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Vulasala SS, Sutphin P, Shyn P, Kalva S. Intraoperative Imaging Techniques in Oncology. Clin Oncol (R Coll Radiol) 2024; 36:e255-e268. [PMID: 38242817 DOI: 10.1016/j.clon.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024]
Abstract
Imaging-based procedures have become well integrated into the diagnosis and management of oncological patients and play a significant role in reducing morbidity and mortality rates. Here we describe the established and upcoming surgical oncological imaging techniques and their impact on cancer management.
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Affiliation(s)
- S S Vulasala
- Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, USA.
| | - P Sutphin
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - P Shyn
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - S Kalva
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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2
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Liu Y, Zeng S, Xu R. Application of Multiple Ultrasonic Techniques in the Diagnosis of Prostate Cancer. Front Oncol 2022; 12:905087. [PMID: 35832558 PMCID: PMC9271763 DOI: 10.3389/fonc.2022.905087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
Abstract
Methods for diagnosing prostate cancer (PCa) are developing in the direction of imaging. Advanced ultrasound examination modes include micro-Doppler, computerized-transrectal ultrasound, elastography, contrast-enhanced ultrasound and microultrasound. When two or more of these modes are used in PCa diagnosis, the combined technique is called multiparameter ultrasound (mp-US). Mp-US provides complementary information to multiparameter magnetic resonance imaging (mp-MRI) for diagnosing PCa. At present, no study has attempted to combine the characteristics of different ultrasound modes with advanced classification systems similar to the PIRADS system in mpMRI for the diagnosis of PCa. As an imaging method, mp-US has great potential in the diagnosis of PCa.
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Affiliation(s)
- Yushan Liu
- Department of Ultrasound, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi Zeng
- Department of Ultrasound, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Ran Xu,
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Gurwin A, Kowalczyk K, Knecht-Gurwin K, Stelmach P, Nowak Ł, Krajewski W, Szydełko T, Małkiewicz B. Alternatives for MRI in Prostate Cancer Diagnostics-Review of Current Ultrasound-Based Techniques. Cancers (Basel) 2022; 14:1859. [PMID: 35454767 PMCID: PMC9028694 DOI: 10.3390/cancers14081859] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
The purpose of this review is to present the current role of ultrasound-based techniques in the diagnostic pathway of prostate cancer (PCa). With overdiagnosis and overtreatment of a clinically insignificant PCa over the past years, multiparametric magnetic resonance imaging (mpMRI) started to be recommended for every patient suspected of PCa before performing a biopsy. It enabled targeted sampling of the suspicious prostate regions, improving the accuracy of the traditional systematic biopsy. However, mpMRI is associated with high costs, relatively low availability, long and separate procedure, or exposure to the contrast agent. The novel ultrasound modalities, such as shear wave elastography (SWE), contrast-enhanced ultrasound (CEUS), or high frequency micro-ultrasound (MicroUS), may be capable of maintaining the performance of mpMRI without its limitations. Moreover, the real-time lesion visualization during biopsy would significantly simplify the diagnostic process. Another value of these new techniques is the ability to enhance the performance of mpMRI by creating the image fusion of multiple modalities. Such models might be further analyzed by artificial intelligence to mark the regions of interest for investigators and help to decide about the biopsy indications. The dynamic development and promising results of new ultrasound-based techniques should encourage researchers to thoroughly study their utilization in prostate imaging.
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Affiliation(s)
- Adam Gurwin
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (P.S.); (Ł.N.); (W.K.); (T.S.)
| | - Kamil Kowalczyk
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (P.S.); (Ł.N.); (W.K.); (T.S.)
| | - Klaudia Knecht-Gurwin
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Paweł Stelmach
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (P.S.); (Ł.N.); (W.K.); (T.S.)
| | - Łukasz Nowak
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (P.S.); (Ł.N.); (W.K.); (T.S.)
| | - Wojciech Krajewski
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (P.S.); (Ł.N.); (W.K.); (T.S.)
| | - Tomasz Szydełko
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (P.S.); (Ł.N.); (W.K.); (T.S.)
| | - Bartosz Małkiewicz
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (P.S.); (Ł.N.); (W.K.); (T.S.)
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Dias AB, O’Brien C, Correas JM, Ghai S. Multiparametric ultrasound and micro-ultrasound in prostate cancer: a comprehensive review. Br J Radiol 2022; 95:20210633. [PMID: 34752132 PMCID: PMC8978255 DOI: 10.1259/bjr.20210633] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer (PCa) is the most common non-cutaneous cancer diagnosed in males. Traditional tools for screening and diagnosis, such as prostate-specific antigen, digital rectal examination and conventional transrectal ultrasound (TRUS), present low accuracy for PCa detection. Multiparametric MRI has become a game changer in the PCa diagnosis pathway and MRI-targeted biopsies are currently recommended for males at risk of clinically significant PCa, even in biopsy-naïve patients. Recent advances in ultrasound have also emerged with the goal to provide a readily accessible and cost-effective tool for detection of PCa. These newer techniques include elastography and contrast-enhanced ultrasound, as well as improved B-mode and Doppler techniques. These modalities can be combined to define a novel ultrasound approach, multiparametric ultrasound. High frequency Micro-ultrasound has emerged as a promising imaging technology for PCa diagnosis. Initial results have shown high sensitivity of Micro-ultrasound in detecting PCa in addition to its potential in improving the accuracy of targeted biopsies, based on targeting under real-time visualization, rather than relying on cognitive/fusion software MRI-transrectal ultrasound-guided biopsy.
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Affiliation(s)
- Adriano Basso Dias
- Joint Department of Medical Imaging, University Health Network–Mount Sinai Hospital–Women’s College Hospital, University of Toronto, Toronto, Canada
| | - Ciara O’Brien
- Joint Department of Medical Imaging, University Health Network–Mount Sinai Hospital–Women’s College Hospital, University of Toronto, Toronto, Canada
| | - Jean-Michel Correas
- Department of Adult Radiology, Paris University and Necker University Hospital, Paris, France
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network–Mount Sinai Hospital–Women’s College Hospital, University of Toronto, Toronto, Canada
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Correas JM, Halpern EJ, Barr RG, Ghai S, Walz J, Bodard S, Dariane C, de la Rosette J. Advanced ultrasound in the diagnosis of prostate cancer. World J Urol 2020; 39:661-676. [PMID: 32306060 DOI: 10.1007/s00345-020-03193-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/30/2020] [Indexed: 12/17/2022] Open
Abstract
The diagnosis of prostate cancer (PCa) can be challenging due to the limited performance of current diagnostic tests, including PSA, digital rectal examination and transrectal conventional US. Multiparametric MRI has improved PCa diagnosis and is recommended prior to biopsy; however, mp-MRI does miss a substantial number of PCa. Advanced US modalities include transrectal prostate elastography and contrast-enhanced US, as well as improved B-mode, micro-US and micro-Doppler techniques. These techniques can be combined to define a novel US approach, multiparametric US (mp-US). Mp-US improves PCa diagnosis but is not sufficiently accurate to obviate the utility of mp-MRI. Mp-US using advanced techniques and mp-MRI provide complementary information which will become even more important in the era of focal therapy, where precise identification of PCa location is needed.
