Korean J Urol.  2006 Jul;47(7):747-751. 10.4111/kju.2006.47.7.747.

Diagnostic Value of Systematic Sextant and Lesion Directed Biopsy Regimen in Patients with Suspicious Lesions on Transrectal Ultrasonography

• Lee SW
• Hong SK
• Byun SS
• Lee SE
• Joo KJ

• KMID: 2294316
• DOI: http://doi.org/10.4111/kju.2006.47.7.747

Abstract

PURPOSE: We evaluated the diagnostic value of systematic sextant and lesion directed biopsy regimen in patients with hypoechoic lesions on transrectal ultrasonography (TRUS) for the detection of prostate cancer.
MATERIALS AND METHODS
Between September 2003 and November 2005, a total of 142 men with sonomorphologic lesions suggestive of prostate cancer on TRUS underwent prostate biopsy. In all the subjects, lesion directed biopsies were taken in addition to the systematic 12 core biopsies. We examined the cancers detected in only the lateral region of 12 cores and the cancers detected in only the lesion directed biopsy, as well as the overall cancer detection rate. And, we compared the cancer detection rates of sextant and lesion directed biopsy, 12 core biopsy, and 12 core and lesion directed biopsy strategy.
RESULTS
Of the 142 patients who underwent 12 core and lesion directed biopsy, 48 patients (33.8%) were diagnosed as having prostate cancer. The prostate cancer detection rate for systematic sextant and lesion directed biopsy and for 12 core biopsy was 28.9% (41/142) and 31.0% (44/142), respectively. There was no significant difference in the overall cancer detection rate between the three biopsy strategies (p=0.667). Also, when stratified by prostate-specific antigen (PSA) level, prostate volume, and digital rectal examination (DRE) findings, there was no significant difference in cancer detection rate between the three regimens.
CONCLUSIONS
The systematic sextant and lesion directed biopsy strategy for patients with focal hypoechoic lesions on TRUS is an adequate and reasonable approach for the detection of prostate cancer with a relatively small number of biopsy cores.

Keyword

Biopsy; Diagnosis; Prostatic neoplasm; Ultrasonography

MeSH Terms

Biopsy*
Diagnosis
Digital Rectal Examination
Humans
Male
Prostate
Prostate-Specific Antigen
Prostatic Neoplasms
Ultrasonography*
Prostate-Specific Antigen

Reference

1. Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol. 1989. 142:71–74.

2. Matlaga BR, Eskew LA, McCullough DL. Prostate biopsy: indications and technique. J Urol. 2003. 169:12–19.

3. Chang JJ, Shinohara K, Bhargava V, Presti JC Jr. Prospective evaluation of lateral biopsies of the peripheral zone for prostate cancer detection. J Urol. 1998. 160:2111–2114.

4. Eskew LA, Bare RL, McCullough DL. Systematic 5 region prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate. J Urol. 1997. 157:199–202.

5. Babaian RJ, Toi A, Kamoi K, Troncoso P, Sweet J, Evans R, et al. A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol. 2000. 163:152–157.

6. Presti JC Jr, O'Dowd GJ, Miller MC, Mattu R, Veltri RW. Extended peripheral zone biopsy schemes increase cancer detection rates and minimize variance in prostate specific antigen and age related cancer rates: results of a community multi-practice study. J Urol. 2003. 169:125–129.

7. Heijmink SW, van Moerkerk H, Kiemeney LA, Witjes JA, Frauscher F, Barentsz JO. A comparison of the diagnostic performance of systematic versus ultrasound-guided biopsies of prostate cancer. Eur Radiol. 2006. 16:927–938.

8. Onur R, Littrup PJ, Pontes JE, Bianco FJ Jr. Contemporary impact of transrectal ultrasound lesions for prostate cancer detection. J Urol. 2004. 172:512–514.

9. Terris MK. Walsh PC, Retik AB, Vaughan ED, Wein AJ, editors. Ultrasonography and biopsy of the prostate. Campbell's urology. 2002. 8th ed. Philadelphia: Saunders;3038–3054.

10. Park HK, Byun SS, Sohn DW, Hong SK, Lee ES, Lee SE, et al. The efficacy of 12-site biopsy protocol in men with elevated serum prostate-specific antigen level only. Korean J Urol. 2005. 46:463–466.

11. Cho SH, Kim SI, Park HY. The efficacy of routine sextant prostate biopsy plus selective lesion-directed prostate biopsy. Korean J Urol. 2005. 46:700–703.

12. Kuligowska E, Barish MA, Fenlon HM, Blake M. Predictors of prostate carcinoma: accuracy of gray-scale and color Doppler US and serum markers. Radiology. 2001. 220:757–764.

13. Halpern EJ, Strup SE. Using gray-scale and color and power Doppler sonography to detect prostatic cancer. AJR Am J Roentgenol. 2000. 174:623–627.

14. Okihara K, Miki T, Joseph Babaian R. Clinical efficacy of prostate cancer detection using power Doppler imaging in American and Japanese men. J Clin Ultrasound. 2002. 30:213–221.

15. Jeon SH, Lee SJ, Lee CH, Chang SG, Kim JI, Lim JW. Role of color Doppler sonography in transrectal ultrasound guided biopsy of prostate. Korean J Urol. 2001. 42:1291–1294.

16. Frauscher F, Klauser A, Volgger H, Halpern EJ, Pallwein L, Steiner H, et al. Comparison of contrast enhanced color Doppler targeted biopsy with conventional systematic biopsy: impact on prostate cancer detection. J Urol. 2002. 167:1648–1652.

17. Pelzer A, Bektic J, Berger AP, Pallwein L, Halpern EJ, Horninger W, et al. Prostate cancer detection in men with prostate specific antigen 4 to 10ng/ml using a combined approach of contrast enhanced color Doppler targeted and systematic biopsy. J Urol. 2005. 173:1926–1929.