Avolio Pier Paolo, Piccolini Andrea, Saitta Cesare, Fasulo Vittorio, Maffei Davide, Moretto Stefano, Cella Ludovica, Beatrici Edoardo, Chiarelli Giuseppe, Paciotti Marco, Saita Alberto, Hurle Rodolfo, Casale Paolo, Buffi Nicolò Maria, Lazzeri Massimo, Lughezzani Giovanni
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Urol Oncol. 2025 Aug;43(8):470.e19-470.e26. doi: 10.1016/j.urolonc.2025.03.012. Epub 2025 Apr 23.
Multiparametric (mp) magnetic resonance imaging (MRI) is essential for prostate cancer (PCa) detection but is limited by availability, cost, and complexity. Micro-ultrasound (microUS) offers real-time, high-resolution imaging and may enhance clinically significant (cs) prostate cancer (PCa) detection when used with mpMRI. This study updates the diagnostic performance of microUS compared to mpMRI in a large prospective cohort.
We prospectively enrolled 1, 423 men with suspected PCa between October 2017 and April 2024. All patients underwent imaging with the ExactVu system, followed by both microUS-targeted and MRI-targeted biopsies. The primary outcome was the accuracy of detecting csPCa, defined as Gleason score ≥3 + 4 (International Society of Urological Pathology Grade Group ≥2), comparing microUS, mpMRI, and their combined use.
CsPCa was diagnosed in 116 (36.3%) patients. MicroUS detected lesions in 1, 076 out of 1, 423 patients (76%) of patients, with a sensitivity of 85% and a negative predictive value of 79% for csPCa. Concordance between microUS and mpMRI findings was 96%. In total, 252 patients (18%) were diagnosed with PCa solely on targeted cores. Among these, 25 csPCa cases were identified exclusively by microUS-targeted and 4 by MRI-targeted biopsies. However, systematic biopsies still identified 22% of csPCa cases missed by both targeted approaches.
MicroUS, especially when combined with mpMRI, significantly enhances csPCa detection. This combined imaging approach may reduce the need for systematic biopsies. Further advancements in microUS technology could refine its diagnostic utility.
多参数（mp）磁共振成像（MRI）对于前列腺癌（PCa）的检测至关重要，但受到可用性、成本和复杂性的限制。微超声（microUS）提供实时、高分辨率成像，与mpMRI联合使用时可能会提高临床显著（cs）前列腺癌（PCa）的检测率。本研究在一个大型前瞻性队列中更新了微超声与mpMRI相比的诊断性能。
我们前瞻性地纳入了2017年10月至2024年4月期间1423名疑似PCa的男性。所有患者均使用ExactVu系统进行成像，随后进行微超声靶向活检和MRI靶向活检。主要结局是检测csPCa的准确性，定义为Gleason评分≥3+4（国际泌尿病理学会分级组≥2），比较微超声、mpMRI及其联合使用的情况。
116名（36.3%）患者被诊断为csPCa。微超声在1423名患者中的1076名（76%）患者中检测到病变，对csPCa的敏感性为85%，阴性预测值为79%。微超声和mpMRI结果之间的一致性为96%。共有252名患者（18%）仅在靶向核心上被诊断为PCa。其中，25例csPCa病例仅通过微超声靶向活检发现，4例通过MRI靶向活检发现。然而，系统活检仍发现两种靶向方法均遗漏了22%的csPCa病例。
微超声，尤其是与mpMRI联合使用时，可显著提高csPCa的检测率。这种联合成像方法可能会减少系统活检的需求。微超声技术的进一步发展可能会提高其诊断效用。
