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Open Access 01-12-2018 | Study protocol

Multiparametric ultrasound: evaluation of greyscale, shear wave elastography and contrast-enhanced ultrasound for prostate cancer detection and localization in correlation to radical prostatectomy specimens

Authors: Christophe K. Mannaerts, Rogier R. Wildeboer, Arnoud W. Postema, Johanna Hagemann, Lars Budäus, Derya Tilki, Massimo Mischi, Hessel Wijkstra, Georg Salomon

Published in: BMC Urology | Issue 1/2018

Abstract

Background

The diagnostic pathway for prostate cancer (PCa) is advancing towards an imaging-driven approach. Multiparametric magnetic resonance imaging, although increasingly used, has not shown sufficient accuracy to replace biopsy for now. The introduction of new ultrasound (US) modalities, such as quantitative contrast-enhanced US (CEUS) and shear wave elastography (SWE), shows promise but is not evidenced by sufficient high quality studies, especially for the combination of different US modalities. The primary objective of this study is to determine the individual and complementary diagnostic performance of greyscale US (GS), SWE, CEUS and their combination, multiparametric ultrasound (mpUS), for the detection and localization of PCa by comparison with corresponding histopathology.

Methods/design

In this prospective clinical trial, US imaging consisting of GS, SWE and CEUS with quantitative mapping on 3 prostate imaging planes (base, mid and apex) will be performed in 50 patients with biopsy-proven PCa before planned radical prostatectomy using a clinical ultrasound scanner. All US imaging will be evaluated by US readers, scoring the four quadrants of each imaging plane for the likelihood of significant PCa based on a 1 to 5 Likert Scale. Following resection, PCa tumour foci will be identified, graded and attributed to the imaging-derived quadrants in each prostate plane for all prostatectomy specimens. Primary outcome measure will be the sensitivity, specificity, negative predictive value and positive predictive value of each US modality and mpUS to detect and localize significant PCa evaluated for different Likert Scale thresholds using receiver operating characteristics curve analyses.

Discussion

In the evaluation of new PCa imaging modalities, a structured comparison with gold standard radical prostatectomy specimens is essential as first step. This trial is the first to combine the most promising ultrasound modalities into mpUS. It complies with the IDEAL stage 2b recommendations and will be an important step towards the evaluation of mpUS as a possible option for accurate detection and localization of PCa.

Trial registration

The study protocol for multiparametric ultrasound was prospectively registered on Clinicaltrials.gov on 14 March 2017 with the registry name ‘Multiparametric Ultrasound-Study for the Detection of Prostate Cancer’ and trial registration number NCT03091231

Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2016;1–12. https://doi.org/10.1016/j.eururo.2016.08.003.CrossRef

Bjurlin MA, Carter HB, Schellhammer P, Cookson MS, Gomella LG, Troyer D, et al. Optimization of initial prostate biopsy in clinical practice: sampling, labeling and specimen processing. J Urol. 2013;189:2039–46.CrossRef

Abraham NE, Mendhiratta N, Taneja SS. Patterns of repeat prostate biopsy in contemporary clinical practice. J Urol. 2015;193:1178–84. https://doi.org/10.1016/j.juro.2014.10.084.CrossRefPubMed

Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, et al. Systematic review of complications of prostate biopsy. Eur Urol. 2013;64:876–92. https://doi.org/10.1016/j.eururo.2013.05.049.CrossRefPubMed

Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MGM. Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate Cancer detection compared to standard Transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol. 2015;68:438–50.CrossRef

Moldovan PC, Van den Broeck T, Sylvester R, Marconi L, Bellmunt J, van den Bergh RCN, et al. What is the negative predictive value of multiparametric magnetic resonance imaging in excluding prostate Cancer at biopsy? A Systematic Review and Meta-analysis from the European Association of Urology Prostate Cancer Guidelines Panel. Eur Urol. 2017;72:250–66.CrossRef

Mertan FV, Greer MD, Shih JH, George AK, Kongnyuy M, Muthigi A, et al. Prospective evaluation of the prostate imaging reporting and data system version 2 for prostate Cancer detection. J Urol. 2016;196:690–6. https://doi.org/10.1016/j.juro.2016.04.057.CrossRefPubMed

Muller BG, Shih JH, Sankineni S, Marko J, Rais-Bahrami S, George A, et al. Prostate Cancer: Interobserver Agreement and Accuracy with the Revised Prostate Imaging Reporting and Data System at Multiparametric MR Imaging. Radiology. 2015;277 May 2016:142818.CrossRef

Zhao C, Gao G, Fang D, Li F, Yang X, Wang H, et al. The efficiency of multiparametric magnetic resonance imaging (mpMRI) using PI-RADS version 2 in the diagnosis of clinically significant prostate cancer. Clin Imaging. 2016;40:885–8. https://doi.org/10.1016/j.clinimag.2016.04.010.CrossRefPubMed

10.

