Correlation of transrectal ultrasound, computer analysis of transrectal ultrasound and histopathology of radical prostatectomy specimen

A system for computerised analysis of ultrasonographic prostate images (AUD EX = Automated Urologic Diagnostic EXpert system) for the detection of pros tate carcinoma was developed. The ultimate goal is to develop a system that is reliable and non-observer dependent. Results of an earlier study with a small group were encouraging and this study describes the results of the c omputerised analysis in a larger group. sixty-two patients who were schedul ed to undergo a radical prostatectomy were prospectively analysed. The radi cal prostatectomy specimens were step-sectioned in the transverse plane, co rresponding to the ultrasound pictures. Malignant regions identified by eac h study were quantified and compared by computer calculation. No correlatio n was observed between ultrasound analysis and pathology result. For the AU DEX analysis an overall sensitivity of 85% and a specificity of 18% with on ly a diagnostic accuracy of 57% was noticed when presence or absence of mal ignancy was evaluated by octant (total 496). When applying a cut-off value of 0.5 mi the numbers were 71%, 33% and 55%, respectively. Correlation was significantly better for the ventral octants. In this study the earlier res ults of our AUDEX system could not be confirmed. Although sensitivity was g ood, specificity and especially diagnostic accuracy were lower than expecte d. We have to conclude that the current settings are inappropriate for rout ine clinical use.