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Affiliation(s)
- Jean-Michel Correas
- Department of Adult Radiology, Paris University and Necker University Hospital, 149 rue de Sèvres, 75015, Paris Cedex 15, France.
| | - Ethan J Halpern
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, OH, USA
| | - Sangeet Ghai
- Department of Medical Imaging, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Sylvain Bodard
- Department of Adult Radiology, Paris University and Necker University Hospital, 149 rue de Sèvres, 75015, Paris Cedex 15, France
| | - Charles Dariane
- Department of Urology, Paris University and European Hospital Georges Pompidou, Paris, France
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Kessner R, Nakamoto DA, Kondray V, Partovi S, Ahmed Y, Azar N. Contrast-Enhanced Ultrasound Guidance for Interventional Procedures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2541-2557. [PMID: 30714653 DOI: 10.1002/jum.14955] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/03/2019] [Indexed: 06/09/2023]
Abstract
Since its introduction, contrast-enhanced ultrasound (CEUS) has gained an important role in the diagnosis and management of abdominal and pelvic diseases. Contrast-enhanced ultrasound can improve lesion detection rates as well as success rates of interventional procedures when compared to conventional ultrasound alone. Additionally, CEUS enables the interventionalist to assess the dynamic enhancement of different tissues and lesions, without the adverse effects of contrast-enhanced computed tomography, such as exposure to ionizing radiation and nephrotoxicity from iodinated contrast material. This review article describes the various applications and advantages of the use of CEUS to enhance performance of ultrasound-guided interventions in the abdomen and pelvis.
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Affiliation(s)
- Rivka Kessner
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Dean A Nakamoto
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Victor Kondray
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sasan Partovi
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yasmine Ahmed
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nami Azar
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Das CJ, Razik A, Sharma S, Verma S. Prostate biopsy: when and how to perform. Clin Radiol 2019; 74:853-864. [PMID: 31079953 DOI: 10.1016/j.crad.2019.03.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 03/15/2019] [Indexed: 12/24/2022]
Abstract
Prostate cancer, unlike other cancers, has been sampled in a non-targeted, systematic manner in the past three decades. On account of the low volume of prostate sampled despite the multiple cores acquired, systematic transrectal (TRUS) biopsy suffered from low sensitivity in picking up clinically significant prostate cancer. In addition, a significant number of cancers of the anterior, lateral peripheral zone, and the apex were missed as these areas were undersampled or missed during this biopsy protocol. Subsequently, the number of cores acquired was increased with special focus given to targeting the previously undersampled areas. These procedures led to an increase in the complication rates as well as detection of more clinically insignificant cancers. The advent of multiparametric magnetic resonance imaging (MRI) and its high intrinsic tissue contrast enabled better detection of prostate cancer. This led to the introduction of MRI-targeted biopsies with either MRI-TRUS fusion or under direct (in-gantry) guidance. MRI-targeted biopsies increased the percentage of positive cores and detection of clinically significant prostate cancers; however, these are expensive, time-intensive, require significant capital investment and operator expertise. This article describes the indications, workflow, complications, advantages, and disadvantages of TRUS-guided biopsy followed by MRI-guided biopsies.
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Affiliation(s)
- C J Das
- Department of Radiology, All India Institute of Medical Sciences (A.I.I.M.S), Ansari Nagar, New Delhi, 110029, India
| | - A Razik
- Department of Radiology, All India Institute of Medical Sciences (A.I.I.M.S), Ansari Nagar, New Delhi, 110029, India
| | - S Sharma
- Department of Radiology, All India Institute of Medical Sciences (A.I.I.M.S), Ansari Nagar, New Delhi, 110029, India
| | - S Verma
- Department of Radiology, The Veterans Administration Hospital Cincinnati, The University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45267, USA.
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Lixue ZMD, Xiaojuan ZMD, Yuxiu GMD, Zhaoyan DMD, Haiyang YMD, Cheng ZMD. Progress in Imaging Diagnosis and Image-guided Puncture Biopsy of Prostate Cancer. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2019. [DOI: 10.37015/audt.2019.191223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Xie SW, Dong BJ, Xia JG, Li HL, Zhang SJ, Du J, Yang WQ, Li FH, Xue W. The utility and limitations of contrast-enhanced transrectal ultrasound scanning for the detection of prostate cancer in different area of prostate. Clin Hemorheol Microcirc 2018; 70:281-290. [PMID: 29710684 DOI: 10.3233/ch-170346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Shao Wei Xie
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bai Jun Dong
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Guo Xia
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Li Li
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shi Jun Zhang
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Du
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Qi Yang
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Hua Li
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Xue
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Abstract
Contrast-enhanced ultrasound (CEUS) has evolved from the use of agitated saline to second generation bioengineered microbubbles designed to withstand insonation with limited destruction. While only one of these newer agents is approved by the Food and Drug Administration for use outside echocardiography, interventional radiologists are increasingly finding off-label uses for ultrasound contrast agents. Notably, these agents have an extremely benign safety profile with no hepatic or renal toxicities and no radiation exposure. Alongside diagnostic applications, CEUS has begun to develop its own niche within the realm of interventional oncology. Certainly, the characterization of focal solid organ lesions (such as hepatic and renal lesions) by CEUS has been an important development. However, interventional oncologists are finding that the dynamic and real-time information afforded by CEUS can improve biopsy guidance, ablation therapy, and provide early evidence of tumor viability after locoregional therapy. Even more novel uses of CEUS include lymph node mapping and sentinel lymph node localization. Critical areas of research still exist. The purpose of this article is to provide a narrative review of the emerging roles of CEUS in interventional oncology.
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Yunkai Z, Yaqing C, Jun J, Tingyue Q, Weiyong L, Yuehong Q, Wenbin G, Lifeng W, Jun Q. Comparison of contrast-enhanced ultrasound targeted biopsy versus standard systematic biopsy for clinically significant prostate cancer detection: results of a prospective cohort study with 1024 patients. World J Urol 2018; 37:805-811. [PMID: 30187133 DOI: 10.1007/s00345-018-2441-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/07/2018] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To assess contrast-enhanced ultrasound (CEUS) targeted biopsy (TB) for clinically significant prostate cancer (PCa) detection compared with systematic biopsy (SB). METHODS A total of 1024 consecutive patients scheduled for prostate biopsy were enrolled in this prospective study. CEUS was performed by an experienced radiologist blinded to all clinical data. Suspicious lesions on postcontrast images were sampled in addition to standard 12-core SB. The clinically significant PCa detection rate by CEUS-TB was evaluated in comparison with SB in the total cohort and in different subgroups. RESULTS In 378 of 1024 patients (36.9%), the diagnosis of PCa was histologically confirmed. PCa was detected by CEUS-TB in 306 patients (29.9%, 306/1024) and SB in 317 patients (31.0%, 317/1024, P = 0.340). Among 378 PCa patients, 326 (86.2%, 326/378) were diagnosed with significant PCa using Epstein criteria. The significant PCa detection rate of CEUS-TB was 28.7% (294/1024), which was higher than that of SB (25.3%, 259/1024, P = 0.000). CEUS-TB resulted in 67 additional cases of clinically significant PCa, including 51 patients missed by SB and 16 patients under-graded by SB. Conversely, SB detected 32 additional significant PCa missed by TB. In the subgroup analysis, CEUS-TB yielded a higher significant cancer detection rate than SB in patients with a PSA level ≤ 10.0 ng/ml or prostate volume from 30 to 60 ml. CONCLUSION The clinically significant PCa detection rate could be improved by the extra sampling of abnormalities on postcontrast images, especially in patients with a PSA level ≤ 10.0 ng/ml or prostate volume from 30 to 60 ml.
