New England Section of the American Urological Association
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Comparison of high-resolution micro-ultrasound and conventional ultrasound in MRI-ultrasound fusion biopsy for diagnosis of clinically significant prostate cancer
Ghazal Khajir, MD, Michael S. Leapman, MD, Preston C. Sprenkle, MD, Joseph F. Renzulli, MD.
Yale school of medicine, New Haven, CT, USA.

Background: High-resolution micro-ultrasound (microUS) is a novel technology that permits the visualization of lesions suspicious of prostate cancer. The present study aimed to assess the utility of MRI-ultrasound fusion targeted biopsy in detecting clinically significant prostate cancer using high-resolution microUS versus conventional ultrasound.Methods: We performed a retrospective analysis of 62 patients who received ExactVu microUS-guided biopsy at a single institution from October 2021 through March 2022 (case group). Targeted biopsies (TB) were taken from multiparametric MRI targets (Prostate Imaging-Reporting and Data System [PI-RADS] ≥2), followed by a 12-core systematic biopsy. We also included a historical control group of 100 men who underwent MRI-US fusion biopsy using the Artemis device at the same institution between January 2019 and February 2020. The rates of cancer detection (any cancer and grade group (GG) ≥2) or missed cancer by TB were compared between the case (MRI-microUS fusion biopsy) and control (MRI-US fusion biopsy) groups.Results: In men undergoing MRI-microUS fusion biopsy (case group), detection rates of any cancer and GG ≥2 were similar between SB and TB (any cancer: 69.3% vs 62.9%, p=0.38; GG ≥2: 48.3% vs 46.7%, p=1.00, Table 1). Moreover, detection rates of any cancer and GG ≥2 using TB were comparable between MRI-microUS and MRI-US fusion biopsy groups (p>0.05, Table 1). In addition, the rate of missed GG ≥2 on TB was similar between MRI-microUS and MRI-US fusion groups (p>0.05). On multivariate analysis of all studied men, biopsy-na´ve status vs. prior negative biopsy (OR 25, p=0.008), PSA density (OR 2.13 per 0.1 unit increase, p<0.001), and PI-RADS score 5 vs. 3 (OR 8.03, p<0.001) were significant predictors in the detection of GG ≥2 (Table 2). However, MRI-US fusion method (microUS or conventional ultrasound) was not associated with the detection of GG ≥2 (p>0.05).Conclusion: Our results suggest that microUS-guided biopsy of MRI targets is comparable to MRI-US fusion biopsy using conventional ultrasound, given similar cancer detection and missing rates. Due to the equivalency between conventional ultrasound and microUS in the setting of MRI fusion, our analysis has shifted to evaluating conventional ultrasound vs. microUS in the absence of MRI guidance.






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