Postema Arnoud W, Frinking Peter J A, Smeenge Martijn, De Reijke Theo M, De la Rosette Jean J M C H, Tranquart Francois, Wijkstra Hessel
Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.
Bracco Suisse SA, Geneva, Switzerland.
BJU Int. 2016 Apr;117(4):598-603. doi: 10.1111/bju.13116. Epub 2015 Jun 29.
To investigate the value of dynamic contrast-enhanced (DCE)-ultrasonography (US) and software-generated parametric maps in predicting biopsy outcome and their potential to reduce the amount of negative biopsy cores.
For 651 prostate biopsy locations (82 consecutive patients) we correlated the interpretation of DCE-US recordings with and without parametric maps with biopsy results. The parametric maps were generated by software which extracts perfusion parameters that differentiate benign from malignant tissue from DCE-US recordings. We performed a stringent analysis (all tumours) and a clinical analysis (clinically significant tumours). We calculated the potential reduction in biopsies (benign on imaging) and the resultant missed positive biopsies (false-negatives). Additionally, we evaluated the performance in terms of sensitivity, specificity negative predictive value (NPV) and positive predictive value (PPV) on a per-prostate level.
Based on DCE-US, 470/651 (72.2%) of biopsy locations appeared benign, resulting in 40 false-negatives (8.5%), considering clinically significant tumours only. Including parametric maps, 411/651 (63.1%) of the biopsy locations appeared benign, resulting in 23 false-negatives (5.6%). In the per-prostate clinical analysis, DCE-US classified 38/82 prostates as benign, missing eight diagnoses. Including parametric maps, 31/82 prostates appeared benign, missing three diagnoses. Sensitivity, specificity, PPV and NPV were 73, 58, 50 and 79%, respectively, for DCE-US alone and 91, 56, 57 and 90%, respectively, with parametric maps.
The interpretation of DCE-US with parametric maps allows good prediction of biopsy outcome. A two-thirds reduction in biopsy cores seems feasible with only a modest decrease in cancer diagnosis.
探讨动态对比增强（DCE）超声检查（US）及软件生成的参数图在预测活检结果方面的价值，以及它们减少阴性活检样本数量的潜力。
对于651个前列腺活检部位（82例连续患者），我们将有无参数图的DCE-US记录解读结果与活检结果进行了关联分析。参数图由软件生成，该软件从DCE-US记录中提取区分良性和恶性组织的灌注参数。我们进行了严格分析（所有肿瘤）和临床分析（具有临床意义的肿瘤）。我们计算了活检（影像学显示为良性）可能减少的数量以及由此导致的漏诊阳性活检（假阴性）数量。此外，我们在每个前列腺水平上评估了敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV）。
基于DCE-US，仅考虑具有临床意义的肿瘤时，651个活检部位中有470个（72.2%）显示为良性，导致40例假阴性（8.5%）。纳入参数图后，651个活检部位中有411个（63.1%）显示为良性，导致23例假阴性（5.6%）。在每个前列腺的临床分析中，DCE-US将82个前列腺中的38个分类为良性，漏诊8例。纳入参数图后，82个前列腺中有31个显示为良性，漏诊3例。仅DCE-US时，敏感性、特异性、PPV和NPV分别为73%、58%、50%和79%，使用参数图时分别为91%、56%、57%和90%。
结合参数图解读DCE-US能够较好地预测活检结果。活检样本数量减少三分之二似乎可行，同时癌症诊断仅有适度下降。
