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Introduction:
To evaluate the detection of prostate cancer from directed prostate biopsies with contrast-enhanced ultrasound using flash replenishment with maximum intensity projection (MIP) MicroFlow Imaging (MFI) compared to systematic biopsy.
Materials & Methods:
259 patients underwent pre and post-contrast enhanced transrectal ultrasound (TRUS) evaluation of the prostate using MFI (Toshiba America Medical Systems, Tustin, CA). Contrast enhanced images were obtained while infusing Definity®, an encapsulated liposomal suspension of perfluoropropane microbubbles. MFI is an imaging technique that utilizes high power flash pulses to destroy contrast microbubbles followed by lower power pulses to show contrast replenishment. Up to 6 MFI guided prostate biopsies were taken per patient followed by a standard systematic 12 core biopsy protocol.
Results:
Prostate cancer was found in 110/259 (42%) patients. 249/3108 (8%) of the systematic cores compared to 187/1175 (15.9%) of the directed cores were positive for cancer. In 12 patients prostate cancer was detected only in targeted biopsy. Among patients with a positive biopsy, the odds ratio for a positive core with targeted biopsy versus systematic biopsy was 3.1 (95% CI: 2.4-4.0, p<0.001). Mean percentage of biopsy core involvement was 32% among patients with a positive targeted core, compared with 15% among patients who were not detected by targeted biopsy (p<0.001). Higher grade cancer (Gleason score > 6) was more common among patients with a positive targeted biopsy (53% versus 18%, p<0.001).
Conclusion:
Targeted biopsy of the prostate using contrast-enhanced TRUS MFI may selectively detect higher grade cancers as compared with systematic 12 core biopsy.