For this study, data from nine sites were aggregated, totaling 866 subjects presenting for ExactVu micro-ultrasound guided biopsy with available mpMRI studies. Samples in all subjects were taken from mpMRI targets and micro-ultrasound targets, with up to 12 systematic samples filled in. Various strategies were used for mpMRI target sampling including cognitive fusion with micro-ultrasound, separate software-fusion systems, and software-fusion using the micro-ultrasound FusionVu system. Clinically significant cancer was considered any Gleason sum > 6 and targeted samples were taken for PI-RADS > 2 or PRI-MUS > 2 lesions.
Overall, 39% of all biopsy cases were positive for clinically significant prostate cancer. mpMRI demonstrated 89% sensitivity and a negative predictive value of 77%. Compared to mpMRI, micro-ultrasound sensitivity (95%) and negative predictive value (87%) were higher. Micro-ultrasound was less specific (21% vs 23% for mpMRI) with similar positive predictive value (44% vs 43%) compared to mpMRI. A summary of the findings is found in the following table:
The aggregate effect demonstrates higher sensitivity for clinically significant prostate cancer with micro-ultrasound compared to mpMRI (p<0.01).
Dr. Lughezzani concluded his presentation with the following take-home points:
- Micro-ultrasound is an attractive option for screening and targeted biopsy
- Sensitivity and negative predictive value appear superior to mpMRI, but specificity is mildly reduced
- Further larger-scale studies are required for validation of these findings
Presented by: Dott. Giovanni Lughezzani, Department of Urology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Italy
Co-Authors: Davide Maffei, Marco Paciotti, José Gregorio Pereira, Andrea Sánchez, Frédéric Staerman, Hannes Cash, Laurent Lopez, Jean Rouffilange , Richard Gaston, Rafael Sanchez-Salas, Xavier Cathelineau, Eric Klein, Robert Abouassaly, Laurence Klotz, Gregg Eure
Written by: Zachary Klaassen, MD, MSc – Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, Twitter: @zklaassen_md at the 2020 American Urological Association (AUA) Annual Meeting, Virtual Experience #AUA20, June 27- 28, 2020
- Ghai S, Eure G, Fradet V, et al. Assessing Cancer Risk in Novel 29 MHz Micro-Ultrasound Images of the Prostate. J Urol. 2016 Aug;196(2):562-569.