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Nam JK, Song WH, Lee SS, Lee HJ, Kim TU, Park SW. Impact of Ultrasonographic Findings on Cancer Detection Rate during Magnetic Resonance Image/Ultrasonography Fusion-Targeted Prostate Biopsy. World J Mens Health 2023; 41:743-749. [PMID: 37357753 DOI: 10.5534/wjmh.220268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/15/2023] [Accepted: 02/26/2023] [Indexed: 06/27/2023] Open
Abstract
PURPOSE To evaluate the impact of paired transrectal ultrasonography (TRUS) findings of index lesions identified by multiparametric magnetic resonance imaging (mpMRI) on the detection rate of clinically significant prostate cancer (csPCa, Gleason score ≥7) during MRI/US fusion-targeted biopsies. MATERIALS AND METHODS From 2019 to 2021, TRUS findings of paired index lesions were prospectively collected from MRI/US cognitive (cTB, n=299) or program-assisted (pTB, n=294) fusion-targeted biopsies. csPCa detection rates according to the presence of a paired hypoechoic lesion (HoEL) and predictive factors for csPCa detection by targeted biopsy were evaluated. RESULTS Among 593 patients with visible lesions on upfront mpMRI (Prostate Imaging-Reporting and Data System score ≥3), 288 (48.6%) had paired HoELs on TRUS. The csPCa detection rates in targeted biopsy patients with and without paired HoELs were 56.3% and 10.5% (p<0.001), respectively. Detection rates in patients with and without paired HoELs in the peripheral zone were 65.0% and 14.5%, respectively, and in the transition zone, 37.4% and 8.2%, respectively. In the cTB cohort, a paired HoEL (OR=6.25; p<0.001) was an independent predictive factor for the detection of csPCa in the target core, but not in the pTB cohort (OR=1.92; p=0.107). CONCLUSIONS During MRI/US fusion-targeted biopsy, csPCa detection rate was higher in patients with paired HoELs on TRUS than in those without it. After adjustment of the zonal location and mpMRI findings, the presence of paired HoELs is an independent predictive factor for csPCa detection in cTB, but not in pTB. Therefore, paired HoELs improve only the targeting of visually estimated biopsies.
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Affiliation(s)
- Jong Kil Nam
- Department of Urology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Won Hoon Song
- Department of Urology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Seung Soo Lee
- Department of Urology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Hyun Jung Lee
- Department of Pathology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Tae Un Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sung-Woo Park
- Department of Urology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
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Jafarieh S, Vishwanath V, Rembielak A. Overview of imaging used to guide management for prostate and bladder malignancy. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2023. [DOI: 10.1111/ijun.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Sarah Jafarieh
- Department of Radiology Royal Oldham Hospital Oldham Manchester UK
| | - Veena Vishwanath
- Department of Radiology Manchester Foundation Trust Manchester UK
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3
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Lan H, Zhou Y, Lin G, Zhao H, Wu G. Magnetic Resonance Imaging Guided Prostate Biopsy in Patients with ≥ One Negative Systematic Transrectal Ultrasound-Guided Biopsy: A Systemic Review and Meta-Analysis. Cancer Invest 2022; 40:789-798. [PMID: 36062985 DOI: 10.1080/07357907.2022.2121965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/29/2021] [Accepted: 09/03/2022] [Indexed: 02/05/2023]
Abstract
The present study aimed to compare prostate cancer (PCa) and clinically significant PCa (csPCa) detection sensitivity between magnetic resonance imaging guided-biopsy (MRI-GB) and transrectal ultrasound-guided biopsy (TRUS-GB) in patients with ≥ 1 negative TRUS-GB, and to explore the additive value of TRUS-GB to MRI-GB. The meta-analysis of 18 studies demonstrated that MRI-GB had a similar sensitivity for PCa detection but a higher sensitivity for csPCa than TRUS-GB. In conclusion, there was limited value in combining TRUS-GB with MRI-GB compared with MRI-GB alone for csPCa detection in patients with one or more negative TRUS-GBs that were suspicious of having PCa.
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Affiliation(s)
- Hailong Lan
- Department of Radiology, Wuchuan People's Hospital, Wuchuan, China
| | - Yanling Zhou
- Department of Radiology, Xiaolan Hospital Affiliated to Southern Medical University, Zhongshan, China
| | - Guisen Lin
- Department of Radiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Hua Zhao
- Department of Radiology, Wuchuan People's Hospital, Wuchuan, China
| | - Guantu Wu
- Department of Urology, Wuchuan People's Hospital, Wuchuan, China
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4
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Callejas MF, Klein EA, Truong M, Thomas L, McKenney JK, Ghai S. Detection of clinically significant index prostate cancer using micro-ultrasound: correlation with radical prostatectomy. Urology 2022; 169:150-155. [PMID: 35843353 DOI: 10.1016/j.urology.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/27/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine the detection of clinically significant prostate cancer (csPCa) index lesion using high resolution transrectal micro-ultrasound (MicroUS) applying PRI-MUS (Prostate Risk Identification using Micro Ultrasound) score v1.0. METHODS Men who underwent radical prostatectomy following biopsy and MicroUS assessment were included. MicroUS dynamic cine loops of these patients were retrospectively reviewed by an experienced radiologist. The radiologist was aware that patients had undergone radical prostatectomy but was blinded to pathological data. Suspicious sites were assigned a PRI-MUS score. Radical prostatectomy specimens were examined with quarter mount technique. Detection rate of csPCa index lesion [Grade Group (GG) ≥2] by MicroUS was assessed at a patient level. RESULTS Twenty-five participants were included in the analysis. The median age was 65.5 years (range 56 - 74). Median PSA was 6.45 ng/dL (range 2 - 31.72). Two of 25 patients did not have csPCa (GG1 disease) on radical prostatectomy. MicroUS visualized 20/23 (87%) of the csPCa index lesions [median length 9 mm (range 1.5- 28.5)]. All identified lesions were categorized PRIMUS score 4 or 5. The 3 missed index lesions were in the transition zone [median length 10.5 mm (range 4.5-22.5)]. MicroUS missed 11 non index csPCa in 9 participants [median length 1.5 mm (range 1.5-10.5)]. Of these, 8 were GG2, two GG3 and one GG5. MicroUS identified the csPCa index lesion in all 9 of these men. CONCLUSION MicroUS showed high sensitivity (87%) in detecting index lesions in the prostate gland and identified 100% of index lesions in the peripheral zone.
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Affiliation(s)
- Matias F Callejas
- Toronto Joint Department of Medical Imaging, University Health Network - Mt Sinai Hospital - Women's College Hospital, University of Toronto. Toronto, Ontario, Canada
| | - Eric A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic. Cleveland, Ohio, USA
| | - Matt Truong
- Glickman Urological and Kidney Institute, Cleveland Clinic. Cleveland, Ohio, USA
| | - Lewis Thomas
- Glickman Urological and Kidney Institute, Cleveland Clinic. Cleveland, Ohio, USA
| | - Jesse K McKenney
- Robert J. Tomsich Pathology and of Laboratory Medicine Institute, Cleveland Clinic. Cleveland, Ohio, USA
| | - Sangeet Ghai
- Toronto Joint Department of Medical Imaging, University Health Network - Mt Sinai Hospital - Women's College Hospital, University of Toronto. Toronto, Ontario, Canada..
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Sharma M, Nerli RB, Nutalapati SH, Ghagane SC. Hypoehoic lesions on Transrectal Ultrasound and its correlation to Gleason grade in the diagnosis of Clinically Significant Prostate Cancer: A Prospective Study. South Asian J Cancer 2021; 10:155-160. [PMID: 34938677 PMCID: PMC8687870 DOI: 10.1055/s-0041-1731906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Context
The importance of hypoechoic lesions on transrectal ultrasound (TRUS) merits re-assessment in the present era of widespread prostate-specific antigen (PSA) testing.
Aims
We aimed to investigate the predictive accuracy of hypoechoic lesions on TRUS of prostate in the diagnosis of prostate cancer and to examine the association of hypoechoic lesions with the aggressiveness of prostate cancer.
Settings and Design
This prospective study was conducted in a tertiary care center in South India from November 2017 to December 2019.
Methods and Material
We included 151 patients undergoing TRUS-guided 12-core prostate biopsy in view of raised serum PSA with or without suspicious digital rectal examination (DRE) findings in the study. Age, DRE findings, serum PSA level, TRUS findings, and histopathology reports were documented. These were compared between patients with and without hypoechoic lesions on TRUS.
Statistical Analysis Used
The statistical analysis for this study was performed using SPSS v20.0 software.
Results
Among 151 men, prostate cancer was diagnosed in 68 (45.03%) with mean age at presentation 69.81 ± 6.49 years. Fifty-eight cases (38.41%) had hypoechoic lesion on TRUS and the cancer detection rate (68.96%) amongst this group was significantly higher than in those without hypoechoic lesion (
p
<0.0001). Patients with hypoechoic lesion were more likely to have higher grade cancer. Abnormal DRE findings and hypoechoic lesion on TRUS were independent predictors of a clinically significant cancer (
p
<0.05).
Conclusion
Hypoechoic lesion on TRUS can be considered as an indicator of clinically significant prostate cancer.