Brock M, Eggert T, Palisaar RJ, Roghmann F, Braun K, Löppenberg B, et al. Multiparametric ultrasound of the prostate: adding contrast enhanced ultrasound to real-time elastography to detect histopathologically confirmed cancer. J Urol. 2013;189:93–8. https://doi.org/10.1016/j.juro.2012.08.183.CrossRefPubMed

11.

Grey A, Scott R, Charman S, Der J Van, Frinking P, Acher P, et al. The CADMUS trial – Multi-parametric ultrasound targeted biopsies compared to multi-parametric MRI targeted biopsies in the diagnosis of clinically significant prostate cancer. Contemp Clin Trials. 2017. https://doi.org/10.1016/J.CCT.2017.10.011.CrossRef

12.

Postema A, Mischi M, de la Rosette J, Wijkstra H. Multiparametric ultrasound in the detection of prostate cancer: a systematic review. World J Urol. 2015;33:1651–9. https://doi.org/10.1007/s00345-015-1523-6.CrossRefPubMedPubMedCentral

13.

Smeenge M, de la Rosette JJMCH, Wijkstra H. Current status of transrectal ultrasound techniques in prostate cancer. Curr Opin Urol. 2012;22:297–302. https://doi.org/10.1097/MOU.0b013e3283548154.CrossRefPubMed

14.

Postema AW, Frinking PJA, Smeenge M, De Reijke TM, De La Rosette JJMCH, Tranquart F, et al. Dynamic contrast-enhanced ultrasound parametric imaging for the detection of prostate cancer. BJU Int. 2016;117:598–603.CrossRef

15.

Boehm K, Salomon G, Beyer B, Schiffmann J, Simonis K, Graefen M, et al. Shear wave elastography for localization of prostate cancer lesions and assessment of elasticity thresholds: implications for targeted biopsies and active surveillance protocols. J Urol. 2015;193:794–800. https://doi.org/10.1016/j.juro.2014.09.100.CrossRefPubMed

16.

Russo G, Mischi M, Scheepens W, De La Rosette JJ, Wijkstra H. Angiogenesis in prostate cancer: Onset, progression and imaging. BJU Int. 2012;110 11 C:794–808.CrossRef

17.

Van Hove A, Henri P, Maurin C, Brunelle S, Gravis G, Salem N, et al. Comparison of image - guided targeted biopsies versus systematic randomized biopsies in the detection of prostate cancer: a systematic literature review of well - designed studies. World J Urol. 2014;32:847–58.CrossRef

18.

Carmeliet P, Jain RK. Angiogenesis in cancer and other diseases. Nature. 2000;407:249–57.CrossRef

19.

Wildeboer RR, Postema AW, Demi L, Kuenen MPJ, Wijkstra H, Mischi M. Multiparametric dynamic contrast-enhanced ultrasound imaging of prostate cancer. Eur Radiol. 2017;27:3226–34. https://doi.org/10.1007/s00330-016-4693-8.CrossRefPubMed

20.

Good DW, Stewart GD, Hammer S, Scanlan P, Shu W, Phipps S, et al. Elasticity as a biomarker for prostate cancer: a systematic review. BJU Int. 2014;113:523–34.CrossRef

21.

Cosgrove D, Barr R, Bojunga J, Cantisani V, Chammas MC, Dighe M, et al. WFUMB guidelines and recommendations on the clinical use of ultrasound Elastography: part 4. Thyroid. Ultrasound Med Biol. 2017;43:4–26. https://doi.org/10.1016/j.ultrasmedbio.2016.06.022.CrossRefPubMed

22.

