The ultrasound characteristics of regions identified as suspicious by magnetic resonance imaging ( MRI MRI ) predict the likelihood of clinically significant cancer on MRI MRI –ultrasound fusion‐targeted biopsy

摘要

Objective To determine whether the presence of an ultrasound hypoechoic region at the site of a region of interest ( ROI ) on magnetic resonance imaging ( MRI ) results in improved prostate cancer ( PC a) detection and predicts clinically significant PC a on MRI –ultrasonography fusion‐targeted prostate biopsy ( MRF ‐ TB ). Materials and Methods Between July 2011 and June 2017, 1058 men who underwent MRF ‐ TB , with or without systematic biopsy, by a single surgeon were prospectively entered into an institutional review board‐approved database. Each MRI ROI was identified and scored for suspicion by a single radiologist, and was prospectively evaluated for presence of a hypoechoic region at the site by the surgeon and graded as 0, 1 or 2, representing none, a poorly demarcated ROI‐HyR, or a well demarcated ROI‐HyR, respectively. The interaction of MRI suspicion score ( mSS ) and ultrasonography grade ( USG ), and the prediction of cancer detection rate by USG , were evaluated through univariate and multivariate analysis. Results For 672 men, the overall and Gleason score ( GS ) ≥7 cancer detection rates were 61.2% and 39.6%, respectively. The cancer detection rates for USG s 0, 1 and 2 were 46.2%, 58.6% and 76.0% ( P 0.001) for any cancer, and 18.7%, 35.2% and 61.1% ( P 0.001) for GS ≥7 cancer, respectively. For MRF ‐ TB only, the GS ≥7 cancer detection rates for USG 0, 1 and 2 were 12.8%, 25.7% and 52.0%, respectively ( P 0.001). On univariate analysis, in men with mSS 2–4, USG was predictive of GS ≥7 cancer detection rate. Multivariable regression analysis showed that USG , prostate‐specific antigen density and mSS were predictive of GS ≥7 PC a on MRF ‐ TB . Conclusions Ultrasonography findings at the site of an MRI ROI independently predict the likelihood of GS ≥7 PC a, as men with a well‐demarcated ROI‐HyR at the time of MRF ‐ TB have a higher risk than men without.