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Affiliation(s)
- Manas Sharma
- Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Rajendra B Nerli
- Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Sree Harsha Nutalapati
- Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Shridhar C Ghagane
- Department of Urology, KLES Kidney Foundation, Urinary Biomarkers Research Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India
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Li C, Yu L, Jiang Y, Cui Y, Liu Y, Shi K, Hou H, Liu M, Zhang W, Zhang J, Zhang C, Chen M. The Histogram Analysis of Intravoxel Incoherent Motion-Kurtosis Model in the Diagnosis and Grading of Prostate Cancer-A Preliminary Study. Front Oncol 2021; 11:604428. [PMID: 34778020 PMCID: PMC8579734 DOI: 10.3389/fonc.2021.604428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/06/2021] [Indexed: 12/09/2022] Open
Abstract
Objectives This study was conducted in order to explore the value of histogram analysis of the intravoxel incoherent motion-kurtosis (IVIM-kurtosis) model in the diagnosis and grading of prostate cancer (PCa), compared with monoexponential model (MEM). Materials and Methods Thirty patients were included in this study. Single-shot echo-planar imaging (SS-EPI) diffusion-weighted images (b-values of 0, 20, 50, 100, 200, 500, 1,000, 1,500, 2,000 s/mm2) were acquired. The pathologies were confirmed by in-bore MR-guided biopsy. The postprocessing and measurements were processed using the software tool Matlab R2015b for the IVIM-kurtosis model and MEM. Regions of interest (ROIs) were drawn manually. Mean values of D, D*, f, K, ADC, and their histogram parameters were acquired. The values of these parameters in PCa and benign prostatic hyperplasia (BPH)/prostatitis were compared. Receiver operating characteristic (ROC) curves were used to investigate the diagnostic efficiency. The Spearman test was used to evaluate the correlation of these parameters and Gleason scores (GS) of PCa. Results For the IVIM-kurtosis model, D (mean, 10th, 25th, 50th, 75th, 90th), D* (90th), and f (10th) were significantly lower in PCa than in BPH/prostatitis, while D (skewness), D* (kurtosis), and K (mean, 75th, 90th) were significantly higher in PCa than in BPH/prostatitis. For MEM, ADC (mean, 10th, 25th, 50th, 75th, 90th) was significantly lower in PCa than in BPH/prostatitis. The area under the ROC curve (AUC) of the IVIM-kurtosis model was higher than MEM, without significant differences (z = 1.761, P = 0.0783). D (mean, 50th, 75th, 90th), D* (mean, 10th, 25th, 50th, 75th), and f (skewness, kurtosis) correlated negatively with GS, while D (kurtosis), D* (skewness, kurtosis), f (mean, 75th, 90th), and K (mean, 75th, 90th) correlated positively with GS. The histogram parameters of ADC did not show correlations with GS. Conclusion The IVIM-kurtosis model has potential value in the differential diagnosis of PCa and BPH/prostatitis. IVIM-kurtosis histogram analysis may provide more information in the grading of PCa than MEM.
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Affiliation(s)
- Chunmei Li
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lu Yu
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuwei Jiang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yadong Cui
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Liu
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Huimin Hou
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Zhang
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jintao Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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7
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Arafa MA, Rabah DM, Khan FK, Farhat KH, Al-Atawi MA. Effectiveness of magnetic resonance imaging-targeted biopsy for detection of prostate cancer in comparison with systematic biopsy in our countries with low prevalence of prostate cancer: our first experience after 3 years. Prostate Int 2021; 9:140-144. [PMID: 34692586 PMCID: PMC8498715 DOI: 10.1016/j.prnil.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/31/2020] [Accepted: 01/06/2021] [Indexed: 10/26/2022] Open
Abstract
Background Some men are subjected to multiple repeated biopsies because of ongoing suspicion of prostate cancer, which might subject them to complications. The aim of the study was to determine the diagnostic accuracy of magnetic resonance imaging (MRI)/target fusion-guided biopsy in comparison with systematic biopsy in our low prevalence prostate cancer population, in terms of validity measure, case detection rate, and detection of clinically significant cancer. Methods This is a retrospective cohort study. All consecutive patients who met the inclusion criteria (all men with persistent high prostate-specific antigen levels >4 ng/ml and/or subnormal finding in direct rectal examination, with suspicious regions identified on prebiopsy MRI) were subjected to transrectal MRI/ultrasound fusion-guided biopsy. Results A total of 165 cases met the inclusion criteria and were included in the study. The cancer detection rate (CDR) of target biopsy was significantly higher than that of standard biopsy (27.9% vs 14%, respectively), and 25 cases (52%) were missed by standard strategy and correctly classified by multiparametric MRI with targeted biopsy (MRI-TB). On the other hand, only 2 cases (4.3%) were misclassified by MRI-TB, and one of them was clinically significant. There was an exact agreement between the 2 strategies in 15 (31%) cases. Targeted biopsy diagnosed 41.5% more high-risk cancers vs systematic biopsy (41.6% vs 6.2%, P < .001). The difference between sensitivity, specificity, and negative predictive value of MRI-TG varies between 80% and 98%. Conclusion The CDR of prostate cancer in general and clinically significant cancer, in specific, is significantly higher with MRI-TG modality than with systematic modality. Yet, MRI-TG biopsy still misses some men with clinically significant prostate cancer. Hence, the addition of a 12-core biopsy is required to evade missing cases of clinically significant and insignificant cancer.
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Affiliation(s)
- Mostafa A Arafa
- Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,High Institute of Public Health, Alexandria University, Egypt
| | - Danny M Rabah
- Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Farruhk K Khan
- Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Karim H Farhat
- Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed A Al-Atawi
- Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Liang L, Zhi X, Sun Y, Li H, Wang J, Xu J, Guo J. A Nomogram Based on a Multiparametric Ultrasound Radiomics Model for Discrimination Between Malignant and Benign Prostate Lesions. Front Oncol 2021; 11:610785. [PMID: 33738255 PMCID: PMC7962672 DOI: 10.3389/fonc.2021.610785] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/25/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives To evaluate the potential of a clinical-based model, a multiparametric ultrasound-based radiomics model, and a clinical-radiomics combined model for predicting prostate cancer (PCa). Methods A total of 112 patients with prostate lesions were included in this retrospective study. Among them, 58 patients had no prostate cancer detected by biopsy and 54 patients had prostate cancer. Clinical risk factors related to PCa (age, prostate volume, serum PSA, etc.) were collected in all patients. Prior to surgery, patients received transrectal ultrasound (TRUS), shear-wave elastography (SWE) and TRUS-guided prostate biopsy. We used the five-fold cross-validation method to verify the results of training and validation sets of different models. The images were manually delineated and registered. All modes of ultrasound radiomics were retrieved. Machine learning used the pathology of “12+X” biopsy as a reference to draw the benign and malignant regions of interest (ROI) through the application of LASSO regression. Three models were developed to predict the PCa: a clinical model, a multiparametric ultrasound-based radiomics model and a clinical-radiomics combined model. The diagnostic performance and clinical net benefit of each model were compared by receiver operating characteristic curve (ROC) analysis and decision curve. Results The multiparametric ultrasound radiomics reached area under the curve (AUC) of 0.85 for predicting PCa, meanwhile, AUC of B-mode radiomics and SWE radiomics were 0.74 and 0.80, respectively. Additionally, the clinical-radiomics combined model (AUC: 0.90) achieved greater predictive efficacy than the radiomics model (AUC: 0.85) and clinical model (AUC: 0.84). The decision curve analysis also showed that the combined model had higher net benefits in a wide range of high risk threshold than either the radiomics model or the clinical model. Conclusions Clinical-radiomics combined model can improve the accuracy of PCa predictions both in terms of diagnostic performance and clinical net benefit, compared with evaluating only clinical risk factors or radiomics score associated with PCa.
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Affiliation(s)
- Lei Liang
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Xin Zhi
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Ya Sun
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Huarong Li
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Jiajun Wang
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Jingxu Xu
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing, China
| | - Jun Guo
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
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9
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Lazarovich A, Raviv G, Laitman Y, Portnoy O, Raz O, Dotan ZA, Ramon J, Rosenzweig B. Histology results of systematic prostate biopsies by in-bore magnetic resonance imaging vs. transrectal ultrasound. Can Urol Assoc J 2020; 15:E244-E247. [PMID: 33119495 DOI: 10.5489/cuaj.6607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to compare systematic biopsies (SBs) of in-bore magnetic resonance-guided prostate biopsy (MRGpB) with those performed under transrectal ultrasound (TRUS) guidance in the clinical setting. METHODS Data on all 161 consecutive patients undergoing prostate biopsy at our institution between November 2017 and July 2019 were retrospectively collected. The patients were referred to biopsy due to elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE) and/or at least one Prostate Imaging Reporting and Data System (PI-RADS) lesion score of ≥3 on multiparametric magnetic resonance imaging (mpMRI). We included patients with PSA levels ≤20 ng/ml and those with 8-12 core biopsies. Histology results of SBs performed by in-bore MRGpB were compared to TRUS SBs. Chi-squared, Fischer's exact, and multivariate Pearson regression tests were used for statistical analysis (SPSS, IBM Corporation). RESULTS In total, 128 patients were eligible for analysis. Their median age was 68 years (interquartile range [IQR] 61.5-72), mean prostate size 55±29 cc, and mean PSA and PSA density levels 7.6±3.5 ng/ml and 0.18±0.13 ng/ml/cc, respectively. Thirty-five patients (27.3%) had suspicious DRE findings. Both biopsy groups were similar for these parameters. Thirty-eight (62.3%) MRGpB patients had a previous biopsy vs. five (7.1%) TRUS-SB patients (p<0.0001). The number of patients diagnosed with clinically significant and non-significant disease was similar for both groups. High-risk disease was more prevalent in the TRUS-SB group (22.4% vs. 4.9%, p<0.01). CONCLUSIONS Our data suggest that in-bore MRGpB is no better than TRUS for guiding SBs for the detection of clinically significant prostate cancer.
