title: Colour Doppler and microbubble contrast agent ultrasonography do not improve cancer detection rate in transrectal systematic prostate biopsy sampling.
abstract: What's known on the subject? and What does the study add? Transrectal gray-scale ultrasonography guided prostate biopsy sampling is the method for diagnosing prostate cancer (PC) in patients with an increased prostate specific antigen level and/or abnormal digital rectal examination. Several imaging strategies have been proposed to optimize the diagnostic value of biopsy sampling, although at the first biopsy nearly 10-30% of PC still remains undiagnosed. This study compares the PC detection rate when employing Colour Doppler ultransongraphy with or without the injection of SonoVue™ microbubble contrast agent, versus the transrectal ultrasongraphy-guided systematic biopsy sampling. The limited accuracy, sensitivity, specificity and the additional cost of using the contrast agent do not justify its routine application in PC detection.
  
  
  OBJECTIVE
  • To compare prostate cancer (PC) detection rate employing colour Doppler ultrasonography with or without SonoVue™ contrast agent with transrectal ultrasonography-guided systematic biopsy sampling.
  
  
  METHODS
  • A total of 300 patients with negative digital rectal examination and transrectal grey-scale ultrasonography, with PSA values ranging between 2.5 and 9.9 ng/mL, were randomized into three groups: 100 patients (group A) underwent transrectal ultrasonography-guided systematic bioptic sampling; 100 patients (group B) underwent colour Doppler ultrasonography, and 100 patients (group C) underwent colour Doppler ultrasonography before and during the injection of SonoVue™. • Contrast-enhanced targeted biopsies were sampled into hypervascularized areas of peripheral, transitional, apical or anterior prostate zones. • All the patients included in Groups B and C underwent a further 13 systematic prostate biopsies. The cancer detection rate was calculated for each group.
  
  
  RESULTS
  • In 88 (29.3%) patients a histological diagnosis of PC was made, whereas 22 (7.4%) patients were diagnosed with high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation. • No significant differences were found among the three groups for cancer detection rate (P= 0.329). • Additionally, low sensitivity, specificity and accuracy of colour Doppler with or without SonoVue™ contrast agent were found.
  
  
  CONCLUSIONS
  • Prostate cancer detection rate does not significantly improve with the use of colour Doppler ultrasonography with or without SonoVue™. • Although no collateral effects have been highlighted, the combined use of colour Doppler ultrasonography and SonoVue™ determines adjunctive costs and increases the mean time for taking a single prostate biopsy.
authors.affiliation: Department of Urology, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy. gianluigi.taverna@humanitas.it
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Taverna
authors.forename: Giovanni
authors.initials: G
authors.lastname: Morandi
authors.forename: Mauro
authors.initials: M
authors.lastname: Seveso
authors.forename: Guido
authors.initials: G
authors.lastname: Giusti
authors.forename: Alessio
authors.initials: A
authors.lastname: Benetti
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Colombo
authors.forename: Francesco
authors.initials: F
authors.lastname: Minuti
authors.forename: Fabio
authors.initials: F
authors.lastname: Grizzi
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Graziotti
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D003287:Contrast Media; D006801:Humans; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D010743:Phospholipids; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride