Abstract:
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Purpose: Recent studies have demonstrated improved detection of prostate cancer with targeted biopsy using microbubble contrast agents. Nonetheless, systematic biopsy in a proscribed spatial distribution (ie. sextant biopsy) remains the standard of care. Our study compares cancer detection with a targeted biopsy approach versus a modified sextant biopsy distribution.
Methods and Materials: Two hundred and one subjects with an elevated PSA (³4ng/ml) or abnormal digital rectal examination were evaluated by transrectal sonography during infusion of a microbubble contrast agent (Imagent; Alliance Pharmaceuticals). Sonography was performed with the Sonoline Elegra (Siemens Medical Systems) using a 6.5MHz end-fire transducer. Up to four targeted biopsy cores were obtained from the sites of greatest enhancement in the outer gland during contrast-enhanced imaging. Six additional outer gland biopsy cores were obtained in a modified sextant distribution.
Results: Cancer was detected in 252 biopsy cores from 67 of 201 subjects (33%). Cancer was found in 16.5% (124/753) of targeted cores versus 10.6% (128/1204) of sextant cores (p < 0.01). The diagnosis of cancer was discovered in 48 subjects by both techniques, in 10 subjects by sextant biopsy alone and in 9 subjects by targeted biopsy alone (p-N.S.). The 10 subjects with cancer detected by sextant biopsy alone included 8 cancers at the gland apex, 1 in the mid-gland and 1 in the base. The 9 subjects with cancer detected by targeted biopsy alone included 6 cancers at the gland base, 2 in the mid-gland and 1 in the apex. While 40% (51/128) of positive sextant cores were obtained at the gland apex, only 18% (22/124) of positive targeted cores were obtained from the gland apex. Only 20% (149/753) of targeted biopsies were directed to the apex.
Conclusion: The cancer detection rate of contrast-enhanced targeted cores is significantly higher when compared to sextant cores. Furthermore, targeted biopsy detected an additional 13% (9/67) of cancers not found by the sextant approach. Nonetheless, targeted biopsy failed to detect 15% (10/67) of cancers, including 8 cancers at the apex of the prostate. The low proportion of targeted biopsy cores at the apex suggests that contrast enhancement is less efficacious at the apex. In order to maximize cancer detection and minimize the number of biopsy cores, we recommend a contrast-enhanced targeted biopsy strategy with additional cores at the apex of the prostate.
Questions about this event email: ethan.halpern@jefferson.edu
Ramey MD, J,
Comparison of Contrast-enhanced Targeted Biopsy of the Prostate to Modified Sextant Biopsy. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3100863.html