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Affiliation(s)
- Alon Lazarovich
- Department of Urology, Chaim Sheba Medical Center, Tel Aviv University, Tel-Aviv, Israel
| | - Gil Raviv
- Department of Urology, Chaim Sheba Medical Center, Tel Aviv University, Tel-Aviv, Israel
| | - Yael Laitman
- Oncogenetics Unit, Institute of Human Genetics and Meirav High-Risk Clinic, Chaim Sheba Medical Center, Tel Aviv University, Tel-Aviv, Israel
| | - Orith Portnoy
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Aviv University, Tel-Aviv, Israel
| | - Orit Raz
- Assuta Ashdod University Hospital, Ashdod, Israel
| | - Zohar A Dotan
- Department of Urology, Chaim Sheba Medical Center, Tel Aviv University, Tel-Aviv, Israel
| | - Jacob Ramon
- Department of Urology, Chaim Sheba Medical Center, Tel Aviv University, Tel-Aviv, Israel
| | - Barak Rosenzweig
- Department of Urology, Chaim Sheba Medical Center, Tel Aviv University, Tel-Aviv, Israel.,Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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10
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Jiang Y, Li C, Liu Y, Shi K, Zhang W, Liu M, Chen M. Histogram analysis in prostate cancer: a comparison of diffusion kurtosis imaging model versus monoexponential model. Acta Radiol 2020; 61:1431-1440. [PMID: 32008343 DOI: 10.1177/0284185120901504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is still little research about histogram analysis of diffusion kurtosis imaging (DKI) using in prostate cancer at present. PURPOSE To verify the utility of histogram analysis of DKI model in detection and assessment of aggressiveness of prostate cancer, compared with monoexponential model (MEM). MATERIAL AND METHODS Twenty-three patients were enrolled in this study. For DKI model and MEM, the Dapp, Kapp, and apparent diffusion coefficient (ADC) were obtained by using single-shot echo-planar imaging sequence. The pathologies were confirmed by in-bore magnetic resonance (MR)-guided biopsy. Regions of interest (ROI) were drawn manually in the position where biopsy needle was put. The mean values and histogram parameters in cancer and noncancerous foci were compared using independent-samples T test. Receiver operating characteristic curves were used to investigate the diagnostic efficiency. Spearman's test was used to evaluate the correlation of parameters and Gleason scores. RESULTS The mean, 10th, 25th, 50th, 75th, and 90th percentiles of ADC and Dapp were significantly lower in prostate cancer than non-cancerous foci (P < 0.001). The mean, 50th, 75th, and 90th percentiles of Kapp were significantly higher in prostate cancer (P < 0.05). There was no significant difference between the AUCs of two models (0.971 vs. 0.963, P > 0.05). With the increasing Gleason scores, the 10th ADC decreased (ρ = -0.583, P = 0.018), but the 90th Kapp increased (ρ = 0.642, P = 0.007). CONCLUSION Histogram analysis of DKI model is feasible for diagnosing and grading prostate cancer, but it has no significant advantage over MEM.
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Affiliation(s)
- Yuwei Jiang
- Peking University Fifth School of Clinical Medicine, Beijing, China
- Radiology Department, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Chunmei Li
- Peking University Fifth School of Clinical Medicine, Beijing, China
- Radiology Department, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Ying Liu
- Radiology Department, Beijing Hospital, National Center of Gerontology, Beijing, China
- Radiology Department, Civil Aviation General Hospital, Civil Aviation Clinical Medical College of Peking University, Beijing, China
| | | | - Wei Zhang
- Pathology Department, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Ming Liu
- Urological Surgical Department, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Min Chen
- Peking University Fifth School of Clinical Medicine, Beijing, China
- Radiology Department, Beijing Hospital, National Center of Gerontology, Beijing, China
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11
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Wildeboer RR, van Sloun RJG, Wijkstra H, Mischi M. Artificial intelligence in multiparametric prostate cancer imaging with focus on deep-learning methods. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 189:105316. [PMID: 31951873 DOI: 10.1016/j.cmpb.2020.105316] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/09/2019] [Accepted: 01/04/2020] [Indexed: 05/16/2023]
Abstract
Prostate cancer represents today the most typical example of a pathology whose diagnosis requires multiparametric imaging, a strategy where multiple imaging techniques are combined to reach an acceptable diagnostic performance. However, the reviewing, weighing and coupling of multiple images not only places additional burden on the radiologist, it also complicates the reviewing process. Prostate cancer imaging has therefore been an important target for the development of computer-aided diagnostic (CAD) tools. In this survey, we discuss the advances in CAD for prostate cancer over the last decades with special attention to the deep-learning techniques that have been designed in the last few years. Moreover, we elaborate and compare the methods employed to deliver the CAD output to the operator for further medical decision making.
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Affiliation(s)
- Rogier R Wildeboer
- Lab of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, De Zaale, 5600 MB, Eindhoven, the Netherlands.
| | - Ruud J G van Sloun
- Lab of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, De Zaale, 5600 MB, Eindhoven, the Netherlands.
| | - Hessel Wijkstra
- Lab of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, De Zaale, 5600 MB, Eindhoven, the Netherlands; Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Massimo Mischi
- Lab of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, De Zaale, 5600 MB, Eindhoven, the Netherlands
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Park JS, Koo KC, Chung BH, Lee KS. Is targeted biopsy really needed when performing systematic prostate biopsy to raise the detection rate for prostate cancer in patients with prostate-specific antigen ≤10 ng/mL? Medicine (Baltimore) 2019; 98:e18505. [PMID: 31861036 PMCID: PMC6940157 DOI: 10.1097/md.0000000000018505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Targeted biopsy with multiparametric magnetic resonance imaging and hypoechoic lesions on transrectal ultrasound has been implemented to increase prostate cancer detection rate.We compared the detection abilities of systematic prostate biopsy, hypoechoic lesion-targeted biopsy (HL-TBx), and cognitive magnetic resonance imaging-targeted biopsy (MRI-TBx) in patients with suspected prostate cancer. Between September 2014 and August 2016, 193 patients with a prostate-specific antigen level of 3 to 10 ng/mL underwent HL-TBx or MRI-TBx. In patients who refused magnetic resonance imaging examination before prostate biopsy, HL-TBx was performed. We compared cancer detection rates and pathologic outcomes between systematic prostate biopsy and HL-TBx or MRI-TBx.The cancer detection rates for HL-TBx and MRI-TBx were 40.8% and 43.8%, respectively, without a significant difference (P = .683). Of the 81 patients diagnosed with prostate cancer, most patients (77 patients, 95.1%) were diagnosed with prostate cancer by systematic prostate biopsy. The detection ability for prostate cancer was significantly better for systematic prostate biopsy than for HL-TBx or MRI-TBx (P < .001).The detection abilities for clinically significant prostate cancer similar between HL-TBx and systematic prostate biopsy. Systematic prostate biopsy alone should be recommended for detection prostate cancer in patients with a prostate-specific antigen ≤10 ng/mL.
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Zhu K, Qin Z, Xue J, Miao C, Tian Y, Liu S, Zhu S, Gu Q, Hou C, Xu A, Yang J, Wang Z. Comparison of prostate cancer detection rates between magnetic resonance imaging-targeted biopsy and transrectal ultrasound-guided biopsy according to Prostate Imaging Reporting and Data System in patients with PSA ≥4 ng/mL: a systematic review and meta-analysis. Transl Androl Urol 2019; 8:741-753. [PMID: 32038971 DOI: 10.21037/tau.2019.12.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Previous studies have investigated magnetic resonance imaging-targeted biopsy (MRI-TBx) on the detection for prostate cancer (PCa). Prostate Imaging Reporting and Data System (PI-RADS), as a standardized MRI reporting system, has widely been used in the management of PCa. However, basing the PI-RADS score, the comparability between MRI-TBx and transrectal ultrasound-guided biopsy (TRUS-Bx) in diagnosing PCa remained inconsistent or even controversial. Thus, this systematic meta-analysis aimed to assess the value of PI-RADS in sifting better prostate biopsy method. Methods A meta-analysis including 10 articles was performed. In these included studies, biopsy-naive subjects with concerning PSA levels and/or an abnormal digital rectal examination (DRE) were consecutively enrolled by referral from urologists. All subjects underwent multiparameter MRI (mpMRI) prostate and the results were scored independently by PI-RADS. Subjects with equivocal (PI-RADS 3) and intermediate/high-risk (PI-RADS 4/5) lesions underwent MRI-TBx and followed by TRUS-Bx performed by a urologist. The online databases PubMed, Embase and Web of Science were searched to find all correlated articles until October 1st, 2019. Data were pooled by odds ratios (ORs) with 95% confidence intervals (CIs) to assess the strength of the associations. Subgroup analyses were conducted based on Gleason score. Results Overall, 10 studies were included in this meta-analysis from January, 2015 to June, 2019. In the comparison of the detection of MRI-TBx and TRUS-Bx in PCa patients, TRUS-Bx had a significant advantage in overall PCa detection compared with MRI-TBx (OR =0.78, 95% CI: 0.62-0.98) in PI-RADS 3. Basing subgroup analysis of Gleason score (csPCa: Gleason score ≥7; non-csPCa: Gleason score <7), a summary analysis of the detection rate of csPCa showed that no significant difference was found (OR =0.82, 95% CI: 0.58-1.16); Meanwhile, no significant difference in non-csPCa patients was also detected (OR =0.83, 95% CI: 0.53-1.28). In PI-RADS 4 or 5, no significant results were detected between MRI-TBx and TRUS-Bx (OR =0.96, 95% CI: 0.87-1.06) for overall PCa detection. The stratification analyses by Gleason score found that TRUS-Bx had an advantage over MRI-TBx in non-csPCa patients (OR =0.76, 95% CI: 0.60-0.98); However, there was no significant difference in the detection rate of csPCa (OR =1.05, 95% CI: 0.93-1.20). Conclusions This meta-analysis indicated that using TRUS-Bx was better than MRI-TBx for the diagnosis of PCa in PI-RADS 3; Besides, TRUS-Bx have an advantage over MRI-TBx in the detection for non-csPCa in PI-RADS 4 or 5. Therefore, PI-RADS could be used as a MRI evaluation system in the selection of prostate biopsy.
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Affiliation(s)
- Kai Zhu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhiqiang Qin
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Jianxin Xue
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.,Department of Urology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, China
| | - Chenkui Miao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ye Tian
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Shouyong Liu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Shenhao Zhu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Qi Gu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Chao Hou
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Aiming Xu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jie Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zengjun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Ding K, Yao Y, Gao Y, Lu X, Chen H, Tang Q, Hua C, Zhou M, Zou X, Yin Q. Diagnostic evaluation of diffusion kurtosis imaging for prostate cancer: Detection in a biopsy population. Eur J Radiol 2019; 118:138-146. [PMID: 31439233 DOI: 10.1016/j.ejrad.2019.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/12/2019] [Accepted: 07/08/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE To prospectively assess the feasibility of diffusional kurtosis (DK) imaging for distinguishing prostate cancer(PCa) from benign prostate hyperplasia (BPH) in comparison with standard diffusion-weighted (DW) imaging, as well as low-from high-grade malignant regions. MATERIALS AND METHODS 147 consecutive patients with suspected PCa underwent multi-parametric 1.5-TMR. Diffusion kurtosis imaging was acquired with with 5 b values (0,600,800,1600,and 2400sec/mm2).Region of interest (ROI)-based measurements were performed on ADC, D, and K map by two radiologists. Data were analyzed by using mixed-model analysis of variance and receiver operating characteristic curves. Correlations among the three parameters (ADC,D and K) in all patients, and correlations between three parameters with the tumor Gleason score (GS) in PCa group were analyzed using Pearson's correlation coefficient in peripheral zone(PZ) and transiton zone(TZ). RESULTS 58 patients were proved with PCa (9 GS 3 + 3[PZ/TZ = 4/5], 49 GS ≥ 7 [PZ/TZ = 26/23]), and 89 patients were with BPH. ADC,D and K were able to distinguish benignance from tumor tissue both in PZ and TZ(P<0.01), but performed poorly in neither differentiating low-(GS 3 + 3) from high-grade (GS≥3 + 4) disease, nor GS(3 + 4) from GS(4 + 3).There was a weak correlation between the GS and ADC, D (PZ:ADC r=-0.113, D r=-0.139; TZ:ADC r=-0.104,D r=-0.103), while a moderate correlation between the GS and K(PZ:K r = 0.492; TZ:K r = 0.433, P<0.01).K had significantly greater area under the curve for differentiating PCa from BHP than ADC both in PZ and TZ. CONCLUSION DK model may add value in PCa detection and diagnosis, but none can differentiate low-from high-grade PCas (including GS=3+4 from GS=4+3).
