Top

Published in:

01-04-2006 | Urogenital

A comparison of the diagnostic performance of systematic versus ultrasound-guided biopsies of prostate cancer

Authors: Stijn W. T. P. J. Heijmink, Hilco van Moerkerk, Lambertus A. L. M. Kiemeney, J. Alfred Witjes, Ferdinand Frauscher, Jelle O. Barentsz

Published in: European Radiology | Issue 4/2006

Abstract

Transrectal ultrasound (TRUS) is an important tool for urologists and radiologists in the detection of prostate cancer. Various TRUS-guided biopsy techniques are applied in clinical practice. Frequently, only the detection rates achieved with these methods are compared. Other diagnostic performance parameters, particularly the specificity and negative predictive value, are seldom compared. After extensive assessment of the available literature, this review describes the methods of TRUS-guided biopsy for prostate cancer detection. A distinction was made between systematic biopsies and biopsies that target a perceived (hypoechoic or Doppler-enhancing) lesion on imaging. Subsequently, the diagnostic performance (sensitivity, specificity, positive and negative predictive values, accuracies) was compared between these techniques. Imaging-guided biopsy showed better diagnostic performance than systematic biopsy with higher sensitivity. The combinations of sensitivity and specificity were highest for colour Doppler and contrast-enhanced targeted biopsy. Studies targeting hypoechoic lesions had relatively high sensitivity, but specificity was low. Presently however, with widespread prostate-specific antigen screening, fewer prostate cancers are hypoechoic, and the value of targeting hypoechoic lesions has diminished. Performing colour or contrast-enhanced Doppler biopsy or adding these techniques to systematic biopsies improves diagnostic performance, particularly by increasing sensitivity.

Jemal A, Murray T, Ward E et al (2005) Cancer statistics, 2005. CA Cancer J Clin 55:10–30CrossRefPubMed

Quinn M, Babb P (2002) Patterns and trends in prostate cancer incidence, survival, prevalence and mortality. Part II: individual countries. BJU Int 90:174–184PubMed

Quinn M, Babb P (2002) Patterns and trends in prostate cancer incidence, survival, prevalence and mortality. Part I: international comparisons. BJU Int 90:162–173PubMed

Crawford ED (2003) Epidemiology of prostate cancer. Urology 62:3–12PubMed

Gronberg H (2003) Prostate cancer epidemiology. Lancet 361:859–864PubMed

Levi F, Lucchini F, Negri E, Boyle P, La Vecchia C (2003) Mortality from major cancer sites in the European Union, 1955–1998. Ann Oncol 14:490–495PubMed

Stewart SL, King JB, Thompson TD, Friedman C, Wingo PA (2004) Cancer mortality surveillance—United States, 1990–2000. MMWR Surveill Summ 53:1–108PubMed

Jemal A, Tiwari RC, Murray T et al (2004) Cancer statistics, 2004. CA Cancer J Clin 54:8–29PubMed

Augustin H, Hammerer PG, Graefen M et al (2003) Insignificant prostate cancer in radical prostatectomy specimen: time trends and preoperative prediction. Eur Urol 43:455–460PubMed

10.

Watanabe H, Kato H, Kato T, Morita M, Tanaka M (1968) Diagnostic application of ultrasonotomography to the prostate. Nippon Hinyokika Gakkai Zasshi 59:273–279PubMed

11.

Watanabe H (1989) History and applications of transrectal sonography of the prostate. Urol Clin North Am 16:617–622PubMed

12.

Hernandez J, Thompson IM (2004) Prostate-specific antigen: a review of the validation of the most commonly used cancer biomarker. Cancer 101:894–904PubMed

13.

Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM (2003) The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 56:1129–1135PubMed

14.

Langlotz CP (2003) Fundamental measures of diagnostic examination performance: usefulness for clinical decision making and research. Radiology 228:3–9PubMed

15.

Strohmeyer D, Rossing C, Strauss F, Bauerfeind A, Kaufmann O, Loening S (2000) Tumor angiogenesis is associated with progression after radical prostatectomy in pT2/pT3 prostate cancer. Prostate 42:26–33PubMed

16.

