2032 COLOUR DOPPLER COMBINED WITH MICROBUBBLE CONTRAST AGENT ULTRASONOGRAPHY AND THE CANCER DETECTION RATE IN TRANSRECTAL SYSTEMATIC PROSTATE BIOPSY SAMPLING

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THE JOURNAL OF UROLOGY姞

Vol. 187, No. 4S, Supplement, Wednesday, May 23, 2012

2033 EXTERNAL VALIDATION OF THE ANNA/C-TRUS SYSTEM REGARDING THE CORRECT IDENTIFICATION OF PROSTATE CANCER LESIONS IN THE DIAGNOSIS OF PROSTATE CANCER Jochen Walz*, Jeanne Thomassin-Piana, Flora Poizat, Serge Brunelle, Naji Salem, Gwenaelle Gravis, Marseille, France

Source of Funding: Canadian Institute for Health Research, Prostate Cancer Research Foundation of Cancer, Ontario Institute for Cancer Research

2032 COLOUR DOPPLER COMBINED WITH MICROBUBBLE CONTRAST AGENT ULTRASONOGRAPHY AND THE CANCER DETECTION RATE IN TRANSRECTAL SYSTEMATIC PROSTATE BIOPSY SAMPLING Gianluigi Taverna*, Guido Giusti, Mauro Seveso, Alessio Benetti, Francesco Minuti, Fabio Grizzi, Pierpaolo Graziotti, Rozzano, Milan, Italy INTRODUCTION AND OBJECTIVES: Prostate cancer (PC) represents the fifth most frequent cancer in the World. Despite many prognostic factors have been proposed, a truthful index for predicting the outcome of patients with PC still remains unidentified. Here we compare PC detection rate employing color Doppler ultrasonography with or without SonoVue(TM) contrast agent with transrectal ultrasonography-guided systematic biopsy sampling. METHODS: A total of 300 patients with negative digital rectal examination and transrectal grey-scale ultrasonography, with prostate specific antigen (PSA) values ranging between 2.5 and 9.9 ng/mL, were randomized into three groups: 100 patients (group A) underwent transrectal ultrasonography-guided systematic bioptic sampling; 100 patients (group B) underwent color Doppler ultrasonography, and 100 patients (group C) underwent color Doppler ultrasonography before and during the injection of SonoVue(TM). Contrast-enhanced targeted biopsies were sampled into hypervascularized areas of peripheral, transitional, apical or anterior prostate zones. All the patients included in Groups B and C underwent a further 13 systematic prostate biopsies. RESULTS: The cancer detection rate was calculated for each group. In 88 (29.3%) patients a histological diagnosis of PC was made, whereas 22 (7.4%) patients were diagnosed with high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation. No significant differences were found among the three groups for cancer detection rate. Additionally, low sensitivity, specificity and accuracy of color Doppler with or without SonoVue(TM) contrast agent were found. CONCLUSIONS: We conclude that: a) non-significant differences in PC detection rate between patients who underwent transrectal grey-scale ultrasonography-guided biopsy sampling and those who underwent color Doppler with or without SonoVue(TM) injection; b) non-significant differences between the categories of vascular density and the prostate cancer detection rate in patients who underwent color Doppler and those who underwent color Doppler with SonoVue(TM) injection, and c) a low sensitivity, specificity and accuracy in PC detection rate of color Doppler with or without combined SonoVue(TM) injection. In conclusion, although no collateral effects have been highlighted, the combined use of color Doppler ultrasonography and SonoVue(TM) determines adjunctive costs and increases the mean time for taking a single prostate biopsy. Source of Funding: None

INTRODUCTION AND OBJECTIVES: Conventional grey scale ultrasound has only limited value in the diagnosis of prostate cancer. The ANNA/C-TRUS system was developed to overcome this problem. It is based on an artificial neuronal network analysis (ANNA) of trans rectal grey scale ultrasound pictures. The system was trained to identify the lesion most suspicious for prostate cancer by coding it in different shades of yellow to red. Based on the analysis targeted biopsies of suspicious lesions can be performed. First clinical results are promising. However, so far no external validation of the system using pathological whole mount sections as the reference was done. Such validation is considered the Goldstandard for the validation of prostate cancer imaging tools. The aim of the study was to perform such a validation. METHODS: Between June and Sept 2011, 28 patients diagnosed with prostate cancer and scheduled for radical prostatectomy underwent ultrasound the day before radical prostatectomy. The preoperative pictures were filed and send via the internet platform to the ANNA/C-TRUS server for analysis. For validation purposes each prostate was partitioned into 6 sectors (left, right and base, middle gland, apex) for a total of 168 sectors evaluated. Suspicious zones were filed depending on their localization. The prostatectomy specimens were processed according to the Stanford protocol and prostate cancer lesion were filed according to the 6 sector scheme. The preoperative and postoperative results regarding tumor localization were then compared and diagnostic values were calculated. RESULTS: In the study group median age was 62 years, median PSA was 6.4ng/ml, pathological stage was pT2a in 3.6%,pT2b in 3.6%, pT2c in 67.9% and pT3 in 25.0%, and pathological Gleason score was ⬍⫽ 6 in 35.7%, 7 in 57.2% and ⬎⫽8 in 7.1%. In total, 86 cancer lesions could be identified with a median of 3 lesions per prostate. Regarding the correct identification of prostate cancer lesions in the prostate the ANNA/C-TRUS system achieved a sensitivity of 83.1%, a specificity of 63.9%, a NPV of 68.4% a PPV of 80.1% and an overall accuracy of 76.2%. CONCLUSIONS: In this study, the ANNA/C-TRUS system showed a high reliability to identify prostate cancer lesions in the prostate as evidenced by the high sensitivity and PPV. ANNA/C-TRUS has great potential to improve prostate cancer diagnosis by targeting biopsies to suspicious lesions. Multicentre biopsy studies need to confirm these results. Source of Funding: None

2034 QUANTATIVE SHEAR WAVE ELASTOSONOGRPAHY IN THE DETECTION OF PROSTATE CANCERS Sarfraz Ahmed*, Omar Aboumarzouk, Stephen Lang, Ghulam Nabi, Dundee, United Kingdom INTRODUCTION AND OBJECTIVES: Shear wave elastosonography is a new method of obtaining quantitative tissue elasticity data during transrectal ultrasound biopsies procedure. The aims of this study were (1) to determine the whether shear wave elastsonography can help in picking up extra cancer foci to the currect12 core biopsies technique (2) to compare quantitative shear wave elastosonography for benign/malignant classification. METHODS: Using the Aixplorer® ultrasound system (SuperSonic Imagine, Aix en Provence, France), 32 men with suspected prostate cancer underwent transrectal 12- core systematic biopsies. Additional biopsies were directed using shearaave mode of the machine, if the lesions appeared to be outside the biopsied area. Two orthogonal elastography images were obtained of each region of the biopsied areas. Elastsonography measurements were correlated with