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Affiliation(s)
- Kai Ding
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299,Qingyang Road, Wuxi, 214000, Jiangsu Province, China.
| | - Yong Yao
- Department of ophthalmology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299, Qingyang Road, Wuxi, 214000, Jiangsu Province, China
| | - Yun Gao
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299,Qingyang Road, Wuxi, 214000, Jiangsu Province, China
| | - Xudong Lu
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299,Qingyang Road, Wuxi, 214000, Jiangsu Province, China
| | - Hongwei Chen
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299,Qingyang Road, Wuxi, 214000, Jiangsu Province, China
| | - Qunfeng Tang
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299,Qingyang Road, Wuxi, 214000, Jiangsu Province, China
| | - Chenchen Hua
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299,Qingyang Road, Wuxi, 214000, Jiangsu Province, China
| | - Ming Zhou
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299,Qingyang Road, Wuxi, 214000, Jiangsu Province, China
| | - Xinnong Zou
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299,Qingyang Road, Wuxi, 214000, Jiangsu Province, China
| | - Qihua Yin
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No.299,Qingyang Road, Wuxi, 214000, Jiangsu Province, China.
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Wegelin O, Exterkate L, van der Leest M, Kummer JA, Vreuls W, de Bruin PC, Bosch J, Barentsz JO, Somford DM, van Melick HH. The FUTURE Trial: A Multicenter Randomised Controlled Trial on Target Biopsy Techniques Based on Magnetic Resonance Imaging in the Diagnosis of Prostate Cancer in Patients with Prior Negative Biopsies. Eur Urol 2019; 75:582-590. [DOI: 10.1016/j.eururo.2018.11.040] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
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Ebeid A, Elshamy A. Hypoechoic versus hypervascular lesion in the diagnosis of prostatic carcinoma. AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Su R, Xu G, Xiang L, Ding S, Wu R. A Novel Scoring System for Prediction of Prostate Cancer Based on Shear Wave Elastography and Clinical Parameters. Urology 2018; 121:112-117. [PMID: 30171925 DOI: 10.1016/j.urology.2018.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 07/31/2018] [Accepted: 08/21/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop a novel scoring system for the prediction of prostate cancer (PCa). METHODS We assessed 127 patients who underwent a prostate biopsy. Prior to biopsy, we performed shear wave elastography (SWE), transrectal ultrasound, digital rectal exam, total prostatic specific antigen, PSA density (PSAD), and free PSA/total PSA ratio (F/T). We developed an 11-point scoring system based on SWE and these clinical parameters. RESULTS PCa was diagnosed in 51 (40.2%) of 127 patients and 192 (25.2%) of 762 sextants on initial biopsy. ROC curve analyses showed that the cutoff value (COV) for SWE was 40.8 kpa at the sextant level. The AUC of score system based on the SWE and clinical parameters (0.911) was significantly different from scoring systems based on SWE alone (0.842) or clinical parameters alone (0.868). For this 11-point scoring system, the optimal COV, Youden index, sensitivity, specificity, PPV, NPV, and AUC were 3 points, 0.66, 76.5% 89.5%, 82.98%, 85.00%, and 0.911, respectively. There were 68 negative biopsy results in patients with 0-3 points, and the detection rate of PCa was 100% in patients with scores exceeding 6 points. CONCLUSION This 11-point scoring system based on SWE and clinical parameters has the good diagnostic performance for predicting PCa. It may be useful in selecting patients for biopsy, substantially reducing the number of unnecessary biopsies while ensuring that few cancers are missed.
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Affiliation(s)
- Rui Su
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Department of Urology, Ningbo First Hospital, the Affiliated Hospital of Ningbo University, Ningbo, China
| | - Guang Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Lihua Xiang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Shisi Ding
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Rong Wu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.
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Lee KS, Koo KC, Chung BH. Quantitation of hypoechoic lesions for the prediction and Gleason grading of prostate cancer: a prospective study. World J Urol 2018; 36:1059-1065. [PMID: 29508049 DOI: 10.1007/s00345-018-2224-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/02/2018] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Hypoechoic lesions are not included as indicators for prostate biopsy. To discriminate the features of hypoechoic lesions, we investigated the ultrasonographic characteristics of hypoechoic lesions using numerical analysis in image. In addition, we evaluated previously suggested subjective parameters on hypoechoic lesion. METHODS We performed one-core targeted biopsy (TBx) for each hypoechoic lesion in up to two lesions in each patient before the 12-core systemic biopsy was obtained between July 2015 and May 2016. Image analysis data were analyzed using grayscale values and Hounsfield units (HU) to measure heterogeneity. Subjective evaluation of hypoechoic lesions including hypoechoicity, irregularity, vascularity, and microcalcification was also validated. RESULTS Of 157 patients (median age = 67.1 years, median prostate-specific antigen = 6.21 ng/mL) included in the study, 77 (49.0%) were diagnosed with prostate cancer (PCa), and 39 (17.0%) diagnoses were confirmed by the results of targeted cores. The existence of hypoechoic lesions was not a final predictor for PCa detection. In multivariate analysis using a combination of clinical and quantitative image analyses, the grayscale value was identified as a significant predictive factor for the presence of PCa and high-grade disease (Gleason score ≥ 7) on target lesions. The combination of clinical and image variables had the highest area under the curve (0.890) for detecting PCa in TBx. CONCLUSIONS The proposed method for the quantitation of hypoechoic lesions using grayscale images and HU is simple. Combined with the current clinical approaches, quantitative scoring of lesions can be useful for detecting PCa and making more precise diagnoses.
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Affiliation(s)
- Kwang Suk Lee
- Department of Urology, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Korea
| | - Kyo Chul Koo
- Department of Urology, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Korea
| | - Byung Ha Chung
- Department of Urology, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, Korea.
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HistoScanningTM to Detect and Characterize Prostate Cancer—a Review of Existing Literature. Curr Urol Rep 2017; 18:97. [DOI: 10.1007/s11934-017-0747-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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20
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Yang T, Zhang L, Chen Y, Cai Y, Jiang H, Ding Q. The predictive efficacy of hypoechoic lesion in ultrasound for prostate cancer in Chinese people: five-year experience in a moderated 10-core transperineal prostate biopsy procedure. Oncotarget 2017; 8:79433-79440. [PMID: 29108322 PMCID: PMC5668055 DOI: 10.18632/oncotarget.18342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/21/2017] [Indexed: 11/25/2022] Open
Abstract
We aim to investigate the predictive efficacy of hypoechoic lesion for prostate cancer at different levels of serum PSA in the procedure of transrectal ultrasound guided 10-core trans-perineal prostate biopsy (TP-PBx). In this study, we collected clinical parameters involving age, digital rectal examination (DRE), PSA, prostate volume, pathological diagnosis, Gleason score, novel Gleason group, and numbers of positive cores from 856 patients who had elevated level of PSA above 4 ng/ml or susceptible nodule of prostate gland in DRE received the moderated 10-core TP-PBx procedure. There were 481 cases (56.2%) with no visible lesion of hypoechoic nodule in transrectal ultrasound (TRUS) and 375 cases (43.8%) with the hypoechoic lesion. The total cancer detection rate is 45.56%. The predictive efficacy of hypoechoic lesion for prostate cancer varies among different PSA intervals. For PSA groups of 0-4, 4-10, 10-20, 20-100, > 100 ng/ml, the Youden's indexes are 0.3483, 0.3506, 0.3941, 0.2795 and 0.8667, respectively. Besides, the visible lesions are inclined to be detected in patients with higher Gleason score. We concluded that the hypoechoic lesions in TRUS could improve the predictive accuracy for diagnosing prostate cancer and present different predictive efficacy in the respective PSA intervals. Besides, it was probably associated with more aggressive clinical significance.
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Affiliation(s)
- Tian Yang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Limin Zhang
- Department of Urology, Huashan North Hospital, Fudan University, Shanghai, China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yixin Chen
- Department of Ultrasonography, Huashan Hospital, Fudan University, Shanghai, China
| | - Yehua Cai
- Department of Ultrasonography, Huashan Hospital, Fudan University, Shanghai, China
| | - Haowen Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
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Wildeboer RR, Postema AW, Demi L, Kuenen MPJ, Wijkstra H, Mischi M. Multiparametric dynamic contrast-enhanced ultrasound imaging of prostate cancer. Eur Radiol 2017; 27:3226-3234. [PMID: 28004162 PMCID: PMC5491563 DOI: 10.1007/s00330-016-4693-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 11/28/2016] [Accepted: 12/01/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this study is to improve the accuracy of dynamic contrast-enhanced ultrasound (DCE-US) for prostate cancer (PCa) localization by means of a multiparametric approach. MATERIALS AND METHODS Thirteen different parameters related to either perfusion or dispersion were extracted pixel-by-pixel from 45 DCE-US recordings in 19 patients referred for radical prostatectomy. Multiparametric maps were retrospectively produced using a Gaussian mixture model algorithm. These were subsequently evaluated on their pixel-wise performance in classifying 43 benign and 42 malignant histopathologically confirmed regions of interest, using a prostate-based leave-one-out procedure. RESULTS The combination of the spatiotemporal correlation (r), mean transit time (μ), curve skewness (κ), and peak time (PT) yielded an accuracy of 81% ± 11%, which was higher than the best performing single parameters: r (73%), μ (72%), and wash-in time (72%). The negative predictive value increased to 83% ± 16% from 70%, 69% and 67%, respectively. Pixel inclusion based on the confidence level boosted these measures to 90% with half of the pixels excluded, but without disregarding any prostate or region. CONCLUSIONS Our results suggest multiparametric DCE-US analysis might be a useful diagnostic tool for PCa, possibly supporting future targeting of biopsies or therapy. Application in other types of cancer can also be foreseen. KEY POINTS • DCE-US can be used to extract both perfusion and dispersion-related parameters. • Multiparametric DCE-US performs better in detecting PCa than single-parametric DCE-US. • Multiparametric DCE-US might become a useful tool for PCa localization.
