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Diagnostic Performance of a Random Versus Lesion‐Directed Biopsy of the Prostate From Transrectal Ultrasound
Author(s) -
Lan Shih-Kai,
Tsai Yuh-Shyan,
Lin Yi-Hsiang,
Tzai Tzong-Shin
Publication year - 2007
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/jum.2007.26.1.11
Subject(s) - medicine , biopsy , rectal examination , prostate cancer , lesion , malignancy , prostate , radiology , prostate biopsy , prostate specific antigen , cancer , ultrasound , rectum , pathology , surgery
Objectives The purpose of this study was to compare cancer detection rates of sonographically suspicious lesion‐directed biopsies and random biopsies through transverse examination of prostate halves in 518 patients over 5 years. Methods From 1998 to 2002, 518 patients were referred for prostate biopsies because of either elevated prostate‐specific antigen (PSA) levels or abnormal digital rectal examination findings. On the basis of transverse examination of prostate halves by transrectal ultrasound, we performed lesion‐directed biopsy of 3 to 5 cores if morphologically suspicious lesions existed on sonography or random biopsy of 3 cores if no obvious suspicious lesions existed. Biopsy specimens were put into 2 labeled containers. Pathologic results were correlated with random and lesion‐directed guided locations. Results Nine‐hundred fifty‐nine results were obtained from 439 random and 520 lesion‐directed biopsies in 518 patients. Cancer was detected in 207 patients (40.7%). Patients with cancer who had PSA levels of 10.0 ng/mL or greater had higher proportions of bilateral cancer lesions than those with PSA levels of less than 10 ng/mL ( P = 0.03). One hundred ten (25.1%) of 439 normal‐appearing halves taken by random biopsy were tumor‐positive compared with 200 (38.5 %) of 520 biopsies from halves with sonographically suspicious lesions. Regardless of having random or lesion‐directed biopsies, patients with PSA levels of 10 ng/mL or greater had higher positive malignancy rates than those with PSA levels of less than 10.0 ng/mL ( P < .001). In about 40 patients, a diagnosis was made by random biopsy from halves that were morphologically normal on sonography, not by lesion‐directed biopsy from tumor‐suspicious contralateral halves. Conclusions Cancer detection rates of lesion‐directed biopsies are superior to those of random biopsies regardless of PSA level.