Dahnert WF, Hamper UM, Eggleston JC, Walsh PC, Sanders RC (1986) Prostatic evaluation by transrectal sonography with histopathologic correlation: the echopenic appearance of early carcinoma. Radiology 158:97–102PubMed

17.

Salo JO, Rannikko S, Makinen J, Lehtonen T (1987) Echogenic structure of prostatic cancer imaged on radical prostatectomy specimens. Prostate 10:1–9PubMed

18.

Frauscher F, Klauser A, Berger AP et al (2003) The value of ultrasound (US) in the diagnosis of prostate cancer. Radiologe 43:455–463PubMed

19.

Onur R, Littrup PJ, Pontes JE, Bianco FJ Jr (2004) Contemporary impact of transrectal ultrasound lesions for prostate cancer detection. J Urol 172:512–514PubMed

20.

Hodge KK, McNeal JE, Terris MK, Stamey TA (1989) Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 142:71–74PubMed

21.

Taylor JA, III, Gancarczyk KJ, Fant GV, McLeod DG (2002) Increasing the number of core samples taken at prostate needle biopsy enhances the detection of clinically significant prostate cancer. Urology 60:841–845PubMed

22.

Eskicorapci SY, Baydar DE, Akbal C et al (2004) An extended 10-core transrectal ultrasonography guided prostate biopsy protocol improves the detection of prostate cancer. Eur Urol 45:444–448PubMed

23.

Singh H, Canto EI, Shariat SF et al (2004) Improved detection of clinically significant, curable prostate cancer with systematic 12-core biopsy. J Urol 171:1089–1092PubMed

24.

Mariappan P, Chong WL, Sundram M, Mohamed SR (2004) Increasing prostate biopsy cores based on volume vs the sextant biopsy: a prospective randomized controlled clinical study on cancer detection rates and morbidity. BJU Int 94:307–310PubMed

25.

Matlaga BR, Eskew LA, McCullough DL (2003) Prostate biopsy: indications and technique. J Urol 169:12–19PubMed

26.

Presti JC Jr (2003) Prostate biopsy: how many cores are enough? Urol Oncol 21:135–140PubMed

27.

Fink KG, Hutarew G, Pytel A et al (2003) One 10-core prostate biopsy is superior to two sets of sextant prostate biopsies. BJU Int 92:385–388PubMed

28.

Gore JL, Shariat SF, Miles BJ et al (2001) Optimal combinations of systematic sextant and laterally directed biopsies for the detection of prostate cancer. J Urol 165:1554–1559PubMed

29.

Naya Y, Ochiai A, Troncoso P, Babaian RJ (2004) A comparison of extended biopsy and sextant biopsy schemes for predicting the pathological stage of prostate cancer. J Urol 171:2203–2208PubMed

30.

Ravery V, Billebaud T, Toublanc M et al (1999) Diagnostic value of ten systematic TRUS-guided prostate biopsies. Eur Urol 35:298–303PubMed

31.

Babaian RJ, Toi A, Kamoi K et al (2000) A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol 163:152–157PubMed

32.

Naughton CK, Miller DC, Mager DE, Ornstein DK, Catalona WJ (2000) A prospective randomized trial comparing 6 versus 12 prostate biopsy cores: impact on cancer detection. J Urol 164:388–392PubMed

33.

Chan TY, Chan DY, Stutzman KL, Epstein JI (2001) Does increased needle biopsy sampling of the prostate detect a higher number of potentially insignificant tumors? J Urol 166:2181–2184PubMed

34.

O’Connell MJ, Smith CS, Fitzpatrick PE et al (2004) Transrectal ultrasound-guided biopsy of the prostate gland: value of 12 versus 6 cores. Abdom Imaging 29:132–136PubMed

35.

Bigler SA, Deering RE, Brawer MK (1993) Comparison of microscopic vascularity in benign and malignant prostate tissue. Hum Pathol 24:220–226PubMed

36.

Neumaier CE, Martinoli C, Derchi LE, Silvestri E, Rosenberg I (1995) Normal prostate gland: examination with color Doppler US. Radiology 196:453–457PubMed

37.

