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Year : 2011  |  Volume : 27  |  Issue : 2  |  Page : 299-300
 

Contrast-enhanced color Doppler-targeted prostate biopsy: An innovative method to improve an accuracy of a transrectal biopsy in patients with suspected cancer prostate


Department of Urology, CSM Medical University (Upgraded King George's Medical College), Lucknow, Uttar Pradesh, India

Date of Web Publication8-Jul-2011

Correspondence Address:
Apul Goel
Department of Urology, CSM Medical University (Upgraded King George's Medical College), Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Kathpalia R, Singh D, Goel A. Contrast-enhanced color Doppler-targeted prostate biopsy: An innovative method to improve an accuracy of a transrectal biopsy in patients with suspected cancer prostate. Indian J Urol 2011;27:299-300

How to cite this URL:
Kathpalia R, Singh D, Goel A. Contrast-enhanced color Doppler-targeted prostate biopsy: An innovative method to improve an accuracy of a transrectal biopsy in patients with suspected cancer prostate. Indian J Urol [serial online] 2011 [cited 2019 Oct 17];27:299-300. Available from: http://www.indianjurol.com/text.asp?2011/27/2/299/82867

Mitterberger M, Aigner F, Pinggera GM, Steiner E, Rehder P, Ulmer H,et al. Contrast-enhanced colour Doppler-targeted prostate biopsy: Correlation of a subjective blood-flow rating scale with the histopathological outcome of the biopsy. BJU Int 2010;106:1315-8.



   Summary Top


Prostate cancer is among the major medical problems being faced by the male population. The main diagnostic tools used to seek evidence of prostate cancer include a digital rectal examination (DRE); the serum level of prostate specific antigen (PSA), and transrectal ultrasound (TRUS)-guided biopsies. The final diagnosis depends on the presence of adenocarcinoma in prostate biopsy cores. [1] Currently; at least 10 biopsy cores are recommended for routine use. However, diagnosing prostate cancer by above methods is far from optimal. [2] Furthermore, a significant number of prostate cancers are also found in patients with low serum PSA values. [3] Therefore, the search for improved diagnostic techniques is a necessity.

Microbubble contrast agents enhance the ultrasonographic visualization of the microvasculature associated with prostate cancer. These agents increase the echogenicity of the intravascular space on grey-scale imaging and provide a dramatic visible increase in the Doppler signal. [4]

The present study included 760 patients from a prostate cancer screening study, with a PSA level of ≥ 1.25 ng/mL and a free-to-total PSA ratio of < 18%. Contrast-enhanced color Doppler (CECD) TRUS-guided biopsies with five cores were taken transrectally only from hypervascular areas of the peripheral zone during administration of sulfur hexafluoride. Each biopsy core was reviewed by a pathologist and reported as cancer with an assigned Gleason score, or as prostatic intraepithelial neoplasia (PIN), inflammation or benign prostatic tissue. For image interpretation, a 5-point subjective rating score was assigned for each biopsy site on each imaging sequence, as follow:

  • Score 1---benign, minimal enhancement (capsular and periurethral flow only);
  • Score 2---probably benign, mild enhancement (symmetric radial flow from capsular branches);
  • Score 3---indeterminate, mildly increased enhancement (asymmetric/increased flow in prostate);
  • Score 4---probably malignant, moderately increased enhancement (asymmetric/ increased flow in prostate);
  • Score 5---malignant, substantially increased enhancement (asymmetric/increased flow in prostate).


Interpreting the results, it was found that as the score increases the chance of malignancy in the biopsy also increased. All patients with score 5 had a positive biopsy for malignancy. There was a statistically significant correlation (r = 0.751, P < 0.01) comparing the blood-flow rating score with the findings on histopathology, showing that the subjective blood-flow rating score was strongly correlated to the findings on histopathology.


   Comments Top


Studies have shown that there is a clear association of increased microvessel density with the presence of carcinoma, metastases, stage of disease, and disease-specific survival. The microvessels which proliferate in prostate cancer are below the resolution of conventional TRUS; hence, microbubble ultrasound contrast agents represent one approach to detect these microvessels. Recently developed ultrasound contrast agents have intravascular residence times of several minutes and can be used for parenchymal organ enhancement.

This study showed that the subjective CECD blood-flow rating score correlated strongly with the histopathological outcome. If there was an asymmetrical substantially increased enhancement of the prostate during CECD TRUS, the probability that the biopsy showed prostate cancer was very high. If there was a capsular and periurethral flow with minimal enhancement on CECD TRUS, the pathology probably showed benign tissue. Moreover, the sensitivity of diagnosing prostate cancer was increased, the overall detection rate was improved, and fewer biopsies were needed to obtain the same detection rate as a conventional prostate biopsy.

Thus, CECD TRUS is an innovative method of improving the accuracy of prostate biopsies, increasing its positive predictive value, and reducing the number of unnecessary biopsies. One of the limitations of the present study was that blood-flow rating was subjective and there was no data on inter- and intra-observer variability. However, this can be overcome by objective measurement, e.g. color pixel counting that could further improve the diagnostic accuracy of CECD TRUS in future.

 
   References Top

1.Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Schmid HP, et al. EAU guidelines on prostate cancer. Eur Urol 2008;53:68-80.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Wink M, Frauscher F, Cosgrove D Chapelon JY, Palwein L, Mitterberger M,et al. Contrast-enhanced ultrasound and prostate cancer:A multicentre European research coordination project. Eur Urol 2008;54:982-92.  Back to cited text no. 2
    
3.Pallwein L, Mitterberger M, Gradl J, Aigner F, Horninger W, Strasser H, et al. Value of contrast-enhanced ultrasound and elastography in imaging of prostate cancer. Curr Opin Urol 2007;17:39-47.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Frauscher F, Klauser A, Halpern EJ, Horninger W, Bartsch G. Detection of prostate cancer with a microbubble ultrasound contrast agent. Lancet 2001;357:1849-50.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  




 

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