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1063. Diagnostic Value of Multiparametric Transrectal Ultrasound in Patients with Suspected Carcinoma of Prostate
Authors * Denotes Presenting Author
  1. Prabhjyot Chowhan *; Post Graduate Institute of Medical Education and Research
  2. Ujjwal Gorsi; Post Graduate Institute of Medical Education and Research
  3. Ravimohan Mavuduru; Post Graduate Institute of Medical Education and Research
  4. Anupam Lal; Post Graduate Institute of Medical Education and Research
  5. Uttam Mete; Post Graduate Institute of Medical Education and Research
  6. Nandita Kakkar; Post Graduate Institute of Medical Education and Research
Objective:
To establish the role of Grayscale Ultrasonography, Shear Wave Elastography (SWE) and Contrast-Enhanced Ultrasound (CEUS) independently and in combination as multiparametric Transrectal Ultrasound (mp-TRUS) in detecting peripheral zone prostate cancer and to compare the performance of mp-TRUS with multiparametric Magnetic Resonance Imaging (mp-MRI) keeping biopsy as gold standard.

Materials and Methods:
Thirty men with clinically suspected prostate cancer were included in this single-center based prospective study conducted over a period of 1 ½ years. All patients underwent mp-MRI (on 3.0 T scanners), mp-TRUS and guided biopsy (in that order). The mp-MRI and mp-TRUS were conducted and interpreted by two different observers who were blinded to each other’s findings. In all 30 patients, biopsy cores were taken from a minimum of 12 pre-determined sites with extra cores taken from lesions suspicious on either grayscale ultrasonography, SWE or CEUS.

Results:
Malignancy was detected in 19 (63.33%) of our patients on mp-TRUS-guided biopsy. A total of 386 cores were obtained with a positive biopsy rate of 38% (147 out of 386). mp-TRUS gave a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of 100%, 63.63%, 82.61%, 100% and 86.67% respectively while the values for mp-MRI were 94.74%, 45.45%, 75.00%, 83.33% and 76.67% respectively. The area under Receiver Operating Characteristic (ROC) curve for mp-TRUS was 0.818 ± 0.076. This value was higher than that for mp-MRI (0.701 ± 0.083). Pairwise comparison of the ROC curves revealed a p value of 0.2155.

Conclusion:
Our results suggest that the performance of mp-TRUS is comparable to that of mp-MRI in diagnosing peripheral zone prostate cancer. This signifies that mp-TRUS may be appropriate as an independent modality for highlighting and selecting targets during guided biopsies without the need of prior MR imaging. Also, with the use of mp-TRUS, unnecessary biopsies could well be avoided (attributable to the high NPV); thereby resulting in an overall reduction in the related medical costs and complications. mp-TRUS also showed promising results in patients with false-negative mp-MRIs, suggesting that it could act as a good adjunct to mp-MRI, especially in patients with PIRADS 2 or 3 lesions but high clinical suspicion of malignancy.