Wilson NM, Masoud AM, Barsoum HB, Refaat MM, Moustafa MI, Kamal TA (2004) Correlation of power Doppler with microvessel density in assessing prostate needle biopsy. Clin Radiol 59:946–950PubMed

38.

Ismail M, Petersen RO, Alexander AA, Newschaffer C, Gomella LG (1997) Color Doppler imaging in predicting the biologic behavior of prostate cancer: correlation with disease-free survival. Urology 50:906–912PubMed

39.

Erbersdobler A, Fritz H, Schnoger S et al (2002) Tumour grade, proliferation, apoptosis, microvessel density, p53, and bcl-2 in prostate cancers: differences between tumours located in the transition zone and in the peripheral zone. Eur Urol 41:40–46PubMed

40.

Bostwick DG, Iczkowski KA (1998) Microvessel density in prostate cancer: prognostic and therapeutic utility. Semin Urol Oncol 16:118–123PubMed

41.

Rubin JM, Adler RS (1993) Power Doppler expands standard color capability. Diagn Imaging (San Franc) 15:66–69

42.

Leventis AK, Shariat SF, Utsunomiya T, Slawin KM (2001) Characteristics of normal prostate vascular anatomy as displayed by power Doppler. Prostate 46:281–288PubMed

43.

Sauvain JL, Palascak P, Bourscheid D et al (2003) Value of power Doppler and 3D vascular sonography as a method for diagnosis and staging of prostate cancer. Eur Urol 44:21–30PubMed

44.

Roy C, Buy X, Lang H, Saussine C, Jacqmin D (2003) Contrast enhanced color Doppler endorectal sonography of prostate: efficiency for detecting peripheral zone tumors and role for biopsy procedure. J Urol 170:69–72PubMed

45.

Kuligowska E, Barish MA, Fenlon HM, Blake M (2001) Predictors of prostate carcinoma: accuracy of gray-scale and color Doppler US and serum markers. Radiology 220:757–764PubMed

46.

Halpern EJ, Frauscher F, Strup SE, Nazarian LN, O’Kane P, Gomella LG (2002) Prostate: high-frequency Doppler US imaging for cancer detection. Radiology 225:71–77PubMed

47.

Rifkin MD, Alexander AA, Helinek TG, Merton DA (1991) Color Doppler as an adjunct to prostate ultrasound. Scand J Urol Nephrol Suppl 137:85–89PubMed

48.

Jakobsen JA, Correas JM (2001) Ultrasound contrast agents and their use in urogenital radiology: status and prospects. Eur Radiol 11:2082–2091PubMed

49.

Cosgrove D (2004) The advances are significant improvements in both the microbubbles used as contrast agents and in the software that allows their selective detection. Eur Radiol 14 Suppl 8:1–3

50.

Abbott JG (1999) Rationale and derivation of MI and TI-a review. Ultrasound Med Biol 25:431–441PubMedMathSciNet

51.

Delorme S, Peschke P, Zuna I, van Kaick G (1999) Sensitivity of color Doppler sonography: an experimental approach. Ultrasound Med Biol 25:541–547PubMed

52.

Terris MK (1999) Sensitivity and specificity of sextant biopsies in the detection of prostate cancer: preliminary report. Urology 54:486–489PubMed

53.

Flanigan RC, Catalona WJ, Richie JP et al (1994) Accuracy of digital rectal examination and transrectal ultrasonography in localizing prostate cancer. J Urol 152:1506–1509PubMed

54.

Hammerer P, Huland H (1994) Systematic sextant biopsies in 651 patients referred for prostate evaluation. J Urol 151:99–102PubMed

55.

Newman JS, Bree RL, Rubin JM (1995) Prostate cancer: diagnosis with color Doppler sonography with histologic correlation of each biopsy site. Radiology 195:86–90PubMed

56.

Slonim SM, Cuttino JT Jr, Johnson CJ et al (1993) Diagnosis of prostatic carcinoma: value of random transrectal sonographically guided biopsies. Am J Roentgenol 161:1003–1006

57.

Ellis WJ, Chetner MP, Preston SD, Brawer MK (1994) Diagnosis of prostatic carcinoma: the yield of serum prostate specific antigen, digital rectal examination and transrectal ultrasonography. J Urol 152:1520–1525PubMed

58.