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Affiliation(s)
- Zhu Yunkai
- Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, People's Republic of China
| | - Chen Yaqing
- Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, People's Republic of China.
| | - Jiang Jun
- Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, People's Republic of China
| | - Qi Tingyue
- Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, People's Republic of China
| | - Liu Weiyong
- Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, People's Republic of China
| | - Qu Yuehong
- Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, People's Republic of China
| | - Guan Wenbin
- Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, People's Republic of China
| | - Wang Lifeng
- Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, People's Republic of China
| | - Qi Jun
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, People's Republic of China
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HistoScanningTM to Detect and Characterize Prostate Cancer—a Review of Existing Literature. Curr Urol Rep 2017; 18:97. [DOI: 10.1007/s11934-017-0747-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Wildeboer RR, Postema AW, Demi L, Kuenen MPJ, Wijkstra H, Mischi M. Multiparametric dynamic contrast-enhanced ultrasound imaging of prostate cancer. Eur Radiol 2017; 27:3226-3234. [PMID: 28004162 PMCID: PMC5491563 DOI: 10.1007/s00330-016-4693-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 11/28/2016] [Accepted: 12/01/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this study is to improve the accuracy of dynamic contrast-enhanced ultrasound (DCE-US) for prostate cancer (PCa) localization by means of a multiparametric approach. MATERIALS AND METHODS Thirteen different parameters related to either perfusion or dispersion were extracted pixel-by-pixel from 45 DCE-US recordings in 19 patients referred for radical prostatectomy. Multiparametric maps were retrospectively produced using a Gaussian mixture model algorithm. These were subsequently evaluated on their pixel-wise performance in classifying 43 benign and 42 malignant histopathologically confirmed regions of interest, using a prostate-based leave-one-out procedure. RESULTS The combination of the spatiotemporal correlation (r), mean transit time (μ), curve skewness (κ), and peak time (PT) yielded an accuracy of 81% ± 11%, which was higher than the best performing single parameters: r (73%), μ (72%), and wash-in time (72%). The negative predictive value increased to 83% ± 16% from 70%, 69% and 67%, respectively. Pixel inclusion based on the confidence level boosted these measures to 90% with half of the pixels excluded, but without disregarding any prostate or region. CONCLUSIONS Our results suggest multiparametric DCE-US analysis might be a useful diagnostic tool for PCa, possibly supporting future targeting of biopsies or therapy. Application in other types of cancer can also be foreseen. KEY POINTS • DCE-US can be used to extract both perfusion and dispersion-related parameters. • Multiparametric DCE-US performs better in detecting PCa than single-parametric DCE-US. • Multiparametric DCE-US might become a useful tool for PCa localization.
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Affiliation(s)
- Rogier R Wildeboer
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, PO-Box 513, 5600 MB, Eindhoven, The Netherlands.
| | - Arnoud W Postema
- Department of Urology, Academic Medical Center University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Libertario Demi
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, PO-Box 513, 5600 MB, Eindhoven, The Netherlands
| | | | - Hessel Wijkstra
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, PO-Box 513, 5600 MB, Eindhoven, The Netherlands
- Department of Urology, Academic Medical Center University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Massimo Mischi
- Laboratory of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, PO-Box 513, 5600 MB, Eindhoven, The Netherlands
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Delgado Oliva F, Arlandis Guzman S, Bonillo García M, Broseta Rico E, Boronat Tormo F. 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? Eur J Radiol 2016; 85:1778-1785. [PMID: 27666616 DOI: 10.1016/j.ejrad.2016.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/25/2016] [Accepted: 07/31/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES 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. MATERIAL AND 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.
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Affiliation(s)
- F Delgado Oliva
- Urology Department, La Fe University and Politechnic Hospital, Valencia, Spain.
| | - S Arlandis Guzman
- Urology Department, La Fe University and Politechnic Hospital, Valencia, Spain
| | - M Bonillo García
- Urology Department, La Fe University and Politechnic Hospital, Valencia, Spain
| | - E Broseta Rico
- Urology Department, La Fe University and Politechnic Hospital, Valencia, Spain
| | - F Boronat Tormo
- Urology Department, La Fe University and Politechnic Hospital, Valencia, Spain
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Validity of the Cancer of the Prostate Risk Assessment Score Derived From Targeted Biopsy: Modeling Evidence From Ultrasound Lesion-Directed Biopsy. Clin Genitourin Cancer 2016; 15:93-99. [PMID: 27522449 DOI: 10.1016/j.clgc.2016.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 07/07/2016] [Accepted: 07/13/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Our aim was to evaluate the impact of direct, ultrasound lesion-targeted prostate biopsy, alone or in combination with systematic sampling, on prostate cancer risk prediction. MATERIALS AND METHODS We reviewed biopsy findings for men with known or clinical suspicion of prostate cancer undergoing direct, ultrasound-targeted biopsy of radiographic lesions with concomitant systematic extended peripheral zone biopsy. We examined the resulting tumor volume estimates, Gleason grade, and Cancer of the Prostate Risk Assessment score generated from each strategy. Resulting multivariate clinical models of adverse surgical pathology-defined as high grade (Gleason pattern, ≥ 4+3) or non-organ-confined disease (≥ pT3a) were compared by the area under the Receiver Operating Characteristic curve. RESULTS A total of 352 patients received ultrasound-targeted biopsy. At diagnosis, the mean age was 63 years, median prostate-specific antigen, 5.7 ng/mL (interquartile range, 4.3-8.2), and median 15 cores (interquartile range, 12-18). The addition of targeted cores to systematic biopsy resulted in reclassification of 52 patients (14.7%) based on Gleason score, 45 (12.8%) by percentage of cores involved > 33%, and 51 (14.5%) by single core positivity > 50%; Cancer of the Prostate Risk Assessment risk category increased in 44 (12.5%). In multivariable logistic regression models of 196 men treated with prostatectomy, the area under the Receiver Operating Characteristic curve for the prediction of adverse pathology generated from targeted (0.754), systematic (0.753), and combined approaches (0.763) were not significantly different (P = .831). CONCLUSIONS The validity of clinical risk prediction assessed with a multi-variable instrument was maintained in the setting of lesion-targeted biopsy.
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Bagley JE, Savage R, DiGiacinto D. Transrectal Elastographic Biopsy and Contrast-Enhanced Transrectal Biopsy May Offer Improvements Over the Current Transrectal Systemic Biopsy Technique. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479316632189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prostate cancer is a common cause of cancer-related death of men in the United States. The purpose of this review is to compare the validity of transrectal ultrasound–guided systemic biopsy with contrast-enhanced transrectal ultrasound–guided systemic biopsy and transrectal elastography–guided systemic biopsy for the detection of prostate cancer. Adding contrast-enhanced or transrectal elastography core targeting to transrectal ultrasound–guided biopsy is a feasible approach to increase detection rates of higher-grade prostate cancers. Because contrast-enhanced imaging of the prostate is not approved for use in the United States, elastography is the most effective sonographic solution to improve prostate cancer detection with current screening techniques.
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Affiliation(s)
| | - Rayna Savage
- University of Oklahoma Health Sciences Center, Tulsa, OK, USA
| | - Dora DiGiacinto
- University of Oklahoma Health Sciences Center, Tulsa, OK, USA
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Pummer K, Rieken M, Augustin H, Gutschi T, Shariat SF. Innovations in diagnostic imaging of localized prostate cancer. World J Urol 2015; 32:881-90. [PMID: 24078105 DOI: 10.1007/s00345-013-1172-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 09/13/2013] [Indexed: 12/12/2022] Open
Abstract
PURPOSE In recent years, various imaging modalities have been developed to improve diagnosis, staging, and localization of early-stage prostate cancer (PCa). METHODS A MEDLINE literature search of the time frame between 01/2007 and 06/2013 was performed on imaging of localized PCa. RESULTS Conventional transrectal ultrasound (TRUS) is mainly used to guide prostate biopsy. Contrast-enhanced ultrasound is based on the assumption that PCa tissue is hypervascularized and might be better identified after intravenous injection of a microbubble contrast agent. However, results on its additional value for cancer detection are controversial. Computer-based analysis of the transrectal ultrasound signal (C-TRUS) appears to detect cancer in a high rate of patients with previous biopsies. Real-time elastography seems to have higher sensitivity, specificity, and positive predictive value than conventional TRUS. However, the method still awaits prospective validation. The same is true for prostate histoscanning, an ultrasound-based method for tissue characterization. Currently, multiparametric MRI provides improved tissue visualization of the prostate, which may be helpful in the diagnosis and targeting of prostate lesions. However, most published series are small and suffer from variations in indication, methodology, quality, interpretation, and reporting. CONCLUSIONS Among ultrasound-based techniques, real-time elastography and C-TRUS seem the most promising techniques. Multiparametric MRI appears to have advantages over conventional T2-weighted MRI in the detection of PCa. Despite these promising results, currently, no recommendation for the routine use of these novel imaging techniques can be made. Prospective studies defining the value of various imaging modalities are urgently needed.
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Postema A, Mischi M, de la Rosette J, Wijkstra H. Multiparametric ultrasound in the detection of prostate cancer: a systematic review. World J Urol 2015; 33:1651-9. [PMID: 25761736 PMCID: PMC4617844 DOI: 10.1007/s00345-015-1523-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 02/28/2015] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To investigate the advances and clinical results of the different ultrasound modalities and the progress in combining them into multiparametric UltraSound (mpUS). METHODS A systematic literature search on mpUS and the different ultrasound modalities included: greyscale ultrasound, computerized transrectal ultrasound, Doppler and power Doppler techniques, dynamic contrast-enhanced ultrasound and (shear wave) elastography. RESULTS Limited research available on combining ultrasound modalities has presented improvement in diagnostic performance. The data of two studies suggest that even adding a lower performing ultrasound modality to a better performing modality using crude methods can already improve the sensitivity by 13-51 %. The different modalities detect different tumours. No study has tried to combine ultrasound modalities employing a system similar to the PIRADS system used for mpMRI or more advanced classifying algorithms. CONCLUSION Available evidence confirms that combining different ultrasound modalities significantly improves diagnostic performance.
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Affiliation(s)
- Arnoud Postema
- Department of Urology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Jean de la Rosette
- Department of Urology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hessel Wijkstra
- Department of Urology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Koh J, Jung DC, Oh YT, Yoo MG, Noh S, Han KH, Rha KH, Choi YD, Hong SJ. Additional Targeted Biopsy in Clinically Suspected Prostate Cancer: Prospective Randomized Comparison between Contrast-Enhanced Ultrasound and Sonoelastography Guidance. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2836-2841. [PMID: 26298036 DOI: 10.1016/j.ultrasmedbio.2015.06.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/24/2015] [Accepted: 06/30/2015] [Indexed: 06/04/2023]
Abstract
Our aim was to improve the detection of prostate cancer by evaluating whether contrast-enhanced ultrasound (CEUS) or sonoelastography (SE) is more helpful in guiding targeted biopsy (TB) performed before systematic biopsy (SB). A total of 52 patients suspected of having prostate cancer were prospectively included and randomly assigned to either the CEUS or SE group. Different, independent radiologists performed TB and twelve-core SB. Within each group, cancer detection rates based on core number were compared between SB and TB. We evaluated the effect of TB on core-based cancer detection rates between the CEUS and SE groups. Cancer detection was higher in overall TB cores 16.4% (28/171) than SB cores 11.4% (71/624) in both groups. In the SE group, TB cores revealed higher cancer detection than did SB cores from 4.49% (14/312) to 12.86% (9/70) (p = 0.01). Compared with CEUS, SE may improve detection rates when considering additional TB guidance methods.
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Affiliation(s)
- Jieun Koh
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Chul Jung
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
| | - Young Taik Oh
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Moon Gyu Yoo
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Songmi Noh
- Department of Pathology, Cha Medical College, Gang-Nam Cha Hospital, Seoul, Korea
| | - Kyung Hwa Han
- Avison Biomedical Research Center, Department of Radiology; Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Koon-Ho Rha
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Kuru TH, Fütterer JJ, Schiffmann J, Porres D, Salomon G, Rastinehad AR. Transrectal Ultrasound (US), Contrast-enhanced US, Real-time Elastography, HistoScanning, Magnetic Resonance Imaging (MRI), and MRI-US Fusion Biopsy in the Diagnosis of Prostate Cancer. Eur Urol Focus 2015; 1:117-126. [PMID: 28723422 DOI: 10.1016/j.euf.2015.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/13/2015] [Accepted: 06/02/2015] [Indexed: 11/17/2022]
Abstract
CONTEXT Debates on overdiagnosis and overtreatment of prostate cancer (PCa) are ongoing and there is still huge uncertainty regarding misclassification of prostate biopsy results. Several imaging techniques that have emerged in recent years could overcome over- and underdiagnosis in PCa. OBJECTIVE To review the literature on transrectal ultrasound (TRUS)-based techniques (contrast enhancement, HistoScanning, elastography) and magnetic resonance imaging (MRI)-based techniques for a nonsystematic overview of their benefits and limitations. EVIDENCE ACQUISITION A comprehensive search of the PubMed database between August 2004 and August 2014 was performed. Studies assessing grayscale TRUS, contrast-enhanced (CE)-TRUS, elastography, HistoScanning, multiparametric MRI (mpMRI), and MRI-TRUS fusion biopsy were included. Publications before 2004 were included if they reported the principle or the first clinical results for these techniques. EVIDENCE SYNTHESIS Grayscale TRUS alone cannot detect PCa foci (detection rate 23-29%). TRUS-based (elastography) and MRI-based techniques (MRI-TRUS fusion biopsy) have significantly improved PCa diagnostics, with sensitivity of 53-74% and specificity of 72-95%. HistoScanning does not provide convincing or homogeneous results (specificity 19-82%). CE-TRUS seems to be user dependent; it is used in a low number of high-volume centers and has wide ranges for sensitivity (54-79%) and specificity (42-95%). For all the techniques reviewed, prospective multicenter studies with consistent definitions are lacking. CONCLUSIONS Standard grayscale TRUS is unreliable for PCa detection. Among the techniques reviewed, mpMRI and MRI-TRUS fusion biopsy seem to be suitable for enhancing PCa diagnostics. Elastography shows promising results according to the literature. CE-TRUS yields very inhomogeneous results and might not be the ideal technique for clinical practice. The value of HistoScanning must be questioned according to the literature. PATIENT SUMMARY New imaging modalities such as elastography and magnetic resonance imaging/transrectal ultrasound fusion biopsies have improved the detection of prostate cancer. This may lower the burden of overtreatment as a result of more precise diagnosis.
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Affiliation(s)
- Timur H Kuru
- Department of Urology, RWTH University, Aachen, Germany.
| | - Jurgen J Fütterer
- Department of Radiology, Radboud University, Nijmegen, The Netherlands
| | - Jonas Schiffmann
- Martini Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Porres
- Department of Urology, RWTH University, Aachen, Germany
| | - Georg Salomon
- Martini Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
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Growing indications for CEUS: The kidney, testis, lymph nodes, thyroid, prostate, and small bowel. Eur J Radiol 2015; 84:1675-84. [PMID: 26014102 DOI: 10.1016/j.ejrad.2015.05.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/05/2015] [Indexed: 12/11/2022]
Abstract
Contrast enhanced ultrasonography (CEUS) is increasingly used for non-hepatic applications as well, so that nearly all organs have been investigated. Among them, there is a growing clinical use for a variety of pathologies of the kidney, testis, and small bowel. The possibility to differentiate benign from malignant nodes in cancer patients has been investigated. A new application is in the detection of sentinel nodes after intradermal microbubble injection. The need to distinguish thyroid nodules eligible for fine needle aspiration cytology has led to the use of CEUS in thyroid examinations as well. The potential of CEUS for prostate cancer detection has been extensively investigated, with encouraging initial results. Early promise, however, has not been fulfilled. New perspective regards evaluation of the extent of prostate tissue devascularization following ablative treatments.
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Chen J, Yi XL, Jiang LX, Wang R, Zhao JG, Li YH, Hu B. 3-Tesla magnetic resonance imaging improves the prostate cancer detection rate in transrectral ultrasound-guided biopsy. Exp Ther Med 2014; 9:207-212. [PMID: 25452804 PMCID: PMC4247284 DOI: 10.3892/etm.2014.2061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 10/21/2014] [Indexed: 01/20/2023] Open
Abstract
The detection rate of prostate cancer (PCa) using traditional biopsy guided by transrectal ultrasound (TRUS) is not satisfactory. The aim of this study was to determine the utility of 3-Tesla (3-T) magnetic resonance imaging (MRI) prior to TRUS-guided prostate biopsy and to investigate which subgroup of patients had the most evident improvement in PCa detection rate. A total of 420 patients underwent 3-T MRI examination prior to the first prostate biopsy and the positions of suspicious areas were recorded respectively. TRUS-guided biopsy regimes included systematic 12-core biopsy and targeted biopsy identified by MRI. Patients were divided into subgroups according to their serum prostate-specific antigen (PSA) levels, PSA density (PSAD), prostate volume, TRUS findings and digital rectal examination (DRE) findings. The ability of MRI to improve the cancer detection rate was evaluated. The biopsy positive rate of PCa was 41.2% (173/420), and 41 of the 173 (23.7%) patients were detected only by targeted biopsy in the MRI-suspicious area. Compared with the systematic biopsy, the positive rate was significantly improved by the additional targeted biopsy (P=0.0033). The highest improvement of detection rate was observed in patients with a PSA level of 4–10 ng/ml, PSAD of 0.12–0.20 ng/ml2, prostate volume >50 ml, negative TRUS findings and negative DRE findings (P<0.05). Therefore, it is considered that 3-T MRI examination could improve the PCa detection rate on first biopsy, particularly in patients with a PSA level of 4–10 ng/ml, PSAD of 0.12–0.20 ng/ml2, prostate volume of >50 ml, negative TRUS findings and negative DRE findings.
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Affiliation(s)
- Jie Chen
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, P.R. China
| | - Xiao-Lei Yi
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, P.R. China
| | - Li-Xin Jiang
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, P.R. China
| | - Ren Wang
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, P.R. China
| | - Jun-Gong Zhao
- Department of Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Yue-Hua Li
- Department of Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, P.R. China
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van Hove A, Savoie PH, Maurin C, Brunelle S, Gravis G, Salem N, Walz J. Comparison of image-guided targeted biopsies versus systematic randomized biopsies in the detection of prostate cancer: a systematic literature review of well-designed studies. World J Urol 2014; 32:847-58. [PMID: 24919965 DOI: 10.1007/s00345-014-1332-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 05/21/2014] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The clinical utility of image-targeted biopsies can only be judged by a comparison of the current standard of systematic 10-12 core biopsy schemes. The aim of this review was to gather the current evidence in favor of or against targeted biopsies in the detection of prostate cancer based on well-designed, controlled studies, in order to draw clinical relevant conclusions. SUBJECTS/PATIENTS AND METHODS A systematic literature review was performed addressing studies that compared the prostate cancer detection rates of targeted and systematic biopsy schemes using the imaging techniques of elastography, contrast-enhanced ultrasound, histoscanning and multiparametric MRI. Only well-designed, controlled studies were included and the results summarized. RESULTS All imaging techniques are associated with varying results regarding better or poorer detection rates relative to systematic biopsies. No technique provides a clear trend in favor of or against image-targeted biopsies. In almost all studies, the combination of targeted and systematic biopsies provided sometimes a substantial, increase in the detection rate relative to systematic biopsies alone. MRI-targeted biopsies show no advantage in the initial biopsy setting, whereas in the repeat biopsy setting improvements in the detection rates are often observed relative to systemic biopsies. CONCLUSION Based on well-designed, controlled studies no clear advantage of targeted biopsies over the current standard of systematic biopsies can be observed. Therefore, targeted biopsies cannot replace systematic biopsies in the diagnosis of prostate cancer. In all indications, the combination of systematic and targeted biopsy schemes provides the highest detection rate.
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Affiliation(s)
- Antoine van Hove
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, 232, Boulevard Ste. Marguerite, BP 156, 13273, Marseille, France
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Hong CW, Amalou H, Xu S, Turkbey B, Yan P, Kruecker J, Pinto PA, Choyke PL, Wood BJ. Prostate biopsy for the interventional radiologist. J Vasc Interv Radiol 2014; 25:675-84. [PMID: 24581731 PMCID: PMC4308315 DOI: 10.1016/j.jvir.2013.12.568] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/14/2013] [Accepted: 12/22/2013] [Indexed: 01/04/2023] Open
Abstract
Prostate biopsies are usually performed by urologists in the office setting using transrectal ultrasound (US) guidance. The current standard of care involves obtaining 10-14 cores from different anatomic sections. Biopsies are usually not directed into a specific lesion because most prostate cancers are not visible on transrectal US. Color Doppler, US contrast agents, elastography, magnetic resonance (MR) imaging, and MR imaging/US fusion are proposed as imaging methods to guide prostate biopsies. Prostate MR imaging and fusion biopsy create opportunities for diagnostic and interventional radiologists to play an increasingly important role in the screening, evaluation, diagnosis, targeted biopsy, surveillance, and focal therapy of patients with prostate cancer.
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Affiliation(s)
- Cheng William Hong
- Center for Interventional Oncology, Clinical Center, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892
| | - Hayet Amalou
- Center for Interventional Oncology, Clinical Center, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892
| | - Sheng Xu
- Center for Interventional Oncology, Clinical Center, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892
| | - Pingkun Yan
- Center for Interventional Oncology, Clinical Center, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892; Philips Research North America, Briarcliff Manor, New York
| | - Jochen Kruecker
- Center for Interventional Oncology, Clinical Center, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892; Philips Research North America, Briarcliff Manor, New York
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892
| | - Bradford J Wood
- Center for Interventional Oncology, Clinical Center, National Cancer Institute, National Institutes of Health, 10 Center Drive MSC 1182, Bethesda, MD 20892.
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Wu X, Zhang F, Chen R, Zheng W, Yang X. Recent advances in imaging-guided interventions for prostate cancers. Cancer Lett 2014; 349:114-9. [PMID: 24769076 DOI: 10.1016/j.canlet.2014.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 04/02/2014] [Accepted: 04/16/2014] [Indexed: 11/26/2022]
Abstract
The numbers of patients diagnosed with prostate cancers is increasing due to the widespread application of prostate-specific antigen screening and subsequent prostate biopsies. The methods of systemic administration of therapeutics are not target-specific and thus cannot efficiently destroy prostate tumour cells while simultaneously sparing the surrounding normal tissues and organs. Recent advances in imaging-guided minimally invasive therapeutic techniques offer considerable potential for the effective management of prostate cancers. An objective understanding of the feasibility, effectiveness, morbidity, and deficiencies of these interventional techniques is essential for both clinical practice and scientific progress. This review presents the recent advances in imaging-guided interventional techniques for the diagnosis and treatment of prostate cancers.
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Affiliation(s)
- Xia Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, China; Image-Guided Bio-Molecular Intervention Research and Section of Vascular & Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican Street, Seattle, WA 98109, USA.
| | - Feng Zhang
- Image-Guided Bio-Molecular Intervention Research and Section of Vascular & Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican Street, Seattle, WA 98109, USA.
| | - Ran Chen
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University,3 East Qingchun Road, Hangzhou 310016, China.
| | - Weiliang Zheng
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, China.
| | - Xiaoming Yang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, China; Image-Guided Bio-Molecular Intervention Research and Section of Vascular & Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican Street, Seattle, WA 98109, USA.
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29
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Tsai YS, Jou YC, Chen CH, Chang CC, Yang WH, Lai JL, Tzai TS. Doppler spectral waveform parameters at neurovascular bundle vessels in patients with prostate biopsy. J Endourol 2013; 28:364-70. [PMID: 24168710 DOI: 10.1089/end.2013.0383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES There is a need to improve prescreening determination of prostate cancer to better select patients who need biopsy. Such a strategy properly implemented, will decrease the number of negative biopsies for prostate cancer and in turn better balance the risks and morbidity for patients recommended for biopsy. The aim of study is to investigate Doppler spectral waveform parameters of neurovascular bundle (NVB) vessels and determine differences between benign and malignant pathologies. PATIENTS AND METHODS We performed a prospective analysis involving 292 patients who received prostate biopsy for elevated prostate-specific antigen (PSA) values or abnormal digital rectal examination, as well as 174 patients with symptomatic benign prostatic hyperplasia. Doppler spectral waveform (DSW) parameters (peak-systolic velocity [PSV], end-diastolic velocity [EDV], and resistive index [RI]) were measured at bilateral NVB vessels through Doppler transrectal ultrasound at the right lateral decubitus position, compared, and analyzed among patients with benign versus malignant histology for each side. RESULTS Overall, both PSV and EDV at malignant sides were significantly higher than those at benign sides, as well as lower RI (all p-values <0.05, unpaired t-test). In subgroup analysis with 93 patients of serum PSA between 10 and 20 ng/mL and 56 patients with one-side malignancy, higher EDV and lower RI were significantly associated with malignancies (all p<0.05). The values of PSV and EDV rather than RI might be influenced by the patients' position and RI by the prostate volume. CONCLUSIONS In this study, DSW parameters (mainly EDV and RI) at NVB vessels were significantly associated with prostate cancer, particularly in patients with serum PSA of 10-20 ng/mL. It should be in caution that the patients' position and prostate volume may influence the Doppler signal as demonstrated in the current study. These findings can provide more diagnostic information before prostate biopsy.
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Affiliation(s)
- Yuh-Shyan Tsai
- 1 Department of Urology, College of Medicine and Hospital, National Cheng Kung University , Tainan, Taiwan
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Abstract
Recently several new technologies for prostate imaging have been developed. The aim of these technologies was to improve the diagnosis of prostate cancer. Especially the transrectal ultrasound (TRUS) has been refined to the so-called enhanced ultrasound, as regular grey scale TRUS has limited ability to identify cancer lesions in the prostate. In several studies elastography has shown good capability to identify cancer lesions in the prostate as well as to absolutely increase the detection rate of randomized biopsies by up to 10 %.. Contrast-enhanced ultrasound shows varying results in the published literature with increased detection rates on the one hand and unchanged detection rates relative to randomized biopsy on the other hand. The online available ANNA/C-TRUS system shows detection rates with six targeted biopsies that are comparable to the published detection rates of randomized saturation biopsies. Direct systematic comparison to randomized biopsies is missing. The Histoscanning system currently provides the poorest data as no biopsy studies are available. Multicenter trials are mandatory for all new imaging technologies in order to implement them as standard into clinical practice.
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Affiliation(s)
- J Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, 232, Boulevard Ste. Marguerite/ B.P.: 156, F-13273 Marseille, Frankreich.
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Chen JJ, Fu SY, Chiang CS, Hong JH, Yeh CK. Characterization of tumor vasculature distributions in central and peripheral regions based on Doppler ultrasound. Med Phys 2013; 39:7490-8. [PMID: 23231298 DOI: 10.1118/1.4762683] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Tumor heterogeneity is a major obstacle to therapy, and thus, how to achieve the maximal therapeutic gain in tumor suppression is an important issue. To accomplish this goal, assessing changes in tumor behaviors before treatment is helpful for physicians to adjust treatment schedules. In this study, the authors longitudinally and spatially investigated tumor perfusion and vascular density by power Doppler imaging and immunohistochemical analysis, respectively. Moreover, the authors developed a method to describe quantitatively the spatial distribution of the vasculature within the central and peripheral regions of tumors. METHODS Tumor perfusion was estimated by power Doppler images at an operating frequency of 25 MHz. To avoid the attenuation effect of such high-frequency ultrasound, murine tumors were subcutaneously transplanted into the thighs of mice and then monitored for 11 days. The tumors were removed at various time intervals for immunohistochemical analysis of their vascular density using CD31 staining. The spatial characteristics of the tumor vasculature were quantified by a γ value, which characterizes the rate at which vascular signals increase with the fractional sizes of the peripheral area within the tumor. RESULTS During tumor progression, the volume of tumor perfusion in the power Doppler images was strongly correlated with the vascular density determined by immunohistochemical analysis. In addition, the γ value significantly decreased with increased tumor size in the power Doppler images but not in the immunohistochemical analysis. CONCLUSIONS Although the tumor perfusion and vascular density estimates showed good temporal correlations during tumor progression, they did not show good spatial correlations due to tumor perfusion patterns changing from homogeneous to heterogeneous. In contrast to the perfusion patterns, the vascular density of the tumor remained uniformly distributed. In the present study, no necrosis regions were found in the tumor experiments. Furthermore, the measurement of γ value is a simple method for assessing the vasculatures of spatial distribution within tumors.