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Affiliation(s)
- Rogier R Wildeboer
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, PO-Box 513, 5600 MB, Eindhoven, The Netherlands.
| | - Arnoud W Postema
- Department of Urology, Academic Medical Center University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Libertario Demi
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, PO-Box 513, 5600 MB, Eindhoven, The Netherlands
| | | | - Hessel Wijkstra
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, PO-Box 513, 5600 MB, Eindhoven, The Netherlands
- Department of Urology, Academic Medical Center University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Massimo Mischi
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, PO-Box 513, 5600 MB, Eindhoven, The Netherlands
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Wegelin O, van Melick HHE, Hooft L, Bosch JLHR, Reitsma HB, Barentsz JO, Somford DM. Comparing Three Different Techniques for Magnetic Resonance Imaging-targeted Prostate Biopsies: A Systematic Review of In-bore versus Magnetic Resonance Imaging-transrectal Ultrasound fusion versus Cognitive Registration. Is There a Preferred Technique? Eur Urol 2016; 71:517-531. [PMID: 27568655 DOI: 10.1016/j.eururo.2016.07.041] [Citation(s) in RCA: 282] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/22/2016] [Indexed: 12/01/2022]
Abstract
CONTEXT The introduction of magnetic resonance imaging-guided biopsies (MRI-GB) has changed the paradigm concerning prostate biopsies. Three techniques of MRI-GB are available: (1) in-bore MRI target biopsy (MRI-TB), (2) MRI-transrectal ultrasound fusion (FUS-TB), and (3) cognitive registration (COG-TB). OBJECTIVE To evaluate whether MRI-GB has increased detection rates of (clinically significant) prostate cancer (PCa) compared with transrectal ultrasound-guided biopsy (TRUS-GB) in patients at risk for PCa, and which technique of MRI-GB has the highest detection rate of (clinically significant) PCa. EVIDENCE ACQUISITION We performed a literature search in PubMed, Embase, and CENTRAL databases. Studies were evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 checklist and START recommendations. The initial search identified 2562 studies and 43 were included in the meta-analysis. EVIDENCE SYNTHESIS Among the included studies 11 used MRI-TB, 17 used FUS-TB, 11 used COG-TB, and four used a combination of techniques. In 34 studies concurrent TRUS-GB was performed. There was no significant difference between MRI-GB (all techniques combined) and TRUS-GB for overall PCa detection (relative risk [RR] 0.97 [0.90-1.07]). MRI-GB had higher detection rates of clinically significant PCa (csPCa) compared with TRUS-GB (RR 1.16 [1.02-1.32]), and a lower yield of insignificant PCa (RR 0.47 [0.35-0.63]). There was a significant advantage (p = 0.02) of MRI-TB compared with COG-TB for overall PCa detection. For overall PCa detection there was no significant advantage of MRI-TB compared with FUS-TB (p=0.13), and neither for FUS-TB compared with COG-TB (p=0.11). For csPCa detection there was no significant advantage of any one technique of MRI-GB. The impact of lesion characteristics such as size and localisation could not be assessed. CONCLUSIONS MRI-GB had similar overall PCa detection rates compared with TRUS-GB, increased rates of csPCa, and decreased rates of insignificant PCa. MRI-TB has a superior overall PCa detection compared with COG-TB. FUS-TB and MRI-TB appear to have similar detection rates. Head-to-head comparisons of MRI-GB techniques are limited and are needed to confirm our findings. PATIENT SUMMARY Our review shows that magnetic resonance imaging-guided biopsy detects more clinically significant prostate cancer (PCa) and less insignificant PCa compared with systematic biopsy in men at risk for PCa.
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Affiliation(s)
- Olivier Wegelin
- Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands.
| | - Harm H E van Melick
- Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Lotty Hooft
- Cochrane Netherlands, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - J L H Ruud Bosch
- Department of Urology, University Medical Centre Utrecht, The Netherlands
| | - Hans B Reitsma
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Jelle O Barentsz
- Department of Radiology, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Diederik M Somford
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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van de Ven WJ, Sedelaar JM, van der Leest MM, Hulsbergen-van de Kaa CA, Barentsz JO, Fütterer JJ, Huisman HJ. Visibility of prostate cancer on transrectal ultrasound during fusion with multiparametric magnetic resonance imaging for biopsy. Clin Imaging 2016; 40:745-50. [PMID: 27317220 DOI: 10.1016/j.clinimag.2016.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/13/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
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Kim J, Hwang SI, Lee HJ, Hong SK, Byun SS, Lee S, Choe G. Focal lesion at the midline of the prostate on transrectal ultrasonography: take it or leave it? Ultrasonography 2016; 36:10-16. [PMID: 27338188 PMCID: PMC5207357 DOI: 10.14366/usg.16014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/01/2016] [Accepted: 05/16/2016] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The purpose of this study was to analyze the detection rate of prostate cancers from targeted biopsy specimens of midline focal lesions and to investigate the ultrasonographic findings to reduce unnecessary additional targeted biopsies. METHODS Ninety-eight men with midline focal lesions detected on transrectal ultrasonography were enrolled. Additional targeted biopsies for midline focal lesions were performed after 12-core random systematic biopsies. Correlations between the ultrasonographic characteristics of midline focal lesions and the pathologic results were analyzed. RESULTS Twenty of 98 targeted biopsy cores (20.4%) were positive for malignancy. In a univariate analysis, midline focal lesions without bulging contours (P=0.023), with involved margins (P=0.001), without hypoechoic perilesional rims (P=0.005), and with longer diameters (P=0.005) were statistically significant for cancer detection. In a multivariate analysis, involved margin (P=0.027), having longer diameter (P=0.011) or absence of hypoechoic perilesional rim (P=0.025) made a statistically significant contribution to cancer detection. CONCLUSION Biopsy of midline focal lesions was not always non-significant in the detection of prostate cancer. Additional targeted biopsies should be considered in cases of midline focal lesions with involved margins but without hypoechoic perilesional rims.
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Affiliation(s)
- Junwoo Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Il Hwang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hak Jong Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
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van de Ven WJM, Hu Y, Barentsz JO, Karssemeijer N, Barratt D, Huisman HJ. Biomechanical modeling constrained surface-based image registration for prostate MR guided TRUS biopsy. Med Phys 2016; 42:2470-81. [PMID: 25979040 DOI: 10.1118/1.4917481] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Adding magnetic resonance (MR)-derived information to standard transrectal ultrasound (TRUS) images for guiding prostate biopsy is of substantial clinical interest. A tumor visible on MR images can be projected on ultrasound (US) by using MR-US registration. A common approach is to use surface-based registration. The authors hypothesize that biomechanical modeling will better control deformation inside the prostate than a regular nonrigid surface-based registration method. The authors developed a novel method by extending a nonrigid surface-based registration algorithm with biomechanical finite element (FE) modeling to better predict internal deformations of the prostate. METHODS Data were collected from ten patients and the MR and TRUS images were rigidly registered to anatomically align prostate orientations. The prostate was manually segmented in both images and corresponding surface meshes were generated. Next, a tetrahedral volume mesh was generated from the MR image. Prostate deformations due to the TRUS probe were simulated using the surface displacements as the boundary condition. A three-dimensional thin-plate spline deformation field was calculated by registering the mesh vertices. The target registration errors (TREs) of 35 reference landmarks determined by surface and volume mesh registrations were compared. RESULTS The median TRE of a surface-based registration with biomechanical regularization was 2.76 (0.81-7.96) mm. This was significantly different than the median TRE of 3.47 (1.05-7.80) mm for regular surface-based registration without biomechanical regularization. CONCLUSIONS Biomechanical FE modeling has the potential to improve the accuracy of multimodal prostate registration when comparing it to a regular nonrigid surface-based registration algorithm and can help to improve the effectiveness of MR guided TRUS biopsy procedures.
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Affiliation(s)
- Wendy J M van de Ven
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
| | - Yipeng Hu
- Centre for Medical Image Computing, University College London, London WC1E 6BT, United Kingdom
| | - Jelle O Barentsz
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
| | - Nico Karssemeijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
| | - Dean Barratt
- Centre for Medical Image Computing, University College London, London WC1E 6BT, United Kingdom
| | - Henkjan J Huisman
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
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Wegelin O, Henken KR, Somford DM, Breuking FAM, Bosch RJ, van Swol CFP, van Melick HHE. An Ex Vivo Phantom Validation Study of an MRI-Transrectal Ultrasound Fusion Device for Targeted Prostate Biopsy. J Endourol 2016; 30:685-91. [PMID: 26886510 DOI: 10.1089/end.2015.0864] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To evaluate the ex vivo accuracy of an MRI-TRUS fusion device for guiding targeted prostate biopsies, to identify the origin of errors, and to evaluate the likelihood that lesions can be accurately targeted. MATERIALS AND METHODS Three prostate phantoms were used to perform 27 biopsies using transperineal MRI-TRUS fusion. All phantoms underwent 3-T MRI. The prostate contour and nine lesions were delineated onto the MRI. A 3D-US dataset was generated and fused with the MRI. Per lesion, one needle was virtually planned. The postbiopsy needle location was virtually registered. The needle trajectory was marked using an MRI-safe guidewire. Postinterventional MRI was performed. The coordinates of the lesion on preinterventional MRI, the virtually planned needle, the virtually registered needle, and the marked needle trajectory on postinterventional MRI were documented and used to calculate the planning error (PE), targeting error (TE), and overall error (OE). Using the OE in the transversal plane, an upper one-sided tolerance interval was calculated to assess the likelihood that a biopsy needle was on target. RESULTS In the transversal plane, the mean PE, TE, and OE were 1.18, 0.39, and 2.33 mm, respectively. Using a single biopsy core, the likelihood that lesions with a diameter of 2 mm can be accurately targeted is 26%; lesions of 3 mm 61%; lesions of 4 mm 86%; lesions of 5 mm 96%; and lesions of 6 mm 99%. The likelihood of accurate sampling increases if more biopsy cores are used. CONCLUSION MRI-TRUS fusion allows for accurate sampling of MRI-identified lesions with an OE of 2.33 mm. Lesions with a diameter of 3 mm or more can be accurately targeted. These results should be considered the lower limit of in vivo accuracy.