Cornud F, Belin X, Piron D et al (1997) Color Doppler-guided prostate biopsies in 591 patients with an elevated serum PSA level: impact on Gleason score for nonpalpable lesions. Urology 49:709–715PubMed

59.

Halpern EJ, Rosenberg M, Gomella LG (2001) Prostate cancer: contrast-enhanced US for detection. Radiology 219:219–225PubMed

60.

Halpern EJ, Frauscher F, Rosenberg M, Gomella LG (2002) Directed biopsy during contrast-enhanced sonography of the prostate. Am J Roentgenol 178:915–919

61.

Smith RA, Cokkinides V, Eyre HJ (2005) American Cancer Society guidelines for the early detection of cancer. CA Cancer J Clin 55:31–44PubMed

62.

Littrup PJ, Bailey SE (2000) Prostate cancer: the role of transrectal ultrasound and its impact on cancer detection and management. Radiol Clin North Am 38:87–113PubMed

63.

Halpern EJ, Strup SE (2000) Using gray-scale and color and power Doppler sonography to detect prostatic cancer. Am J Roentgenol 174:623–627

64.

Browne JE, Watson AJ, Hoskins PR, Elliott AT (2004) Validation of a sensitivity performance index test protocol and evaluation of colour Doppler sensitivity for a range of ultrasound scanners. Ultrasound Med Biol 30:1475–1483PubMed

65.

Kravchick S, Cytron S, Peled R, Altshuler A, Ben Dor D (2003) Using gray-scale and two different techniques of color Doppler sonography to detect prostate cancer. Urology 61:977–981PubMed

66.

Goossen T, Wijkstra H (2003) Transrectal ultrasound imaging and prostate cancer. Arch Ital Urol Androl 75:68–74PubMed

67.

Okihara K, Miki T, Joseph BR (2002) Clinical efficacy of prostate cancer detection using power Doppler imaging in American and Japanese men. J Clin Ultrasound 30:213–221PubMed

68.

Halpern EJ, Frauscher F, Forsberg F et al (2002) High-frequency Doppler US of the prostate: effect of patient position. Radiology 222:634–639PubMed

69.

Aarnink RG, Beerlage HP, de la Rosette JJ, Debruyne FM, Wijkstra H (1998) Transrectal ultrasound of the prostate: innovations and future applications. J Urol 159:1568–1579PubMed

70.

Rifkin MD, Sudakoff GS, Alexander AA (1993) Prostate: techniques, results, and potential applications of color Doppler US scanning. Radiology 186:509–513PubMed

71.

Lavoipierre AM, Snow RM, Frydenberg M et al (1998) Prostatic cancer: role of color Doppler imaging in transrectal sonography. Am J Roentgenol 171:205–210

72.

Remzi M, Dobrovits M, Reissigl A et al (2004) Can power Doppler enhanced transrectal ultrasound guided biopsy improve prostate cancer detection on first and repeat prostate biopsy? Eur Urol 46:451–456PubMed

73.

Bogers HA, Sedelaar JP, Beerlage HP et al (1999) Contrast-enhanced three-dimensional power Doppler angiography of the human prostate: correlation with biopsy outcome. Urology 54:97–104PubMed

74.

Frauscher F, Klauser A, Volgger H et al (2002) Comparison of contrast enhanced color Doppler targeted biopsy with conventional systematic biopsy: impact on prostate cancer detection. J Urol 167:1648–1652PubMed

75.

Pelzer A, Bektic J, Berger AP et al (2005) Prostate cancer detection in men with prostate specific antigen 4 to 10 ng/ml using a combined approach of contrast enhanced color Doppler targeted and systematic biopsy. J Urol 173:1926–1929PubMed

76.

Ragde H, Kenny GM, Murphy GP, Landin K (1997) Transrectal ultrasound microbubble contrast angiography of the prostate. Prostate 32:279–283PubMed

77.

Loughlin M, Carlbom I, Busch C et al (1998) Three-dimensional modeling of biopsy protocols for localized prostate cancer. Comput Med Imaging Graph 22:229–238PubMed

78.