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Affiliation(s)
- Jia-Jiun Chen
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
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Abstract
PURPOSE OF REVIEW The advent of prostate-specific antigen screening has led to a seven-fold increase in the incidence of prostate cancer without a resultant decrease in mortality rate. This has led to the belief that urologists are overdetecting and overtreating clinically insignificant disease. To maintain the delicate balance between high cancer cure rate and overtreatment, which could potentially lead to unnecessary morbidities, focal therapy has emerged as the reasonable middle ground. In this article, we present the conceptual basis and the challenges of focal therapy, while emphasizing the critical role of imaging in focal treatment of prostate cancer. RECENT FINDINGS Multiple phase I trials have demonstrated the feasibility, short-term efficacy, and safety of focal therapy. Fundamental to the success of these trials and the ultimate acceptance of focal therapy is the integral role of imaging in optimal patient selection. Among the different imaging modalities, only ultrasound and multiparametric MRI are intimately involved in the detection, diagnosis, staging, and treatment of prostate cancer. Each modality has its own unique advantages and shortcomings. Recent advances in enhanced ultrasound modalities, functional MRIs, and biopsy platforms have taken focal therapy one step closer to becoming the standard of care. SUMMARY Although early results of phase I focal therapy trials are encouraging, long-term oncological outcomes remain to be elucidated. Incorporation of these technological advances into large prospective trials is needed to establish focal therapy as an important asset in the urologist's armamentarium against prostate cancer.
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Halpern EJ, Gomella LG, Forsberg F, McCue PA, Trabulsi EJ. Contrast enhanced transrectal ultrasound for the detection of prostate cancer: a randomized, double-blind trial of dutasteride pretreatment. J Urol 2012; 188:1739-45. [PMID: 22998915 DOI: 10.1016/j.juro.2012.07.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE The identification of clinically significant disease is crucial for optimal treatment of prostate cancer. Selective detection of prostate cancer with increased microvessel density is possible with contrast enhanced ultrasound. Preliminary studies suggest that pretreatment with a 5α-reductase inhibitor may improve the efficiency of contrast enhanced ultrasound targeted biopsy. This study was designed to quantify prostate cancer detection with contrast enhanced ultrasound with or without short-term pretreatment with dutasteride. MATERIALS AND METHODS In this randomized, double-blind, placebo controlled trial of oral dutasteride pretreatment, contrast enhanced ultrasound findings were graded and used to direct targeted biopsy (up to 6 cores per prostate). A blinded 12-core systematic biopsy was subsequently performed on every subject based on standard medial and lateral sampling of each sextant. RESULTS Of 311 subjects who underwent randomization, 272 completed participation. Positive biopsies were obtained in 276 of 3,264 (8.5%) systematic cores and 203 of 1,237 (16.4%) targeted cores (OR 2.1, 95% CI 1.7-2.6, p <0.001). ROC analysis for the detection of all prostate cancers demonstrated an increase in diagnostic accuracy from pre-contrast imaging to contrast enhanced ultrasound (A(z) 0.60 vs 0.64, p = 0.005). For the detection of high grade cancer (Gleason score 7 or greater) ROC analysis demonstrated improved accuracy for pre-contrast imaging (A(z) 0.74) and contrast enhanced ultrasound (A(z) 0.80, p = 0.0005). For the detection of high grade cancer with greater than 50% biopsy core involvement, excellent accuracy was demonstrated with pre-contrast and contrast enhanced ultrasound, A(z) 0.83 and 0.90, respectively (p = 0.001). Pretreatment with dutasteride had no significant impact on the detection of prostate cancer (p = 0.97). CONCLUSIONS Contrast enhanced ultrasound targeted biopsy provides a significant benefit for the detection of high grade/high volume prostate cancer.
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Affiliation(s)
- Ethan J Halpern
- Department of Radiology, Jefferson Prostate Diagnostic Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107-5244, USA.
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Russo G, Mischi M, Scheepens W, De la Rosette JJ, Wijkstra H. Angiogenesis in prostate cancer: onset, progression and imaging. BJU Int 2012; 110:E794-808. [DOI: 10.1111/j.1464-410x.2012.11444.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Harvey CJ, Pilcher J, Richenberg J, Patel U, Frauscher F. Applications of transrectal ultrasound in prostate cancer. Br J Radiol 2012; 85 Spec No 1:S3-17. [PMID: 22844031 DOI: 10.1259/bjr/56357549] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Transrectal ultrasound (TRUS) was first developed in the 1970s. TRUS-guided biopsy, under local anaesthetic and prophylactic antibiotics, is now the most widely accepted method to diagnose prostate cancer. However, the sensitivity and specificity of greyscale TRUS in the detection of prostate cancer is low. Prostate cancer most commonly appears as a hypoechoic focal lesion in the peripheral zone on TRUS but the appearances are variable with considerable overlap with benign lesions. Because of the low accuracy of greyscale TRUS, TRUS-guided biopsies have become established in the acquisition of systematic biopsies from standard locations. The number of systematic biopsies has increased over the years, with 10-12 cores currently accepted as the minimum standard. This article describes the technique of TRUS and biopsy and its complications. Novel modalities including contrast-enhanced modes and elastography as well as fusion techniques for increasing the sensitivity of TRUS-guided prostate-targeted biopsies are discussed along with their role in the diagnosis and management of prostate cancer.
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Affiliation(s)
- C J Harvey
- Department of Imaging, Imperial Healthcare Trust, Hammersmith Hospital, London, UK.
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Abstract
PURPOSE OF REVIEW The ability to accurately localize and target prostate cancer, whether for staging or future interventions, is an important concept in prostate cancer management. In this review, we describe the emerging technologies that allow for enhanced visualization and precise targeting of the prostate cancer. RECENT FINDINGS Uses of prostate-specific antigen and conventional prostate biopsy with image-blinded random systematic techniques have led to overdiagnosis of insignificant cancer and underdiagnosis of significant cancer. Active surveillance and focal therapy have become hot topics in prostate cancer management as the incidence of low-risk prostate cancer rises. For either management, it is essential to localize, characterize, and target the clinically important cancer in the prostate. Emerging techniques in ultrasound as well as MRI modalities allow for enhancement of tumor visualization, and characterization. Digital mapping technique of biopsy trajectory is an emerging technique that allows for three-dimensional mapping of biopsy-proven cancer lesions as well as potential future delivery of focal therapy. Molecular or cancer-specific targeting is promising for specific imaging and therapeutic approach at the cell level. SUMMARY Emerging technologies improve clinically relevant prostate cancer identification using digitalized multiparametric anatomical and functional imaging and enhance the ability to precisely target the known-cancer.
