MP18-05: Echogenicity Enhances Risk Assessment of Lesions on MP-MRI for Clinically Significant Prostate Cancer
Friday, May 3, 2024 3:30 PM to 5:30 PM · 2 hr. (US/Central)
302B
Abstract
Information
Full Abstract and Figures
Author Block
Garret Wegner, Amir Khan*, Michael Panagos, Shu Wang, Alexa J Van Besien, Michael Naslund, Mohummad Minhaj Siddiqui, Baltimore, MD
Introduction
The combination of Multiparametric Magnetic Resonance Imaging (MP-MRI)/ ultrasound-guided fusion biopsy, which is a targeted biopsy technique, is gaining prominence as an alternative for diagnosing Prostate cancer (PCa). Many patients, including those under active surveillance, often require repeated biopsies along with a series of MRIs. Notably, upwards of 80% of PIRADS 3 lesions and 50% of PIRADS 4 lesions are benign. In this context, we tested the hypothesis that echogenicity observed during the fusion of MRI and ultrasound images may be associated with the detection of clinically significant prostate cancer in targeted biopsy of MP-MRI lesions.
Methods
This retrospective study, spanning from March 2017 to February 2022, focused on patients who underwent both standard 12-core random biopsies and targeted MP-MRI/ ultrasound-guided biopsies at our institution. We documented lesion-specific ultrasound echogenicity. Lesions observed during the target biopsy were categorized as strongly, weakly, or not hypoechoic. Clinically significant PCa (csPCA) was defined as a Gleason score = 7 and intermediate was defined as a Gleason score = 6.
Results
In an analysis of 221 patients undergoing biopsy, 59.3% were diagnosed with PCa, and among them, 68% had csPCa. Among 429 lesions, 19.1% were strongly hypoechoic, with 45% classified as csPCa. Additionally, 29.8% were weakly hypoechoic, with 25% considered csPCa, while 51.1% were not hypoechoic, with 11.8% being csPCa (p<0.0001). Figure 1 illustrates the distribution of Gleason grades concerning echogenicity and PIRADS score. Notably, for PIRADS =3, echogenicity improved csPCa detection from 7% (non-hypoechoic) to 27% (strongly hypoechoic). For PIRADS 4, it increased from 13.1% to 35.1%, and for PIRAD 5, it enriched from 42% to 64%. On the ROC curve for the detection of csPCa, the AUCs of PIRADS, Echogenicity, and the combination of the two were 0.69, 0.69, and 0.74 (all p<0.001).
Conclusions
The echogenicity of a lesion detected through ultrasound during a prostate biopsy serves as a valuable complement to PIRADS for diagnosing csPCa. Echogenicity can be harnessed by providers to stratify cancer risk and assist in their decision-making when performing biopsies.
Source Of Funding
Not Applicable
Author Block
Garret Wegner, Amir Khan*, Michael Panagos, Shu Wang, Alexa J Van Besien, Michael Naslund, Mohummad Minhaj Siddiqui, Baltimore, MD
Introduction
The combination of Multiparametric Magnetic Resonance Imaging (MP-MRI)/ ultrasound-guided fusion biopsy, which is a targeted biopsy technique, is gaining prominence as an alternative for diagnosing Prostate cancer (PCa). Many patients, including those under active surveillance, often require repeated biopsies along with a series of MRIs. Notably, upwards of 80% of PIRADS 3 lesions and 50% of PIRADS 4 lesions are benign. In this context, we tested the hypothesis that echogenicity observed during the fusion of MRI and ultrasound images may be associated with the detection of clinically significant prostate cancer in targeted biopsy of MP-MRI lesions.
Methods
This retrospective study, spanning from March 2017 to February 2022, focused on patients who underwent both standard 12-core random biopsies and targeted MP-MRI/ ultrasound-guided biopsies at our institution. We documented lesion-specific ultrasound echogenicity. Lesions observed during the target biopsy were categorized as strongly, weakly, or not hypoechoic. Clinically significant PCa (csPCA) was defined as a Gleason score = 7 and intermediate was defined as a Gleason score = 6.
Results
In an analysis of 221 patients undergoing biopsy, 59.3% were diagnosed with PCa, and among them, 68% had csPCa. Among 429 lesions, 19.1% were strongly hypoechoic, with 45% classified as csPCa. Additionally, 29.8% were weakly hypoechoic, with 25% considered csPCa, while 51.1% were not hypoechoic, with 11.8% being csPCa (p<0.0001). Figure 1 illustrates the distribution of Gleason grades concerning echogenicity and PIRADS score. Notably, for PIRADS =3, echogenicity improved csPCa detection from 7% (non-hypoechoic) to 27% (strongly hypoechoic). For PIRADS 4, it increased from 13.1% to 35.1%, and for PIRAD 5, it enriched from 42% to 64%. On the ROC curve for the detection of csPCa, the AUCs of PIRADS, Echogenicity, and the combination of the two were 0.69, 0.69, and 0.74 (all p<0.001).
Conclusions
The echogenicity of a lesion detected through ultrasound during a prostate biopsy serves as a valuable complement to PIRADS for diagnosing csPCa. Echogenicity can be harnessed by providers to stratify cancer risk and assist in their decision-making when performing biopsies.
Source Of Funding
Not Applicable
Sessions
MP18: Imaging/Uroradiology I
302B