Boehm K, Budeaus L, Tennstedt P, Beyer B, Schiffmann J, Larcher A, et al. Prediction of significant prostate Cancer at prostate biopsy and per Core detection rate of targeted and systematic biopsies using real-time shear wave Elastography. Urol Int. 2015;95:189–96.CrossRef

23.

Barr RG, Memo R, Schaub CR. Shear wave ultrasound Elastography of the prostate. Ultrasound Q. 2012;28:13–20. https://doi.org/10.1097/RUQ.0b013e318249f594.CrossRefPubMed

24.

Nelson ED, Slotoroff CB, Gomella LG, Halpern EJ. Targeted biopsy of the prostate: the impact of color Doppler imaging and Elastography on prostate Cancer detection and Gleason score. Urology. 2007;70:1136–40.CrossRef

25.

Wildeboer RR, Schalk SG, Demi L, Wijkstra H, Mischi M. Three-dimensional histopathological reconstruction as a reliable ground truth for prostate cancer studies. Biomed Phys Eng Express. 2017;3.CrossRef

26.

Schalk SG, Postema A, Saidov TA, Demi L, Smeenge M, De JJMCH, et al. 3D surface-based registration of ultrasound and histology in prostate cancer imaging. Comput Med Imaging Graph. 2016;47:29–39. https://doi.org/10.1016/j.compmedimag.2015.11.001.CrossRefPubMed

27.

McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, et al. No surgical innovation without evaluation: the IDEAL recommendations. Lancet. 2009;374:1105–12.CrossRef

28.

Kuenen MPJ, Saidov TA, Wijkstra H, Mischi M. Contrast-ultrasound dispersion imaging for prostate cancer localization by improved spatiotemporal similarity analysis. Ultrasound Med Biol. 2013;39:1631–41.CrossRef

29.

Kuenen MP, Mischi M, Wijkstra H. Contrast-ultrasound diffusion imaging for localization of prostate cancer. IEEE Trans Med Imaging. 2011;30:1493–502.CrossRef

30.

Kuenen MP, Saidov TA, Wijkstra H, de la Rosette JJ, Mischi M. Spatiotemporal correlation of ultrasound contrast agent dilution curves for angiogenesis localization by dispersion imaging. IEEE Trans Ultrason Ferroelectr Freq Control. 2013;60:2665–9.CrossRef

31.

van Sloun RJ, Demi L, Postema AW, de la Rosette JJ, Wijkstra H, Mischi M. Ultrasound-contrast-agent dispersion and velocity imaging for prostate cancer localization. Med Image Anal. 2017;35:610–9.CrossRef

32.

Van Sloun RJ, Demi L, Postema AW, Jmch De La Rosette J, Wijkstra H, Mischi M. Entropy of Ultrasound-Contrast-Agent Velocity Fields for Angiogenesis Imaging in Prostate Cancer. IEEE Trans Med Imaging. 2017;36:826–37.CrossRef

33.

Schlomm T, Tennstedt P, Huxhold C, Steuber T, Salomon G, Michl U, et al. Neurovascular structure-adjacent frozen-section examination (NeuroSAFE) increases nerve-sparing frequency and reduces positive surgical margins in open and robot-assisted laparoscopic radical prostatectomy: experience after 11 069 consecutive patients. Eur Urol. 2012;62:333–40.CrossRef

34.

Schalk S, Demi L, Bouhouch N, Kuenen M, Postema A, de la Rosette J, et al. Contrast-enhanced ultrasound angiogenesis imaging by mutual information analysis for prostate Cancer localization. IEEE Trans Biomed Eng. 2016;9294(c):1–1.

35.

Turkbey B, Mani H, Shah V, Rastinehad AR, Bernardo M, Pohida T, et al. Multiparametric 3T prostate magnetic resonance imaging to detect cancer: histopathological correlation using prostatectomy specimens processed in customized magnetic resonance imaging based molds. J Urol. 2011;186:1818–24.CrossRef

36.

Hoeks CCM A, Barentsz JJO, Hambrock T, Yakar D, Somford DM, Heijmink SWTPJ, et al. Prostate cancer: multiparametric MR imaging for detection, localization, and staging. Radiology 2011;261:46–66. https://doi.org/10.1148/radiol.11091822.CrossRef

37.

Isebaert S, Van Den Bergh L, Haustermans K, Joniau S, Lerut E, De Wever L, et al. Multiparametric MRI for prostate cancer localization in correlation to whole-mount histopathology. J Magn Reson Imaging. 2013;37:1392–401.CrossRef

38.