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SCHNEIDER MICHEL, BROILLET ANNE, TARDY ISABELLE, POCHON S, BUSSAT PHILIPPE, BETTINGER THIERRY, HELBERT ALEXANDRE, COSTA MARIA, TRANQUART FRANÇOIS. Use of Intravital Microscopy to Study the Microvascular Behavior of Microbubble-Based Ultrasound Contrast Agents. Microcirculation 2012; 19:245-59. [DOI: 10.1111/j.1549-8719.2011.00152.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Uemura H, Sano F, Nomiya A, Yamamoto T, Nakamura M, Miyoshi Y, Miki K, Noguchi K, Egawa S, Homma Y, Kubota Y. Usefulness of perflubutane microbubble-enhanced ultrasound in imaging and detection of prostate cancer: phase II multicenter clinical trial. World J Urol 2012; 31:1123-8. [PMID: 22311543 DOI: 10.1007/s00345-012-0833-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 01/19/2012] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To explore the possibility of targeted biopsy (TBx) using transrectal ultrasound (US) with perflubutane microbubbles, we studied the findings of different cancerous tissue imaging modalities and evaluated needle biopsy in prostate cancer (PCa) using contrast-enhanced US (CEUS) in a multicenter clinical trial. METHODS Seventy-one patients undergoing prostate biopsy received intravenous injection of perflubutane microbubbles (Sonazoid(®)). We evaluated and compared images obtained by CEUS. The safety observation period was 2 days after contrast administration. RESULTS Among the 30 patients with cancer, one or more sites with findings suggestive of cancer in CEUS were detected in 23 patients (32.4%) by TBx. Although 22 patients had positive cores of cancer by systematic biopsy (SBx), 8 patients had positive cores of cancer in TBx alone (11.3%). There was a significant difference in cancer detection rate by TBx between two cohorts with PSA < 10 ng/mL (22.9%) and PSA ≥ 10 ng/mL (52.2%) (P < 0.02). Close observation of various CEUS findings with Sonazoid(®) enabled targeting of cancerous areas, and consequently, a significant difference (P < 0.05) in the detection rate of cancer was recognized in the transition zone (TZ): SBx; 21/120 (17.5%) and TBx; 17/55 (30.9%). The incidence of adverse events was 6.7% and that of adverse reactions was 4%. CONCLUSIONS CEUS with Sonazoid(®) improved the detection rate of PCa by visualizing cancerous lesions. More detailed examination of CEUS images provided efficient characterization especially in the TZ area. TBx according to this procedure is expected to enable a lower number of biopsies and more accurate diagnosis of PCa.
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Affiliation(s)
- Hiroji Uemura
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan,
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Abstract
In patients with known malignant disease, 51% of liver lesions less than 1.5 cm turn out to be benign. Whether the probability of malignancy is high or low, further investigations are often necessary to definitely exclude malignancy. Contrast-enhanced ultrasonography has a prominent role in lesion characterization with a diagnostic accuracy comparable with computed tomography and magnetic resonance imaging. Anti-angiogenic treatment is common in most oncological institutions and the response evaluation is a new challenge with a research focus on the change in tumour vasculature and perfusion. In planning biopsies, CEUS can identify necrotic and viable areas of tumours and improve the diagnostic accuracy.
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Affiliation(s)
- H H T Madsen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
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Xie SW, Li HL, Du J, Xia JG, Guo YF, Xin M, Li FH. Contrast-enhanced ultrasonography with contrast-tuned imaging technology for the detection of prostate cancer: comparison with conventional ultrasonography. BJU Int 2011; 109:1620-6. [PMID: 21939490 DOI: 10.1111/j.1464-410x.2011.10577.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? The present study was to perform contrast-tuned imaging (CnTI) technology to detect prostate cancer and compare the use of CnTI technology for the detection of prostate cancer with conventional ultrasonography. The preliminary data from our study suggested that targeted biopsy of the prostate with CnTI technology could improve the cancer detection and detect higher grade prostate cancers. OBJECTIVES To perform contrast-enhanced ultrasonography (CEUS) using contrast-tuned imaging (CnTI) technology to detect prostate cancer. To evaluate the detection of prostate cancer with CnTI compared with conventional grey-scale and power Doppler ultrasonography. PATIENTS AND METHODS In all, 150 patients referred for prostate biopsy were evaluated using transrectal grey-scale, power Doppler and CnTI ultrasonography. Biopsy was performed at 10 sites in each patient. If an abnormality was found at any of these three ultrasonography examinations, a biopsy specimen was targeted towards from the corresponding site. The performances of the three ultrasonography techniques for prostate cancer detection were compared. RESULTS Prostate cancer was detected at 383 sites from 73 patients. The combination of these three examinations detected more patients with prostate cancer than grey-scale (P= 0.002), power Doppler (P= 0.001) or baseline imaging (the combination of grey-scale and power Doppler; P= 0.031) alone. By biopsy site, CnTI had higher sensitivity and accuracy (73.1% and 83.7%) than grey-scale (50.9%; P < 0.001 and 78.8%; P < 0.001) or power Doppler (48.3%; P < 0.001 and 77.7%; P < 0.001), while the specificity was similar for grey-scale (88.4%), power Doppler (87.8%) and CnTI (87.3%; P > 0.05 in each case). CnTI had higher sensitivity (73.1% vs 62.9%; P < 0.001), specificity (87.3% vs 82.1%; P < 0.001) and accuracy (83.7% vs 77.2%; P < 0.001) than baseline imaging. The mean Gleason score of CnTI-positive cases was significantly higher than CnTI-negative cases (7.1 vs 6.3; P= 0.002). CONCLUSIONS CEUS using CnTI technology enables a visualization of the microvasculature associated with prostate cancer. CnTI technology could be used to guide biopsy and improve the detection rate of prostate cancer. CnTI technology was able to detect higher grade prostate cancers.
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Affiliation(s)
- Shao Wei Xie
- Department of Ultrasound, Shanghai Jiao Tong University, Shanghai, China
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Abstract
Prostate cancer is the most common malignancy in men, in general. Most patients diagnosed with prostate cancer have localized disease confined to the prostate. A small percentage of patients with aggressive tumors will progress to develop local, extracapsular tumor extension and distant metastases. The aim of prostate cancer management is to identify and treat those patients with aggressive disease before they develop locally advanced or metastatic disease, and to avoid overtreating indolent tumors, which are unlikely to be life threatening. Imaging has been shown to be valuable in local staging of prostate cancer and as an aid to the management of clinically significant disease. In this article, we discuss the different established imaging modalities and emerging techniques for prostate cancer imaging in patients with clinically localized disease who may be suitable for radical treatment.
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Affiliation(s)
- Adel Abdellaoui
- Plymouth Hospitals NHS Trust, Radiology Department, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, UK
| | - Srikanth Iyengar
- Plymouth Hospitals NHS Trust, Radiology Department, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, UK
| | - Simon Freeman
- Plymouth Hospitals NHS Trust, Radiology Department, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, UK
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