Yonsei Med J.  2011 Sep;52(5):768-772. 10.3349/ymj.2011.52.5.768.

Palpation Device for the Identification of Kidney and Bladder Cancer: A Pilot Study

• Lee JW
• Lorenzo EI
• Ahn B
• Oh CK
• Kim HJ
• Han WK
• Kim J
• Rha KH

• KMID: 1108069
• DOI: http://doi.org/10.3349/ymj.2011.52.5.768

Abstract

PURPOSE
To determine the ability of a novel palpation device to differentiate between benign and malignant tissues of the kidney and bladder by measuring tissue elasticity.
MATERIALS AND METHODS
A novel palpation device was developed, mainly composed of a micromotor, a linear position sensor, a force transducer, and a hemisphere tip and cylindrical body probe. Motion calibration as well as performance validation was done. The tissue elasticity of both benign and malignant tissues of the kidney and bladder was measured using this device. A single investigator performed the ex-vivo palpation experiment in twelve kidneys and four bladder specimens. Malignant tissues were made available from partial nephrectomy specimens and radical cystectomy specimens. Palpations for benign renal parenchyma tissue were carried out on nephroureterectomy specimens while non-involved areas in the radical cystectomy specimens were used for benign bladder samples. Elastic modulus (Young's modulus) of tissues was estimated using the Hertz-Sneddon equation from the experimental results. These were then compared using a t-test for independent samples.
RESULTS
Renal cell carcinoma tissues appear to be softer than normal kidney tissues, whereas tissues from urothelial carcinoma of the bladder appear to be harder than normal bladder tissues. The results from renal cell carcinoma differed significantly from those of normal kidney tissues (p=0.002), as did urothelial carcinoma of the bladder from normal bladder tissues (p=0.003).
CONCLUSION
Our novel palpation device can potentially differentiate between malignant and benign kidney and bladder tissues. Further studies are necessary to verify our results and define its true clinical utility.

Keyword

Elastic modulus; palpation device; renal cell carcinoma; urothelial carcinoma

MeSH Terms

Adult
Aged
Elastic Modulus
Elasticity Imaging Techniques/*instrumentation
Equipment Design
Female
Humans
Kidney/physiology
Kidney Neoplasms/*diagnosis/physiopathology
Male
Middle Aged
Palpation/*instrumentation
Phantoms, Imaging
Pilot Projects
Urinary Bladder/physiology
Urinary Bladder Neoplasms/*diagnosis/physiopathology

Figure

• 

  Fig. 1 The experimental setup for mechanical testing.

• 

  Fig. 2 The palpation device.

• 

  Fig. 3 The palpation device measuring the kidney tumor.

Reference

1. Okamura AM. Haptic feedback in robot-assisted minimally invasive surgery. Curr Opin Urol. 2009. 19:102–107.

2. Novick AC, Campbell SC, Belldegrun A, Blute ML, Chow GK, Derweesh IH, et al. Guideline for management of the clinical stage 1 renal mass. AUA Guidelines 2009. 2009. Washington, D.C.: AUA Education and Research, Inc.

3. Pinto PA. Renal carcinoma: minimally invasive surgery of the small renal mass. Urol Oncol. 2009. 27:335–336.

4. Allaparthi S, Ramanathan R, Balaji KC. Robotic partial cystectomy for bladder cancer: a single-institutional pilot study. J Endourol. 2010. 24:223–227.

5. Kaul S, Laungani R, Sarle R, Stricker H, Peabody J, Littleton R, et al. da Vinci-assisted robotic partial nephrectomy: technique and results at a mean of 15 months of follow-up. Eur Urol. 2007. 51:186–191.

6. Nyce DS. . Linear position sensors theory and application. 2003. Hoboken: A John Wiley & Sons, Inc., Publication.

7. Ottensmeyer MP. Minimally invasive instrument for in vivo measurement of solid organ mechanical impedance. 2001. Mechanical Engineering, Massachusetts Institute of Technology;Ph.D. thesis.

8. Ottensmeyer MP, Kerdok AE, Howe RD, Dawson SL. The effects of testing environment on the viscoelastic properties of soft tissues. Lect Notes Comput Sci. 2004. 3078:9–18.

9. Gravas S, Mamoulakis C, Rioja J, Tzortzis V, de Reijke T, Wijkstra H, et al. Advances in ultrasound technology in oncologic urology. Urol Clin North Am. 2009. 36:133–145. vii

10. Manduca A, Oliphant TE, Dresner MA, Mahowald JL, Kruse SA, Amromin E, et al. Magnetic resonance elastography: non-invasive mapping of tissue elasticity. Med Image Anal. 2001. 5:237–254.

11. Fahey BJ, Nelson RC, Bradway DP, Hsu SJ, Dumont DM, Trahey GE. In vivo visualization of abdominal malignancies with acoustic radiation force elastography. Phys Med Biol. 2008. 53:279–293.

12. Clevert DA, Stock K, Klein B, Slotta-Huspenina J, Prantl L, Heemann U, et al. Evaluation of Acoustic Radiation Force Impulse (ARFI) imaging and contrast-enhanced ultrasound in renal tumors of unknown etiology in comparison to histological findings. Clin Hemorheol Microcirc. 2009. 43:95–107.