Premium
Contrast‐enhanced ultrasonography using cadence‐contrast pulse sequencing technology for targeted biopsy of the prostate
Author(s) -
Aigner Friedrich,
Pallwein Leo,
Mitterberger Michael,
Pinggera Germar M.,
Mikuz Gregor,
Horninger Wolfgang,
Frauscher Ferdinand
Publication year - 2009
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2008.08038.x
Subject(s) - medicine , biopsy , prostate cancer , vascularity , prostate , radiology , prostate biopsy , transrectal ultrasonography , cancer , urology
OBJECTIVE To evaluate contrast‐enhanced ultrasonography (US) using cadence‐contrast pulse sequencing (CPS) technology, compared with systematic biopsy for detecting prostate cancer, as grey‐scale US has low sensitivity and specificity for detecting prostate cancer. PATIENTS AND METHODS In all, 44 men with suspicious prostate‐specific antigen (PSA) levels and CPS findings were assessed; all had CPS‐targeted and systematic biopsy. Transrectal CPS images were taken with a low mechanical index (0.14). A microbubble contrast agent (SonoVue, Bracco International BV, Amsterdam, the Netherlands) was administered as a bolus, with a maximum dose of 4.8 mL. CPS was used to assess prostatic vascularity. Areas with a rapid and increased contrast enhancement within the peripheral zone were defined as suspicious for prostate cancer. Up to five CPS targeted biopsies were taken and subsequently a 10‐core systematic biopsy was taken. Cancer detection rates for the two techniques were compared. RESULTS Overall, cancer was detected in 35 of 44 patients (80%), with a mean PSA level of 3.8 ng/mL. Lesions suspicious on CPS showed cancer in 35 of 44 patients (80%) and systematic biopsy detected cancer in 15 of 44 patients (34%). CPS‐targeted cores were positive in 105 of 220 cores (47.7%) and in 41 of 440 systematic biopsy cores (9.3%) ( P < 0.001). Lesions suspicious on CPS were false‐positive in nine of 44 patients (20%). The mean Gleason score for systematic biopsy was 6.7 and for CPS‐targeted biopsy 6.8 ( P > 0.05). The sensitivity of CPS for detecting cancer was 100% (confidence interval, 95%). However, limitations in the series included that only CPS‐positive cases were investigated, and CPS‐targeted biopsy should be evaluated in a more extended biopsy scheme. CONCLUSIONS Contrast‐enhanced US using CPS enables excellent visualization of the microvasculature associated with prostate cancer, and can improve the detection of prostate cancer compared with systematic biopsy.