F, Carbone A. et al . Transrectal colour Doppler contrast sonography in the diagnosis of local recurrence after radical prostatectomy - comparison with MRI. Ultraschall in Med. 2006; 27 146-151 - 11 Wichmann M W, Muller C, Lau-Werner U. et al . The role of carcinoembryonic antigen for the detection of recurrent disease following curative resection of large-bowel cancer. Langenbecks Arch Surg. 2000; 385 271-275 - 12 Stroh C, Manger T. Ultrasound diagnosis of rare retrorectal tumors. Zentralbl Chir. 2003; 128 1075-1079 - 13 Albrecht H, Stroszczynski C, Felix R. et al . Real time 3D (4D) ultrasound-guided percutaneous biopsy of solid tumours. Ultraschall in Med. 2006; 27 324-328 - 14 Hunerbein M, Totkas S, Moesta K T. et al . The role of transrectal ultrasound-guided biopsy in the postoperative follow-up of patients with rectal cancer. Surgery. 2001; 129 164-169 - 15 Weiss H, Duntsch U. Complications of fine needle puncture. DEGUM survey II. Ultraschall in Med. 1996; 17 118-130 - 16 Giede C, Toi A, Chapman W. et al . The use of transrectal ultrasound to biopsy pelvic masses in women. Gynecol Oncol. 2004; 95 552-556 - 17 Gupta R K, Cheung Y K, alAnsari A G. et al . Value of image-guided needle aspiration cytology in the assessment of pelvic and retroperitoneal masses. A study of 112 cases. Acta Cytol. 2003; 47 393-398 - 18 Nagano T, Nakai Y, Taniguchi F. et al . Diagnosis of paraaortic and pelvic lymph node metastasis of gynecologic malignant tumors by ultrasound-guided percutaneous fine-needle aspiration biopsy. Cancer. 1991; 68 2571-2574 Dr. Ludwig Rinnab Urology, University Hospital Prittwitzstreet 43 89075 Ulm Phone: ++49/7 31/50 02 78 07 Fax: ++49/7 31/5 00-2 78 56 Email: [email protected]