Diagnostic performance of power doppler and ultrasound contrast agents in early imaging-based diagnosis of organ-confined prostate cancer: Is it possible to spare cores with contrast-guided biopsy?
OBJECTIVE
To evaluate the diagnostic performance of gray scale transrectal ultrasound-B-mode US (BMUS), power Doppler (PDUS), and sonographic contrast (CEUS) in early imaging-based diagnosis of localized prostate cancer (PCa) and to compare the diagnostic profitability of randomized biopsy (RB), US-targeted prostate biopsy by means of PDUS and CEUS.


METHODS
A single-center, prospective, transversal, epidemiological study was conducted from January 2010 to January 2014. We consecutively included patients who an imaging study of the prostate with BMUS, PDUS, and CEUS was performed, followed by prostate biopsy due to clinical suspicion of prostate cancer (PSA 4-20ng/mL and/or rectal exam suggestive of malignancy). The diagnostic performance of BMUS, PDUS, and CEUS was determined by calculating the Sensitivity (S), Specificity (Sp), Predictive values (PV), and diagnostic odds ratio (OR) of the diagnosis tests and, for these variables, in the population general and based on their clinical stage according to rectal exam (cT1 and cT2). PCa detection rates determined by means of a randomized 10-core biopsy scheme were compared with detection rates of CEUS-targeted (SonoVue) 2-core biopsies.


RESULTS
Of the initial 984 patients, US contrast SonoVue was administered to 179 (18.2%). The PCa detection rate by organ of BMUS/PDUS in the global population was 38% versus 43% in the subpopulation with CEUS. The mean age of the patients was 64.3±7.01years (95% CI, 63.75-64.70); mean total PSA was 8.9±3.61ng/mL (95% CI, 8.67-9.13) and the mean prostate volume was 56.2±29cc (95% CI, 54.2-58.1). The detection rate by organ of targeted biopsy with BMUS, PDUS, and CEUS were as follows: Global population (10.6, 8.2, 24.5%), stage cT1 (5.6, 4.2, 16.4%), and stage cT2 (32.4, 22.3, 43.5%). Comparing the detection rates of the CEUS-targeted biopsy and randomized biopsy, the following results were obtained: Global population (24.5% vs. 41.8%), stage cT1 (16% vs. 35%), and stage cT2 (43.5% vs. 66.6%), with a p value<0.05. Following the "core-by-core" analysis, the detection rates by core of CEUS-targeted biopsy versus randomized biopsy were: Global population (16% vs. 13%), stage cT1 (30.3% vs. 28%), and stage cT2 (48% vs. 37%), with a p value>0.05. The NNT for CEUS-targeted biopsy was 83.3.


CONCLUSIONS
The low sensitivity, specificity, positive predictive and negative predictive values of gray scale-B-mode, PDUS and CEUS represent scant diagnostic performance of these variables in prostate cancer detection. Prostate cancer detection rates yielded by randomized biopsy were superior than the detection rate of targeted biopsy using B-mode, PDUS and CEUS; as a result, randomized biopsy versus CEUS-targeted biopsies cannot be excluded from biopsy strategy plans for the diagnosis of prostate cancer.
Urology Department, La Fe University and Politechnic Hospital, Valencia, Spain. Electronic address: frandelgol@hotmail.com.
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Delgado Oliva
Urology Department, La Fe University and Politechnic Hospital, Valencia, Spain.
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Arlandis Guzman
Urology Department, La Fe University and Politechnic Hospital, Valencia, Spain.
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Bonillo García
Urology Department, La Fe University and Politechnic Hospital, Valencia, Spain.
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Broseta Rico
Urology Department, La Fe University and Politechnic Hospital, Valencia, Spain.
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Boronat Tormo
D000368:Aged; D001706:Biopsy; D062005:Biopsy, Large-Core Needle; D003287:Contrast Media / Q000627:therapeutic use; D055088:Early Detection of Cancer / Q000295:instrumentation*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010743:Phospholipids / Q000627:therapeutic use; D011446:Prospective Studies; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D012007:Rectum / Q000000981:diagnostic imaging* / Q000473:pathology; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride / Q000627:therapeutic use; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D017430:Prostate-Specific Antigen; D013459:Sulfur Hexafluoride
Biopsy; Contrast; Power doppler; Prostate cancer