Bokor D, Chambers JB, Rees PJ, Mant TG, Luzzani F, Spinazzi A. Clinical safety of SonoVue™, a new contrast agent for ultrasound imaging, in healthy volunteers and in patients with chronic obstructive pulmonary disease. Investig Radiol. 2001;36:104–9.CrossRef

39.

Tang C, Fang K, Guo Y, Li R, Fan X, Chen P, et al. Safety of sulfur hexafluoride microbubbles in sonography of abdominal and superficial organs: retrospective analysis of 30,222 cases. J Ultrasound Med. 2017;36:531–8. https://doi.org/10.7863/ultra.15.11075.CrossRefPubMed

40.

Piscaglia F, Bolondi L, Aiani L, Luigi Angeli M, Arienti V, Barozzi L, et al. The safety of Sonovue® in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol. 2006;32:1369–75.CrossRef

41.

Mai Z, Xiao Y, Yan W, Zhou Y, Zhou Z, Liang Z, et al. Comparison of lesions detected and undetected by template-guided transperineal saturation prostate biopsy. BJU Int. 2017. https://doi.org/10.1111/bju.13977.CrossRef

42.

Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. Pi-Rads v2. Am Coll Radiol. 2015.

43.

Wildeboer RR, van Sloun RJG, Postema AW, Mannaerts CK, Gayet M, Beerlage HP, et al. Accurate validation of ultrasound imaging of prostate cancer: a review of challenges in registration of imaging and histopathology. J Ultrasound. 2018;21:197–207. https://doi.org/10.1007/s40477-018-0311-8.CrossRefPubMedPubMedCentral

44.

Isebaert S, Bergh L Van Den, Haustermans K, Joniau S, Lerut E, Wever L De, et al. Multiparametric MRI for Prostate Cancer Localization in Correlation to Whole-Mount Histopathology 2012;0:1–10.

45.

Turkbey B, Pinto PA, Mani H, Bernardo M, Pang Y, McKinney YL, et al. Prostate cancer: value of multiparametric MR imaging at 3 T for detection--histopathologic correlation. Radiology. 2010;255:89–99. https://doi.org/10.1148/radiol.09090475.CrossRefPubMedPubMedCentral

46.

Greer MD, Brown AM, Shih JH, Summers RM, Marko J, Law YM, et al. Accuracy and agreement of PIRADSv2 for prostate cancer mpMRI: a multireader study. J Magn Reson Imaging. 2017;45:579–85.CrossRef

47.

Mulazzani L, Salvatore V, Ravaioli F, Allegretti G, Matassoni F, Granata R, et al. Point shear wave ultrasound elastography with Esaote compared to real-time 2D shear wave elastography with supersonic imagine for the quantification of liver stiffness. J Ultrasound. 2017;21(20):213–25.CrossRef

48.

Postema AW, Scheltema MJV, Mannaerts CK, Van Sloun RJG, Idzenga T, Mischi M, et al. The prostate cancer detection rates of CEUS-targeted versus MRI-targeted versus systematic TRUS-guided biopsies in biopsy-naïve men: a prospective, comparative clinical trial using the same patients. BMC Urol. 2017;17(1):27. https://doi.org/10.1186/s12894-017-0213-7.

Title: Multiparametric ultrasound: evaluation of greyscale, shear wave elastography and contrast-enhanced ultrasound for prostate cancer detection and localization in correlation to radical prostatectomy specimens
Authors: Christophe K. Mannaerts
Rogier R. Wildeboer
Arnoud W. Postema
Johanna Hagemann
Lars Budäus
Derya Tilki
Massimo Mischi
Hessel Wijkstra
Georg Salomon
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Urology / Issue 1/2018
Electronic ISSN: 1471-2490
DOI: https://doi.org/10.1186/s12894-018-0409-5

ACC 2024 Congress

Springer Medicine

Multiparametric ultrasound: evaluation of greyscale, shear wave elastography and contrast-enhanced ultrasound for prostate cancer detection and localization in correlation to radical prostatectomy specimens

Abstract

Background

Methods/design

Discussion

Trial registration

ACC 2024 Congress

Springer Medicine

Abstract

Background

Methods/design

Discussion

Trial registration

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