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Affiliation(s)
- Olivier Wegelin
- 1 Department of Urology, St. Antonius Hospital , Nieuwegein, The Netherlands
| | - Kirsten R Henken
- 2 Department of Medical Physics and Instrumentation, St. Antonius Hospital , Nieuwegein, The Netherlands
| | - Diederik M Somford
- 3 Department of Urology, Canisius Wilhelmina Hospital , Nijmegen, The Netherlands
| | - Frans A M Breuking
- 4 Department of Radiology, St. Antonius Hospital , Nieuwegein, The Netherlands
| | - Ruud J Bosch
- 5 Department of Urology, University Medical Centre , Utrecht, The Netherlands
| | - Christiaan F P van Swol
- 2 Department of Medical Physics and Instrumentation, St. Antonius Hospital , Nieuwegein, The Netherlands
| | - Harm H E van Melick
- 1 Department of Urology, St. Antonius Hospital , Nieuwegein, The Netherlands
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Assessing Cancer Risk on Novel 29 MHz Micro-Ultrasound Images of the Prostate: Creation of the Micro-Ultrasound Protocol for Prostate Risk Identification. J Urol 2016; 196:562-9. [PMID: 26791931 DOI: 10.1016/j.juro.2015.12.093] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE Conventional ultrasound systems operate at 6 to 9 MHz and serve as the standard of care to guide prostate biopsies. We present a protocol using a novel high resolution (29 MHz) transrectal prostate micro-ultrasound system. This protocol includes a scoring system to assess the risk of prostatic carcinoma and enable real-time targeted biopsies. MATERIALS AND METHODS The ExactVu™ system is currently being used in a multisite, 2,000-patient, randomized clinical trial. Cine loops of 400 biopsies from this trial were used to create the PRI-MUS™ (prostate risk identification using micro-ultrasound) protocol and risk scale. Validation was performed in an independent, pathology blinded set of 100 cines. Three of the 5 investigators performing this validation were familiar with micro-ultrasound but naïve to the PRI-MUS protocol and they received only 1 hour of training. RESULTS Each increase in risk score demonstrated a 10.1% increase (95% CI 9.3-10.8) in the probability of clinically significant cancer. The risk score also increased with Gleason sum and cancer length with a slope of 0.15 (95% CI 0.09-0.21) and 0.58 (95% CI 0.43-0.73), respectively. Sensitivity and specificity were 80% and 37%, respectively, and the mean ± SD ROC AUC was 60% ± 2%. The protocol was more accurate for detecting high grade disease (Gleason sum greater than 7) with a peak AUC of 74% (mean 66%). CONCLUSIONS The new resolution of the micro-ultrasound platform paired with the PRI-MUS protocol shows promise for real-time visualization of suspicious lesions and targeting of biopsies. The improved performance of the protocol in more significant disease is consistent with the focus of the field on decreasing insignificant diagnoses and detecting high risk disease early.
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Beauval JB, Mazerolles M, Salomon L, Soulié M. Évaluation préthérapeutique du patient candidat à la chirurgie du cancer de la prostate. Prog Urol 2015; 25:947-65. [DOI: 10.1016/j.purol.2015.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 10/22/2022]
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Koh J, Jung DC, Oh YT, Yoo MG, Noh S, Han KH, Rha KH, Choi YD, Hong SJ. Additional Targeted Biopsy in Clinically Suspected Prostate Cancer: Prospective Randomized Comparison between Contrast-Enhanced Ultrasound and Sonoelastography Guidance. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2836-2841. [PMID: 26298036 DOI: 10.1016/j.ultrasmedbio.2015.06.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/24/2015] [Accepted: 06/30/2015] [Indexed: 06/04/2023]
Abstract
Our aim was to improve the detection of prostate cancer by evaluating whether contrast-enhanced ultrasound (CEUS) or sonoelastography (SE) is more helpful in guiding targeted biopsy (TB) performed before systematic biopsy (SB). A total of 52 patients suspected of having prostate cancer were prospectively included and randomly assigned to either the CEUS or SE group. Different, independent radiologists performed TB and twelve-core SB. Within each group, cancer detection rates based on core number were compared between SB and TB. We evaluated the effect of TB on core-based cancer detection rates between the CEUS and SE groups. Cancer detection was higher in overall TB cores 16.4% (28/171) than SB cores 11.4% (71/624) in both groups. In the SE group, TB cores revealed higher cancer detection than did SB cores from 4.49% (14/312) to 12.86% (9/70) (p = 0.01). Compared with CEUS, SE may improve detection rates when considering additional TB guidance methods.
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Affiliation(s)
- Jieun Koh
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Chul Jung
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
| | - Young Taik Oh
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Moon Gyu Yoo
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Songmi Noh
- Department of Pathology, Cha Medical College, Gang-Nam Cha Hospital, Seoul, Korea
| | - Kyung Hwa Han
- Avison Biomedical Research Center, Department of Radiology; Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Koon-Ho Rha
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Jang DR, Jung DC, Oh YT, Noh S, Han K, Kim K, Rha KH, Choi YD, Hong SJ. Repeat Targeted Prostate Biopsy under Guidance of Multiparametric MRI-Correlated Real-Time Contrast-Enhanced Ultrasound for Patients with Previous Negative Biopsy and Elevated Prostate-Specific Antigen: A Prospective Study. PLoS One 2015; 10:e0130671. [PMID: 26083348 PMCID: PMC4471162 DOI: 10.1371/journal.pone.0130671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 05/24/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To prospectively determine whether multi-parametric MRI (mpMRI) - contrast-enhanced ultrasound (CEUS) correlated, imaging-guided target biopsy (TB) method could improve the detection of prostate cancer in re-biopsy setting of patients with prior negative biopsy. METHODS From 2012 to 2014, a total of 42 Korean men with a negative result from previous systematic biopsy (SB) and elevated prostate-specific antigen underwent 3T mpMRI and real-time CEUS guided TB. Target lesions were determined by fusion of mpMRI and CEUS. Subsequently, 12-core SB was performed by a different radiologist. We compared core-based cancer detection rates (CaDR) using the generalized linear mixed model (GLIMMIX) for each biopsy method. RESULTS Core-based CaDR was higher in TB (17.92%, 38 of 212 cores) than in SB (6.15%, 31 of 504 cores) (p < 0.0001; GLIMMIX). In the cancer-positive TB cores, CaDR with suspicious lesions by mpMRI was higher than that by CEUS (86.8% vs. 60.5%, p= 0.02; paired t-test) and concordant rate between mpMRI and CEUS was significantly different with discordant rate (48% vs. 52%, p=0.04; McNemar's test). CONCLUSION The mpMRI-CEUS correlated TB technique for the repeat prostate biopsy of patients with prior negative biopsy can improve CaDR based on the number of cores taken.
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Affiliation(s)
- Dong Ryul Jang
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Chul Jung
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Young Taik Oh
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Songmi Noh
- Department of Pathology, Cha Medical College, Gang-Nam Cha Hospital, Seoul, Republic of Korea
| | - Kyunghwa Han
- Avison Biomedical Research Center; Department of Radiology; Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kiwook Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Koon-Ho Rha
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Joon Hong
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Quentin M, Pentang G, Schimmöller L, Kott O, Müller-Lutz A, Blondin D, Arsov C, Hiester A, Rabenalt R, Wittsack HJ. Feasibility of diffusional kurtosis tensor imaging in prostate MRI for the assessment of prostate cancer: preliminary results. Magn Reson Imaging 2014; 32:880-5. [PMID: 24848289 DOI: 10.1016/j.mri.2014.04.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 04/02/2014] [Accepted: 04/12/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess the feasibility of full diffusional kurtosis tensor imaging (DKI) in prostate MRI in clinical routine. Histopathological correlation was achieved by targeted biopsy. MATERIALS AND METHODS Thirty-one men were prospectively included in the study. Twenty-one were referred to our hospital with increased prostate specific antigen (PSA) values (>4ng/ml) and suspicion of prostate cancer. The other 10 men were volunteers without any history of prostate disease. DKI applying diffusion gradients in 20 different spatial directions with four b-values (0, 300, 600, 1000s/mm(2)) was performed additionally to standard functional prostate MRI. Region of interest (ROI)-based measurements were performed in all histopathologically verified lesions of every patient, as well as in the peripheral zone, and the central gland of each volunteer. RESULTS DKI showed a substantially better fit to the diffusion-weighted signal than the monoexponential apparent diffusion coefficient (ADC). Altogether, 29 lesions were biopsied in 14 different patients with the following results: Gleason score 3+3=6 (n=1), 3+4=7 (n=7), 4+3=7 (n=6), 4+4=8 (n=1), and 4+5=9 (n=2), and prostatitis (n=12). Values of axial (Kax) and mean kurtosis (Kmean) were significantly different in the tumor (Kax 1.78±0.39, Kmean 1.84±0.43) compared with the normal peripheral zone (Kax 1.09±0.12, Kmean 1.16±0.13; p<0.001) or the central gland (Kax 1.40±0.12, Kmean 1.44±0.17; p=0.01 respectively). There was a minor correlation between axial kurtosis (r=0.19) and the Gleason score. CONCLUSION Full DKI is feasible to utilize in a routine clinical setting. Although there is some overlap some DKI parameters can significantly distinguish prostate cancer from the central gland or the normal peripheral zone. Nevertheless, the additional value of DKI compared with conventional monoexponential ADC calculation remains questionable and requires further research.
