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Role of Transrectal Ultrasonography in the Prediction of Prostate Cancer

Artificial Neural Network Analysis

Departments of Radiology (H.J.L.) and Urology (S.-S.B., S.E.L., S.K.H.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (H.J.L.); Clinical Research Institute (H.J.L.) and Department of Radiology, Seoul National University College of Medicine (K.G.K., S.H.K.), Seoul National University Hospital; Seoul, Korea; Department of Radiology, College of Medicine, Hallym University, Chuncheon, Korea (S.I.H.); and Department of Diagnostic Radiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (S.I.J.).

Address correspondence to Seung Hyup Kim, MD, Department of Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea. E-mail: kimsh{at}radcom.snu.ac.kr

Objective. The purpose of this study was to evaluate the diagnostic performance of an artificial neural network (ANN) model with and without transrectal ultrasonographic (TRUS) data. Methods. Six hundred eighty-four consecutive patients who had undergone TRUS-guided prostate biopsy from May 2003 to January 2005 were enrolled. We constructed 2 ANN models. One (ANN_1) incorporated patient age, digital rectal examination findings, prostate-specific antigen (PSA) level, PSA density, transitional zone volume, and PSA density in the transitional zone as input data, whereas the other (ANN_2) was constructed with the above and TRUS findings as input data. The performances of these 2 ANN models according to PSA levels (group A, 0–4 ng/mL; group B, 4–10 ng/mL; and group C, >10 ng/mL) were evaluated using receiver operating characteristic analysis. Results. Of the 684 patients who underwent prostate biopsy, 214 (31.3%) were confirmed to have prostate cancer; of 137 patients with positive digital rectal examination results, 60 (43.8%) were confirmed to have prostate cancer; and of 131 patients with positive TRUS findings, 93 (71%) were confirmed to have prostate cancer. In groups A, B, and C, the AUCs for ANN_1 were 0.738, 0.753, and 0.774, respectively; the AUCs for ANN_2 were 0.859, 0.797, and 0.894. In all groups, ANN_2 showed better accuracy than ANN_1 (P < .05). Conclusions. According to receiver operating characteristic analysis, ANN with TRUS findings was found to be more accurate than ANN without. We conclude that TRUS findings should be included as an input data component in ANN models used to diagnose prostate cancer.

Key Words: cancer • neural networks • prostate cancer • transrectal ultrasonography

Abbreviations: ANN, artificial neural network • AUC, area under the curve • DRE, digital rectal examination • PSA, prostate-specific antigen • PSAD, PSA density • PATZ, PSAD in the transitional zone • ROC, receiver operating characteristic • TRUS, transrectal ultrasonography