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Updated: May 10, 2025
Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
Enhanced diagnostic accuracy of micro-ultrasound in prostate cancer detection: An updated series from a single-center
Pier Paolo Avolio1, Andrea Piccolini1, Cesare Saitta1
1Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Introduction:
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.
Materials And Methods:
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.
Results:
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.
Conclusion:
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.
