The benefit of adopting Microultrasound in the prostate cancer imaging pathway: A lesion-by-lesion analysis

Introduction. - Microultrasound (MicroUS) is a novel imaging modality relying on a highfrequency transducer which confers a three-fold improvement in spatial resolution as compared with conventional transrectal ultrasound. We evaluated the diagnostic value of MRI-MicroUS fusion biopsy and determined the additional bene t of employing MicroUS. Methods. - Retrospective analysis of consecutive treatment-naive men undergoing MRI-MicroUS fusion biopsy between May 2018 and March 2019. Pre-biopsy MRI was systematically reviewed in a dedicated meeting where suspicious lesions PIRADS >= 3 were registered and uploaded in the ExactVu MicroUS device. MRI and MicroUS lesions were individually marked in a PIRADS v2 scheme. The biopsy protocol included MRI-MicroUS fusion and MicroUS targeted biopsies; systematic biopsies were performed at clinician's discretion. The diagnostic value was evaluated in terms of detection rate of clinically signi cant prostate cancer, de ned as Gleason pattern >= 4 at histology. Results. - In all, 148 patients with a median age of 69 years (IQR 63-74) and median PSA density of 0.16 ng/ml/cc (0.10-0.23) were included. Clinically signi cant cancer was detected in 42.5% (63/148) patients. MRI detected 89 lesions in the peripheral zone; 73% (65/89) were visible on MicroUS. Clinically signi cant cancer was detected in 46.1% (30/65) MRI and MicroUS visible lesions, and in 4.2% (1/24) lesions only visible on mpMRI. MicroUS additionally identi ed 35 suspicious lesions non-visible on MRI of which clinically signi cant cancer was present in 25.7% (9/35). Conclusion. - Adding MicroUS to the conventional pathway seems to increase the detection rate of clinically signi cant disease in unselected men undergoing biopsy. (C) 2022 Elsevier Masson SAS. All rights reserved.