Egevad L, Frimmel H, Mattson S, Bengtsson E, Busch C (1999) Biopsy protocol stability in a three-dimensional model of prostate cancer: changes in cancer yield after adjustment of biopsy positions. Urology 54:862–868PubMed

79.

Egevad L, Frimmel H, Norberg M et al (1999) Three-dimensional computer reconstruction of prostate cancer from radical prostatectomy specimens: evaluation of the model by core biopsy simulation. Urology 53:192–198PubMed

80.

Burns PN (1996) Harmonic imaging with ultrasound contrast agents. Clin Radiol 51(Suppl 1):50–55PubMed

81.

Burns PN, Hope SD, Averkiou MA (2000) Nonlinear imaging. Ultrasound Med Biol 26(Suppl 1):S19–S22PubMed

82.

Halpern EJ, McCue PA, Aksnes AK, Hagen EK, Frauscher F, Gomella LG (2002) Contrast-enhanced US of the prostate with Sonazoid: comparison with whole-mount prostatectomy specimens in 12 patients. Radiology 222:361–366PubMed

83.

Zangos S, Eichler K, Engelmann K et al (2005) MR-guided transgluteal biopsies with an open low-field system in patients with clinically suspected prostate cancer: technique and preliminary results. Eur Radiol 15:174–182PubMed

84.

Beyersdorff D, Winkel A, Hamm B, Lenk S, Loening SA, Taupitz M (2005) MR imaging-guided prostate biopsy with a closed MR unit at 1.5 T: initial results. Radiology 234:576–581PubMed

85.

Salomon L, Colombel M, Patard JJ et al (1999) Value of ultrasound-guided systematic sextant biopsies in prostate tumor mapping. Eur Urol 35:289–293PubMed

86.

Wefer J, Hricak H, Vigneron DB et al (2000) Sextant localization of prostate cancer: comparison of sextant biopsy, magnetic resonance imaging and magnetic resonance spectroscopic imaging with step section histology. J Urol 164:400–404PubMed

87.

Kelly IM, Lees WR, Richards D (1993) Prostate cancer and the role of color Doppler US. Radiology 189:153–156

88.

Norberg M, Egevad L, Holmberg L, Sparen P, Norlen BJ, Busch C (1997) The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer. Urology 50:562–566PubMed

89.

Patel U, Rickards D (1994) The diagnostic value of colour Doppler flow in the peripheral zone of the prostate, with histological correlation. Br J Urol 74:590–595PubMed

90.

Ito H, Kamoi K, Yokoyama K, Yamada K, Nishimura T (2003) Visualization of prostate cancer using dynamic contrast-enhanced MRI: comparison with transrectal power Doppler ultrasound. Br J Radiol 76:617–624PubMed

91.

Inahara M, Suzuki H, Nakamachi H et al (2004) Clinical evaluation of transrectal power Doppler imaging in the detection of prostate cancer. Int Urol Nephrol 36:175–180PubMed

Title: A comparison of the diagnostic performance of systematic versus ultrasound-guided biopsies of prostate cancer
Authors: Stijn W. T. P. J. Heijmink
Hilco van Moerkerk
Lambertus A. L. M. Kiemeney
J. Alfred Witjes
Ferdinand Frauscher
Jelle O. Barentsz
Publication date: 01-04-2006
Publisher: Springer-Verlag
Published in: European Radiology / Issue 4/2006
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-005-0035-y

At a glance: The STEP trials

Springer Medicine

A comparison of the diagnostic performance of systematic versus ultrasound-guided biopsies of prostate cancer

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2006

Unknown internal carotid artery atherosclerotic stenoses detected with biphasic multidetector computed tomography for head and neck cancer

A young female patient with vague abdominal pain (2006: 4a)

FLAIR imaging for multiple sclerosis: a comparative MR study at 1.5 and 3.0 Tesla

ESSR 2006 Congress

Relationships between brain water content and diffusion tensor imaging parameters (apparent diffusion coefficient and fractional anisotropy) in multiple sclerosis

Scarred myocardium imposes additional burden on remote viable myocardium despite a reduction in the extent of area with late contrast MR enhancement