The purpose of this study was to evaluate if the use of micro-ultrasound can detect clinically significant prostate pathology when compared to histology obtained during a transperineal prostate biopsy.
Patients suspected of having prostate cancer, who had a pre-biopsy magnetic resonance imaging and could tolerate a transrectal examination, were prospectively recruited. All patients had a micro-ultrasound scan prior to their biopsy. The findings of magnetic resonance imaging, micro-ultrasound and histology were risk stratified in accordance with local pathways. Comparison of assigned risk scores was made using histology as the reference standard.
Data from 101 patients were evaluated. Histology showed that clinically significant prostate cancer was detected in 48.5% (n = 49/101) of patients. Moderate inter-rater agreement was found in both magnetic resonance imaging and micro-ultrasound with К of 0.31 in both modalities. High-risk findings were identified in 81% (n = 82/101) patients at magnetic resonance imaging and in 66% (n = 67/101) patients at micro-ultrasound. Sensitivity and specificity of magnetic resonance imaging were found to be 87% and 34.6% and for micro-ultrasound 73.3% and 53.8%, respectively.
A limitation of this study was that the biopsy was not performed with micro-ultrasound which may have resulted in unidentified cancers and lowered the apparent accuracy of the technique. However, we conclude that while micro-ultrasound was diagnostic, magnetic resonance imaging demonstrated higher sensitivity in our local population and remains the pre-biopsy imaging modality of choice. However, the higher specificity of micro-ultrasound identified does indicate that it may be of value when magnetic resonance imaging is contraindicated. The role of micro-ultrasound, within an active surveillance pathway for prostate cancer, warrants further investigation.
Ultrasound (Leeds, England). 2024 Feb 14 [Epub]
Pamela Parker, Maureen Twiddy, Alan Rigby, Paul Whybrow, Matthew Simms
University of Hull and Hull University Teaching Hospitals NHS Trust, Kingston upon Hull, UK., Institute of Clinical and Applied Health Research, Hull York Medical School, Kingston upon Hull, UK., Hull University Teaching Hospitals NHS Trust, Kingston upon Hull, UK.