(Ultrasound Review) Directed biopsy during contrast-enhanced sonography of the prostate improves the sonographic detection of malignant foci in the prostate. Radiologists and urologists from Thomas Jefferson University in Philadelphia proved this in a study reported in the American Journal of Roentgenology.
According to the authors, both grayscale imaging and color Doppler have proven inadequate in differentiating benign from malignant lesions. "Isoechoic cancers are found in up to 32% of patients with prostate cancer," they said.
They studied 60 men in order to determine whether "supplemental targeted biopsies using contrast-enhanced harmonic grayscale imaging of the prostate" would improve positive diagnostic yield. Endorectal prostate imaging was performed before ultrasound contrast administration, after continuous contrast infusion and following bolus injection of contrast agent. They used a recently developed contrast agent that consists of liposome encapsulated perfluoropropane microbubbles (Definity, Bristol-Myers Squibb Medical Imaging, North Billerica, MA).
Endorectal ultrasound imaging was performed in transverse and longitudinal using a 6.5 MHz transducer. Precontrast imaging used the fundamental frequency, and scans after contrast administration used wideband harmonic pulse inversion imaging optimized for contrast imaging. An intermittent scanning mode and low mechanical index were used to reduce bubble destruction and lengthen the time the contrast agent was visible.
"Pathology results revealed malignant foci in 30 biopsy sites in 16 of the patients (40%)," they reported. Precontrast imaging showed a sensitivity of 33% and a specificity of 79% for demonstrating cancer. Postcontrast using infusion showed a sensitivity of 40% and a specificity of 81%. The odds ratio for finding cancer went from 2.3 for grayscale to 3.5 for localization of a cancer during contrast enhancement using an infusion method. There was no significant difference in cancer detection between contrast infusion and bolus administration.
They also reported that "a suspicious site evaluated with two cores was five times more likely to have positive biopsy findings than a standard sextant site." Overall 14% of biopsy specimens showed prostatitis, and prostatitis was the cause of false positive findings in 17.6% of cases postcontrast. The authors concluded, "the performance of multiple biopsies of suspicious enhancing foci significantly improves the detection of cancer."
"Directed biopsy during contrast-enhanced sonography of the prostate"E Halpern et al
Department of radiology, Jefferson Prostate Diagnostic Center, Thomas Jefferson University, Philadelphia, PA
AJR 2002 May; 178:915-919
By Ultrasound Review
June 27, 2002
Copyright © 2002 AuntMinnie.com
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![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
