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Post-MRI transrectal micro-ultrasonography of transition zone PI-RADS > 2 lesions for biopsy guidance

  • Urogenital
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Abstract

Objective

To prospectively determine the value of post-MRI micro-ultrasonography (microUS) in the diagnosis of transition zone (TZ) significant prostate cancer (sPCa).

Patients and methods

Eighty-four consecutive men (66 ± 6.3 years) with a mean PSA level of 10.2 ± 7.4 ng/mL and at least one TZ-PI-RADS > 2 lesion were included. All patients had MRI-directed microUS and biopsy. Sensitivity and specificity of post-MRI microUS to visualize PI-RADS > 2 TZ lesions, the cancer detection rate of TZ-sPCa, and tumor characteristics according to their visibility on microUS were evaluated. Interreader agreement for detecting microUS+ lesions was evaluated using Cohen’s kappa test.

Results

Of the 92 PI-RADS > 2 lesions, 71 (71/92; 77%) were visible on microUS and biopsy was performed without image fusion, which was required for the 21 invisible lesions (21/92; 22.8%). TZ-sPCa detection rate was 51.1% (47/92). Sensitivity and specificity of MRI-directed microUS were 83% (39/47; 95% CI: 69.2–92.4%) and 28.9% (13/45; 95% CI: 16.4–44.3%), on a per-lesion basis and 86.4% (38/45; 95% CI: 72.6–94.8%) and 27.5% (11/40; 95% CI: 14.6–43.9%) on a per-patient basis. Visible tumors on microUS exhibited a larger volume and a lower mean ADC value than non-visible tumors (15.8 ± 5.1 vs. 12.5 ± 3.6 mm and 0.82 ± 1.1 × 103 vs. 0.9 ± 1.4 × 10−3 mm2/s) (p = 0.02). Non-visible tumors showed a heterogeneous non-specific echotexture or were masked by the shadowing caused by corpora amylacea. Interreader agreement was almost perfect (kappa = 0.88; 95% CI: 0.79–0.95). The main limitation is the single-center feature of the study.

Conclusion

MRI-targeted transrectal microUS is effective to detect TZ-sPCa. TRUS-MRI image fusion helps overcome limitations due to TZ tissue heterogeneity.

Key Points

  • microUS can visualize the majority of MRI-detected PI-RADS > 2 TZ lesions (sensitivity = 83%).

  • Interreader agreement of MRI-directed microUS in the detection of TZ lesions appears excellent (kappa = 0.88).

  • In 77% of PI-RADS > 2 TZ lesions, biopsy was performed under microUS visual control. MRI fusion system was only used to overcome limitations due to tissue heterogeneity of benign prostatic hyperplasia.

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Abbreviations

ADC:

Apparent diffusion coefficient

AFMS:

Anterior fibro muscular stroma

BPH:

Benign prostatic hyperplasia

bp-MRI:

Biparametric-MRI

DWI:

Diffusion-weighted imaging

microUS:

Micro-ultrasound

MRI:

Magnetic resonance imaging

PCa:

Prostate cancer

PI-RADS:

Prostate Imaging Reporting and Data System

PSA:

Prostate-specific antigen

PZ:

Peripheral zone

ROI:

Region of interest

SD:

Standard deviation

sPCa:

Significant prostate cancer

T2WI:

T2-weighted images

TRUS:

Transrectal ultrasound

TZ:

Transition zone

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Acknowledgements

The authors thank Mrs. Dorothee BOSSIS, PhD, for her manuscript editing.

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Authors and Affiliations

  1. Department of Radiology, Clinique de l’Alma, 75007, Paris, France

    François Cornud & Arnaud Lefevre

  2. Centre de Pathologie des Hauts de France, Amiens, France

    Philippe Camparo

  3. Department of Radiology, Hôpital Cochin, 75014, Paris, France

    Maxime Barat & Philippe Soyer

  4. Department of Urology, Clinique Turin, 75009, Paris, France

    Olivier Dumonceau

  5. Department of Urology, Clinique de l’Alma, Paris, France

    Marc Galiano & Thierry Flam

  6. Service de Radiologie, Department of Radiology, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France

    Matthias Barral

Authors
  1. François Cornud
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  2. Arnaud Lefevre
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  4. Maxime Barat
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  7. Thierry Flam
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  8. Philippe Soyer
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Correspondence to Matthias Barral.

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The scientific guarantor of this publication is F. H. Cornelis.

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The authors declare no competing interests.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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• performed at one institution

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Cornud, F., Lefevre, A., Camparo, P. et al. Post-MRI transrectal micro-ultrasonography of transition zone PI-RADS > 2 lesions for biopsy guidance. Eur Radiol 32, 7504–7512 (2022). https://doi.org/10.1007/s00330-022-08788-2

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  • DOI: https://doi.org/10.1007/s00330-022-08788-2

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