Multiparametric MRI-TRUS Fusion Guided Biopsy With Multiparametric Ultrasonography For The Diagnosis Of Clinically Significant Prostate Cancer

Background: Currently,systematic biopsies(SB)guided by transrectal ultrasound(TRUS)serves as the gold standard for diagnosis of prostate cancer(PCa).However,clinical applications of SB are limited by misdiagnosis of clinically significant prostate cancers(csPCa),under-estimation of tumor invasiveness,excessive detection of clinically insignificant prostate cancer(ciPCa),leading to under-diagnosis of csPCa and over-diagnosis of ciPCa.Multi-parameter magnetic resonance imaging and TRUS(mpMRI-TRUS)fusion imaging can effectively combine mpMRI with TRUS and allow targeted biopsies(TB).Compared with TRUS,multiparametric ultrasound(mpUS)imaging can effectively display PCa.Sun et al.demonstrated that contrast-enhanced ultrasonography(CEUS)has a high application value in the differential diagnosis of benign and malignant prostate lesions.Tomoaki et al.demonstrated that real-time elastography(RTE)exhibits high sensitivity in the diagnosis of PCa compared with TRUS.In this study,the TB for prostate was conducted using mpMRI-TRUS fusion imaging to improve the diagnostic efficiency of csPCa and avoid over-diagnosis and treatment of ciPCa.Meanwhile,the results of TB and SB were compared with each other.Additionally,mpUS feature analysis was conducted on the targeted area and the diagnostic value of the combination of mpMRI-TRUS fusion imaging and mpUS for csPCa was investigated.PART One Comparison of Multiparametric MRI-TRUS fusion guided biopsy versus systematic biopsy for clinically significant prostate cancer detectionObjective: To assess mpMRI-TRUS fusion targeted biopsy(MRF-TB)for csPCa detection compared with SB.Methods: From November 2019 to November 2021,biopsy-na?ve patients underwent mpMRI within one month before undergoing MRF-TB and SB to assess a clinical suspicion of PCa.Results:1.Comparison of the detection rate of csPCa between MRF-TB and SBA total of 243 prostate lesions(196 patients)were included in the final analysis,of which109 were csPCa,16 were ciPCa and 118 were noncancerous.In the detection of csPCa,the detection rate of MRF-TB was higher than that of SB(42.8% vs.38.7%,p < 0.05).2.Comparison of the positive core rate of csPCa between MRF-TB and SB142 of 341 cores were positive for csPCa on TB,and 822 of 2334 cores were positive for csPCa on SB.TB had a higher csPCa positive core rate than SB(41.6% vs 35.2%,p<0.05).Conclusion: MRF-TB can be used to improve the detection rate of csPCa,thereby being effectively used in the diagnosis and risk assessment of csPCa.PART Two The Value of mpMRI-TRUS fusion combined with mpUS in the diagnosis of clinically significant prostate cancerObjective: To evaluate the performance of a combination of mpMRI-TRUS fusion and mpUS for csPCa detection.Methods: 242 male patients with abnormal PSA and DRE who were received by Inner Mongolia People’s Hospital during November 2019-November 2021 and examined by mpMRI were enrolled in this study.196 patients were examined by mpMRI-TRUS fusion imaging and mpUS.The mpUS imaging features of 243 focuses obtained by fusion imaging were analyzed.The diagnostic values of mpMRI-TRUS fusion imaging and mpMRI-TRUS fusion imaging combined with mpUS for csPCa were compared with each other.Results:1.The mpUS imaging features of mpMRI-TRUS fusion imaging target areasB-mode: The main ultrasonography signs in the PCa group were hypoechoic(60.80%),irregular edges(37.60%),aspect ratio ≥ 1(60.00%),signs of capsule bulge(71.20%),asymmetric blood flow distribution(56.00%).The main ultrasonography signs in the nonPCa group were isoechoic(73.73%),regular edges(90.68%),aspect ratio <1(66.95%),and symmetrical blood flow distribution(83.05%).CEUS: The main ultrasonography signs in the PCa group were fast-forward enhancement(22.40%),or fast forward and backward enhancement(40.80%),hyperperfusion(44.00%),hypoperfusion/nonperfusion(18.40%),diffuse enhancement(63.20%).The main ultrasonography signs in the non-PCa group were no fast forward or backward enhancement(65.25%),and normal perfusion(70.34%).RTE: The main ultrasonography signs in the PCa group were focal non-strain or asymmetric strain(72.00%).The main ultrasonography signs in the non-PCa group were homogeneous strain(11.86%),and symmetric heterogeneous strain(47.46%).The proportions of characteristics mentioned above in PCa patients were higher than those of the non-PCa group(p<0.001).2.MpMRI-TRUS fusion imaging combined with mpUS to diagnose csPCaCompared with mpMRI-TRUS fusion imaging,the positive predictive value,the false positive rate and the area under curve(AUC)of csPCa diagnosis by mpMRI-TRUS fusion imaging combined with mpUS increased from 65.20% to 79.00%,decreased from 35.07% to15.67%,and increased from 0.728 to 0.784(p<0.05),respectively.Conclusions:1.The mpUS features of the target areas can provide valuable diagnostic information for mpMRI-TRUS fusion imaging,which is helpful for the further visualization of PCa foci.2.The mpMRI-TRUS fusion imaging combined with mpUS has a high diagnostic value for csPCa,can facilitate accurate detection of csPCa,and provide guidance for the next clinical treatment.