전립선비대증의 조직학적 구성과 경직장초음파검사 결과의 비교
The Evaluation of Correlation between the Histologic Composition of BPH and TRUS Findings
김정균, 안한종, 조경식,
소속 상세정보
김정균 ( )
울산대학교 의과대학 비뇨기과학교실
안한종 ( )
울산대학교 의과대학 비뇨기과학교실
조경식 ( )
울산대학교 의과대학 진단방사선과학교실
KMID : 0358319980390010051
Abstract
서론
전립선은 평활근과 섬유조직으로 이루어진 기질성분(stromal component)과 선상피
(glandular epithelium)와 선강(glandular lumen)으로 이루어진 선성분(glandular component)
으로 구성되어 있으며, 전립선비대증의 내과적 치료약제로 널리 쓰이는 알파차단제(α
-blocker)는 평활근에 작용하며 5α-reductase 억제제는 주로 선성분에 작용하는 것으로 추
측된다 따라서 비대된 전립선의 조직학적 구성을 약물치료 전에 파악하면 치료약제를 선택
하는데 유용한 정보를 얻을 수 있을 것으로 기대된다
저자들은 비대된 전립선의 초음파소견이 전립선의 조직학적 구성성분을 반영할 수 있는지
를 알아보고자 전립선비대증 환자에서 경요도적으로 제거된 전립선 조직을 조직학적 검사를
시행하여 수술전 경직장초음파검사 결과와 비교하였다 아울러 조직학적 구성성분이 임상적
전립선 비대증의 발생연령, 전립선의 크기, 요속, 증상 등의 임상적 지표와 관련이 있는지를
검토하였다
#초록#
Purpose: It has been believed that o-blocker affects the stromal component of BPH,
while 5α-reductase inhibitor affects the glandular component. Information on the tissue
composition of BPH might be helpful to choose an appropriate medical therapeutic agent.
We evaluated whether transrectal ultrasonographic findings could reflect the histologic
composition of BPH and the correlation of the composition of BPH and the clinical
parameters such as patient's age, peak flow rate, IPSS symptom score, and prostate
volume.
Materials and Methods: Fifty five patients with BPH treated by transurethral resection
were studied. The proportions of stromal and glandular area in the resected prostate
were determined by image analyzer. 'Stromal hyperplasia'was defined when more than
75% of the resected prostate was composed of stromal tissue and microscopically,
abundant stromal tissue with normal or atrophic glands were dominant. 'Glandular
hyperplasia' was defined when more than 25% of the prostate was composed of
glandular tissue and microscopically, hyperplastic glandular cells and dilated lumen with
occasional cystic changes were dominant. Ultrasonographically, it is classified as stromal
hyperplasia when the echo of central gland is fine and lower echogenic than that of
peripheral gland, and classlfied as glandular hyperplasia when the echo of central gland
Is coarse and isoechogenic or hyperechogenic with focal echopenic areas. Statistical
significance was judged by Student t-test and linear regression analysis. Concordance of
ultrasonographic findings and histopathologic findings of BPH was determined by Kappa
index.
Results: Sixty nine percent of resected prostate tissue were composed of stromal tissue.
The proportion of stromal tissue in stromal hyperplasia and glandular hyperplasia was
85.8± 1.6% and 64.8± 1.0%, respectively(p<0.001). Ultrasonography accurately reflect
histopathologlc type in 50 of 55 BPH. Two of 12 stromal hyperplasia and 3 of 43
glandular hyperplasia were falsely interpreted on ultrasonography. Three of 5 falsely
interpreted cases showed marginal stromal tissue composition(60.9%, 72.9%, 73.3%,
76.4%, and 84.2%). Kappa index of ultrasonogrhaphic finding and histopathologic
classification was 0.74(fair to good). In the meantime, clinical parameters including
patient's age, peak flow rate, IPSS symptom scores did not correlate with tissue
composition. Only prostate volume and resected prostate weight showed negative
correlation with proportion of stromal tissue(p=0.0953 and p=0.0794, respectively).
Conclusions: Using our sonographic criteria, transrectal ultrasonography could reflect
histologic type of BPH so that choice of medical therapeutic agent may be possible.
Larger prostates had less stromal tissue, however, the histologic composition of the
prostate was not related to the severity of symptoms or peak flow rate.
키워드
Benign prostatic hyperplasia; Ultrasonography; Histology;
원문 및 링크아웃 정보
등재저널 정보