title: Focal lesion at the midline of the prostate on transrectal ultrasonography: take it or leave it?
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Junwoo
authors.identifier: 0000-0001-8680-658X
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Sung Il
authors.identifier: 0000-0001-7516-5369
authors.initials: SI
authors.lastname: Hwang
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Hak Jong
authors.identifier: 0000-0003-0858-7873
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Sung Kyu
authors.identifier: 0000-0002-8344-6774
authors.initials: SK
authors.lastname: Hong
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Seok-Soo
authors.identifier: 0000-0001-7979-9035
authors.initials: SS
authors.lastname: Byun
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Sangchul
authors.identifier: 0000-0003-0844-6843
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Gheeyoung
authors.identifier: 0000-0001-6547-5603
authors.initials: G
authors.lastname: Choe
keywords: Image-guided biopsy; Prostatic neoplasms; Ultrasonography