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Affiliation(s)
- Michael Quentin
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - Gael Pentang
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - Lars Schimmöller
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - Olga Kott
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - Anja Müller-Lutz
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - Dirk Blondin
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - Christian Arsov
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - Andreas Hiester
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - Robert Rabenalt
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - Hans-Jörg Wittsack
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
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Role of transrectal ultrasound in the diagnosis of extracapsular prostate cancer. J Ultrasound 2014; 17:47-51. [DOI: 10.1007/s40477-014-0070-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022] Open
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Abstract
BACKGROUND Imaging of prostate carcinoma is an important adjunct to clinical evaluation and prostate specific antigen measurement for detecting metastases and tumor recurrence. In the past, the ability to assess intraprostatic tumor was limited. METHODS Pertinent literature was reviewed to describe the capabilities and limitations of the currently available imaging techniques for assessing prostate carcinoma. Evaluation of primary tumor and metastatic disease by ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine techniques is discussed. RESULTS Ultrasonography and MRI have limited usefulness for local staging of prostate cancer because of suboptimal sensitivity and specificity for identifying tumor extent and capsular penetration. Additional MRI techniques such as magnetic resonance-based perfusion imaging, diffusion imaging, and spectroscopy may provide incremental benefit. CT and bone scanning provide an assessment of metastatic disease but are also limited by the poor sensitivity of lymph node size as a criterion for detecting metastases. Novel imaging techniques such as hybrid imaging devices in the form of single-photon emission CT/CT gamma cameras, positron emission tomography/CT cameras, and, in the near future, positron emission tomography/MRI combined with tumor specific imaging radiotracers may have a significant impact on tumor staging and treatment response. CONCLUSIONS Cross-sectional imaging and scintigraphy have an important role in assessing prostate carcinoma metastases and treatment response. Increasingly, the incremental value of primary tumor imaging through MRI is being realized.
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Affiliation(s)
- Eric K Outwater
- Department of Diagnostic Imaging, Moffitt Cancer Center, Tampa, FL 33612, USA.
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Tsai YS, Jou YC, Chen CH, Chang CC, Yang WH, Lai JL, Tzai TS. Doppler spectral waveform parameters at neurovascular bundle vessels in patients with prostate biopsy. J Endourol 2013; 28:364-70. [PMID: 24168710 DOI: 10.1089/end.2013.0383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES There is a need to improve prescreening determination of prostate cancer to better select patients who need biopsy. Such a strategy properly implemented, will decrease the number of negative biopsies for prostate cancer and in turn better balance the risks and morbidity for patients recommended for biopsy. The aim of study is to investigate Doppler spectral waveform parameters of neurovascular bundle (NVB) vessels and determine differences between benign and malignant pathologies. PATIENTS AND METHODS We performed a prospective analysis involving 292 patients who received prostate biopsy for elevated prostate-specific antigen (PSA) values or abnormal digital rectal examination, as well as 174 patients with symptomatic benign prostatic hyperplasia. Doppler spectral waveform (DSW) parameters (peak-systolic velocity [PSV], end-diastolic velocity [EDV], and resistive index [RI]) were measured at bilateral NVB vessels through Doppler transrectal ultrasound at the right lateral decubitus position, compared, and analyzed among patients with benign versus malignant histology for each side. RESULTS Overall, both PSV and EDV at malignant sides were significantly higher than those at benign sides, as well as lower RI (all p-values <0.05, unpaired t-test). In subgroup analysis with 93 patients of serum PSA between 10 and 20 ng/mL and 56 patients with one-side malignancy, higher EDV and lower RI were significantly associated with malignancies (all p<0.05). The values of PSV and EDV rather than RI might be influenced by the patients' position and RI by the prostate volume. CONCLUSIONS In this study, DSW parameters (mainly EDV and RI) at NVB vessels were significantly associated with prostate cancer, particularly in patients with serum PSA of 10-20 ng/mL. It should be in caution that the patients' position and prostate volume may influence the Doppler signal as demonstrated in the current study. These findings can provide more diagnostic information before prostate biopsy.
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Affiliation(s)
- Yuh-Shyan Tsai
- 1 Department of Urology, College of Medicine and Hospital, National Cheng Kung University , Tainan, Taiwan
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Nieto-Morales ML, Fernández-Ramos J, Pérez-Méndez L, Alventosa-Fernández E, Pastor-Santoveña MS, Arias-Rodríguez Á, Aguirre-Jaime A. Improving the Gleason grading accuracy of transrectal ultrasound-guided biopsy. Acta Radiol 2013; 54:1218-23. [PMID: 23858506 DOI: 10.1177/0284185113491250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transrectal ultrasound (TRUS)-guided prostate biopsy is the technique of choice for the assessment of clinical suspicion of prostate cancer (PC) based on abnormal digital rectal examination (DRE) and/or elevated or rising levels of prostate-specific antigen (PSA). PURPOSE To identify factors involved in TRUS-guided prostate biopsy, which can be modified by radiologists in order to improve Gleason score (GS) accuracy, and to assess the influence of clinical variables. MATERIAL AND METHODS We carried out a retrospective review of the records of 185 patients with PC treated surgically at our hospital between 2005 and 2008. Biopsy schemes were classified according to the number of cores (≤7, 8-9, 10-11, 12-15) and the needle length (11, 16, 20 mm). Clinical characteristics - age, family history of PC, DRE, PSA levels, and sonographic data - and prostatectomy GS (pGS) were collected. RESULTS Non-random concordance between biopsy Gleason score (bGS) and pGS was obtained for 36% of patients (P < 0.001). Under- and over-staging were 30% and 4%, respectively. Concordance was correlated with the core number (45% for ≤7, 54% for 8-9, 85% for 10-11, and 80% for 12-15; P < 0.001), but not with the needle length. The concordance rate showed a seven-fold increase when 10-11 cores were obtained (95% CI, 2-18; P < 0.001) compared to those cases in which the core number obtained was ≤7. Among clinical variables, only PSA correlated with concordance, showing an inverse relationship. CONCLUSION The Gleason correlation values were not improved when 12 or more cores were collected. These values reached a plateau beyond that number of samples. Therefore, when determining treatment strategies, physicians must consider the biopsy scheme used since it has proven to be a predictor of the accuracy of the PC grading system.
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Affiliation(s)
- María Luisa Nieto-Morales
- Diagnostic Imaging Department, Nuestra Señora de Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | - Julián Fernández-Ramos
- Diagnostic Imaging Department, Canarias University Hospital, La Laguna University, Tenerife, Spain
| | - Lina Pérez-Méndez
- CIBER Respiratory Diseases, Carlos III Health Institute, Madrid, Spain
- Research Unit, Nuestra Señora de Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | - Elena Alventosa-Fernández
- Diagnostic Imaging Department, Nuestra Señora de Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | | | | | - Armando Aguirre-Jaime
- Research Unit, Nuestra Señora de Candelaria University Hospital, Santa Cruz de Tenerife, Spain
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Quentin M, Schimmöller L, Arsov C, Rabenalt R, Antoch G, Albers P, Blondin D. 3-T in-bore MR-guided prostate biopsy based on a scoring system for target lesions characterization. Acta Radiol 2013; 54:1224-9. [PMID: 23878360 DOI: 10.1177/0284185113492972] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To estimate potential malignant lesions within the prostate gland, the usage of a scoring system has recently been proposed by a European consensus meeting. PURPOSE To prospectively investigate a scoring system for functional prostate magnetic resonance imaging (MRI) using in-bore MR-guided prostate biopsy at 3-T. MATERIAL AND METHODS Prostate MRI examinations of 59 patients (between February 2011 and May 2012) with no known prostate cancer, elevated prostate specific antigen (PSA) level, and unsuspicious digital rectal examination were included in the study. In each patient up to three lesions were defined and scored using a 5-point scoring system for each MR sequence (T2-weighted images, diffusion-weighted imaging, dynamic contrast-enhanced imaging). Following MRI-guided in-bore biopsy these lesions were correlated to the histopathological findings. RESULTS A total number of 144 lesions were defined in 59 patients. In 28 patients (51 lesions) MR-guided in-bore biopsy was positive for tumor (Gleason grade 6 or higher). A cut-off limit of 10 or more points in summation of the individual scores of all three sequences was used, leading to a 90% sensitivity, 63% specificity, 58% positive predictive value, and 92% negative predictive value. CONCLUSION A simple 5-point scoring system of functional prostate MRI achieves excellent sensitivity and moderate specificity for directing 3-T-guided prostate biopsy relative to the histopathological findings.
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Affiliation(s)
- Michael Quentin
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Lars Schimmöller
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Christian Arsov
- Department of Urology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Robert Rabenalt
- Department of Urology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Peter Albers
- Department of Urology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Dirk Blondin
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
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Li L, Wang L, Feng Z, Hu Z, Wang G, Yuan X, Wang H, Hu D. Prostate cancer magnetic resonance imaging (MRI): multidisciplinary standpoint. Quant Imaging Med Surg 2013; 3:100-12. [PMID: 23630657 DOI: 10.3978/j.issn.2223-4292.2013.03.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 03/12/2013] [Indexed: 12/11/2022]
Abstract
Prostate cancer is the most common cancer diagnosed in men and a leading cause of death. Accurate assessment is a prerequisite for optimal clinical management and therapy selection of prostate cancer. There are several parameters and nomograms to differentiate between patients with clinically insignificant disease and patients in need of treatment. Magnetic resonance imaging (MRI) is a technique which provides more detailed anatomical images due to high spatial resolution, superior contrast resolution, and multiplanar capability. State-of-the-art MRI techniques, such as diffusion weighted imaging (DWI), MR spectroscopic imaging (MRSI), dynamic contrast enhanced MRI (DCE-MRI), improve interpretation of prostate cancer imaging. In this article, we review the major role of MRI in the advanced management of prostate cancer to noninvasively improve tumor staging, biologic potential, treatment planning, therapy response, local recurrence, and to guide target biopsy for clinical suspected cancer with previous negative biopsy. Finally, future challenges and opportunities in prostate cancer management in the area of functional MRI are discussed as well.
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Affiliation(s)
- Liang Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Ultrasonography in prostate cancer: current roles and potential applications in radiorecurrent disease. World J Urol 2013; 31:1353-9. [PMID: 23636742 DOI: 10.1007/s00345-013-1080-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/10/2013] [Indexed: 01/03/2023] Open
Abstract
The use of ultrasound technology for prostate cancer imaging has evolved over many years. In order to fully appreciate today's application of prostate ultrasound in the primary diagnostic setting as well as for radiorecurrent prostate cancer, it is helpful to understand the progression of this technology from its inception. This review begins with a brief history of the development of ultrasonography for the prostate. This is followed by a summary of the data evaluating ultrasound in the primary diagnosis of prostate cancer. Its application in the post-treatment setting is then addressed. Finally, several emerging technologies are discussed, including contrast-enhanced ultrasound, elastography and HistoScanning. These new modalities may hold promise for identifying incompletely ablated prostate tissue following radiation therapy or other ablative techniques.
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[Standardised scoring of a multi-parametric 3-T MRI for a targeted MRI-guided prostate biopsy]. Urologe A 2012; 51:848-56. [PMID: 22476739 DOI: 10.1007/s00120-012-2825-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The use of multi-parametric MRI and MRI-guided biopsy for the detection of prostate cancer is rapidly increasing. This is a pilot study to evaluate the consensus-based international MRI scoring system as decision criterion for targeted MRI-guided prostate biopsy. MATERIAL AND METHODS After a multi-parametric 3-T MRI (T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced MRI) in 23 consecutive patients a total of 47 lesions were scored according to a 5-point scale for each MRI sequence. A total score of ≥ 10 points was considered to be suspicious for prostate cancer. All 47 lesions were histologically assessed after MRI-guided biopsy. RESULTS At the cut-off score of 10 points, sensitivity, specificity, negative predictive value and positive predictive value of multi-parametric MRI were 94.1, 43.3, 92.9 and 48.5%, respectively. CONCLUSIONS A standardised scoring of lesions on multi-parametric MRI is feasible. The cut-off value leads to excellent values for sensitivity and negative predictive value. The values for specificity and positive predictive value are modest. Lesions with a total score <10 points are very unlikely to be malignant.
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Jiang J, Chen YQ, Zhu YK, Yao XH, Qi J. Factors influencing the degree of enhancement of prostate cancer on contrast-enhanced transrectal ultrasonography: correlation with biopsy and radical prostatectomy specimens. Br J Radiol 2012; 85:e979-86. [PMID: 22700257 DOI: 10.1259/bjr/63794331] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study was designed to identify factors that influenced the degree of enhancement of prostate cancer on contrast-enhanced transrectal ultrasonography (CETRUS). METHODS 139 patients suspected of prostate cancer were evaluated with CETRUS followed by systematic and targeted transrectal ultrasound-guided biopsies. The degree of enhancement of the lesions was objectively measured using peak intensity with time-intensity curve analysis software. Ultrasound findings were correlated with clinical characteristics as well as biopsy and radical prostatectomy findings. RESULTS Prostate cancers were detected in 230 biopsy sites from 91 patients. The mean peak intensity value of prostate cancer was significantly higher than that of the benign lesions (9.82 ± 3.73 vs 7.51 ± 2.97; p<0.001), and the peak intensity value of the cancer foci varied across the prostate. The mixed model analysis revealed that the location and Gleason score of tumour foci were the influencing factors of the peak intensity value, and the former had a stronger influence upon peak intensity than the latter (p=0.000 and 0.040, respectively). However, age, prostate volume or serum prostate-specific antigen of the patient had no significant influence on the peak intensity value (p>0.05). Furthermore, the peak intensity value of tumours larger than 5 mm diameter was significantly higher than tumours of 5 mm or smaller diameter (9.28 ± 2.46 vs 6.69 ± 2.65; p<0.001). CONCLUSIONS The prostate cancer lesions with a higher Gleason score and larger tumour size which were located in the lateral peripheral zone (PZ) were more likely to show a marked enhancement. Lesions with lower peak intensity that are located in the medial PZ should also be treated as suspicious.
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Affiliation(s)
- J Jiang
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Engehausen DG, Engelhard K, Schwab SA, Uder M, Wach S, Wullich B, Krause FS. Magnetic resonance image-guided biopsies with a high detection rate of prostate cancer. ScientificWorldJournal 2012; 2012:975971. [PMID: 22489209 PMCID: PMC3317570 DOI: 10.1100/2012/975971] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 10/15/2011] [Indexed: 12/21/2022] Open
Abstract
AIM To explore the potential of transrectal magnetic resonance image- (MRI-) guided biopsies of the prostate in a patient cohort with prior negative ultrasound guided biopsies. PATIENTS AND METHODS Ninety-six men with suspected prostate cancer underwent MRI-guided prostate biopsies under real-time imaging control in supine position. RESULTS Adenocarcinoma of the prostate was detected in 39 of 96 patients. For individual core biopsies, MRI yielded a sensitivity of 93.0% and a specificity of 94.4%. When stratifying patients according to the free-to-total prostate-specific antigen (PSA) ratio, the prostate cancer discovery rate was significantly higher in the group with ratios less than 0.15 (57.1%). CONCLUSION MRI-guided biopsy of the prostate is a diagnostic option for patients with suspected prostate cancer and a history of repeatedly negative transrectal ultrasound-guided biopsies. Combined with the free-to-total PSA ratio, it is a highly effective method for detecting prostate cancer.
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Affiliation(s)
- Dirk G Engehausen
- Department of Urology, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany.
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Pal RP, Elmussareh M, Chanawani M, Khan MA. The role of a standardized 36 core template-assisted transperineal prostate biopsy technique in patients with previously negative transrectal ultrasonography-guided prostate biopsies. BJU Int 2011; 109:367-71. [DOI: 10.1111/j.1464-410x.2011.10355.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
OBJECTIVES To evaluate BR55, a new VEGFR2-specific ultrasound contrast agent, for imaging prostate tumors in an orthotopic model in the rat. MATERIALS AND METHODS Rat prostate adenocarcinoma were established by injection of G Dunning R-3327 tumor cells in one lobe of the prostate of Copenhagen rats. Imaging experiments were performed with BR55, SonoVue, and streptavidin-functionalized microbubbles coupled with an anti-vascular endothelial growth factor receptor 2 (VEGFR2) antibody using a clinical ultrasound scanner. Contrast enhancement in the tumor and healthy prostate was followed over time by intermittent imaging at low acoustic power. Signal quantification and statistical analysis were performed in the tumor and healthy tissue to compare the behavior of the 3 contrast agents. Immunohistochemistry was performed on the prostate and tumor specimen to determine the expression of VEGFR2. RESULTS Comparable contrast enhancement was observed in tumors at peak intensity for BR55 and SonoVue. Then, once unbound microbubbles had cleared from the circulation, a strong enhancement of the tumor was obtained with BR55, whereas no significant microbubble accumulation was detected in the healthy prostate tissue. SonoVue microbubbles were rapidly eliminated, and no significant binding was observed in the tumor. The tumor to prostate ratio calculated after signal quantification was about 20 for the 3 doses of BR55 tested. The enhancement obtained with BR55 in the tumor was not significantly different from the one observed with antibody-coupled streptavidin microbubbles. Intense staining for VEGFR2 was detected in the tumor vessels by immunohistochemistry. CONCLUSIONS This study showed that BR55 binding to prostate tumors resulted in a strong enhancement of the lesions as early as a few minutes after contrast injection, whereas minimal nonspecific accumulation occurred in the healthy part of the gland. BR55, like SonoVue, provide information on tissue perfusion during the early vascular phase, but BR55 binding to the tumoral endothelium allows to gain additional information by highlighting the sites of active angiogenesis. The late phase enhancement of the tumor should be particularly valuable for prostate cancer detection and for biopsy guidance.
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Salomon L, Azria D, Bastide C, Beuzeboc P, Cormier L, Cornud F, Eiss D, Eschwège P, Gaschignard N, Hennequin C, Molinié V, Mongiat Artus P, Moreau JL, Péneau M, Peyromaure M, Ravery V, Rebillard X, Richaud P, Rischmann P, Rozet F, Staerman F, Villers A, Soulié M. Recommandations en Onco-Urologie 2010 : Cancer de la prostate. Prog Urol 2010; 20 Suppl 4:S217-51. [PMID: 21129644 DOI: 10.1016/s1166-7087(10)70042-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Roy C, Pasquali R, Matau A, Bazille G, Lang H. Rôle de l’IRM de diffusion pour la détection du cancer de la prostate avant ponction biopsie : étude multiparamétrique de 111 patients à 3 Tesla. ACTA ACUST UNITED AC 2010; 91:1121-8. [DOI: 10.1016/s0221-0363(10)70157-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Candefjord S, Ramser K, Lindahl OA. Technologies for localization and diagnosis of prostate cancer. J Med Eng Technol 2010; 33:585-603. [PMID: 19848851 DOI: 10.3109/03091900903111966] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The gold standard for detecting prostate cancer (PCa), systematic biopsy, lacks sensitivity as well as grading accuracy. PSA screening leads to over-treatment of many men, and it is unclear whether screening reduces PCa mortality. This review provides an understanding of the difficulties of localizing and diagnosing PCa. It summarizes recent developments of ultrasound (including elastography) and MRI, and discusses some alternative experimental techniques, such as resonance sensor technology and vibrational spectroscopy. A comparison between the different methods is presented. It is concluded that new ultrasound techniques are promising for targeted biopsy procedures, in order to detect more clinically significant cancers while reducing the number of cores. MRI advances are very promising, but MRI remains expensive and MR-guided biopsy is complex. Resonance sensor technology and vibrational spectroscopy have shown promising results in vitro. There is a need for large prospective multicentre trials that unambiguously prove the clinical benefits of these new techniques.
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Affiliation(s)
- S Candefjord
- Department of Computer Science and Electrical Engineering, Luleå University of Technology, Luleå, Sweden.
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Aigner F, Pallwein L, Mitterberger M, Pinggera GM, Mikuz G, Horninger W, Frauscher F. Contrast-enhanced ultrasonography using cadence-contrast pulse sequencing technology for targeted biopsy of the prostate. BJU Int 2009; 103:458-63. [DOI: 10.1111/j.1464-410x.2008.08038.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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50
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Oliveira Reis L, Deeke Sasse A, Eduardo Matheus W, Denardi F, Mamprim Stopiglia R, Moreira da Silva M, Ferreira U. Cáncer de próstata: práctica clínica basada en la evidencia. Actas Urol Esp 2009; 33:344-50. [PMID: 19579883 DOI: 10.1016/s0210-4806(09)74158-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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