You have accessJournal of UrologyCME1 May 2022PD41-08 THE ROLE OF MICRO-ULTRASOUND AMONG PATIENTS WITH A PIRADS 5 LESION AT MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING Marco Paciotti, Davide Maffei, Pier Paolo Avolio, Cesare Saitta, Vittorio Fasulo, Nicola Frego, Roberto Contieri, Alessandro Uleri, Alberto Saita, Rodolfo Hurle, Massimo Lazzeri, Paolo Casale, Rozzano, Giorgio Guazzoni, Nicolò Buffi, and Giovanni Lughezzani Marco PaciottiMarco Paciotti More articles by this author , Davide MaffeiDavide Maffei More articles by this author , Pier Paolo AvolioPier Paolo Avolio More articles by this author , Cesare SaittaCesare Saitta More articles by this author , Vittorio FasuloVittorio Fasulo More articles by this author , Nicola FregoNicola Frego More articles by this author , Roberto ContieriRoberto Contieri More articles by this author , Alessandro UleriAlessandro Uleri More articles by this author , Alberto SaitaAlberto Saita More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , Paolo CasalePaolo Casale More articles by this author , Rozzano Rozzano More articles by this author , Giorgio GuazzoniGiorgio Guazzoni More articles by this author , Nicolò BuffiNicolò Buffi More articles by this author , and Giovanni LughezzaniGiovanni Lughezzani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002602.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiparametric magnetic resonance imaging (MRI) improved the detection rate of clinically significant prostate cancer (csPCa). However, a significant proportion of patients with highly-suspicious MRI findings are found to have no cancer on histological examination after biopsy. We investigated whether high-resolution micro-ultrasound (mUS) might be able to stratify this population according to the risk of harboring csPCa. METHODS: We analyzed 126 consecutive patients scheduled for a prostate biopsy with ≥1 PIRADS 5 lesion at MRI. Before biopsy, all patients underwent a mUS examination by an operator blinded to MRI result. The Prostate Risk Identification using MicroUS (PRIMUS) protocol was used to assess the risk of csPCa, defined as ISUP >1 PCa. All patients received both targeted and systematic biopsies. The primary endpoint was to determine the diagnostic accuracy of mUS. Multivariable logistic regression models (MLRM) were fitted to identify predictors of csPCa. The diagnostic accuracy was reported as area under the ROC curve. Finally, we evaluated the diagnostic value of mUS in non-biopsy-naïve patients with PIRADS 5 lesions at MRI. RESULTS: Overall, 76 (60.3%) patients were biopsy-naïve, while 50 (39.7%) had ≥1 previous biopsy. Median age was 69years (IQR 61-74), median PSA was 9.1ng/ml (IQR 6.6-13). Overall, 93 (73.81%) patients were diagnosed with PCa and 81 (64.3%) had csPCa. MUS detected a suspicious (i.e. PRIMUS >2) lesion in 102 (81.0%) patients; of those, 75 (73.5%) were diagnosed with csPCa. MUS sensitivity was 73.5%, specificity 75.0%, positive predictive value 92.6%, and negative predictive value (NPV) 40.0%. At MLRM, factors associated with csPCa were: a positive mUS assessment (OR: 8.44, 95%CI: 2.17-32.92), increasing age (OR: 1.09, 95%CI: 1.02-1.16), being biopsy-naïve (OR: 8.63, 95%CI: 2.95-25.23), and a PSA density >15% (OR: 3.16, 95%CI 1.13-8.83). The accuracy of a model including those 4 variables was 0.83 (95%CI: 0.74-0.92). Of 50 patients with a PRIMUS 5 lesions who already had ≥1 previous biopsy, 12 (24%) and 38 (76%) had a negative and positive mUS assessment, respectively. Among mUS-negative patients, only 1 (4.6%) was diagnosed with csPCa at pathological examination. In this subgroup, mUS had a NPV of 91.7%. CONCLUSIONS: MUS is a highly accurate diagnostic tool in patients presenting with a PIRADS 5 lesion at MRI. Together with easily available clinical variables, it might be able to further stratify csPCa risk in this population. Whether this information can improve the follow-up of these patients needs to be answered yet. Source of Funding: No © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e692 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marco Paciotti More articles by this author Davide Maffei More articles by this author Pier Paolo Avolio More articles by this author Cesare Saitta More articles by this author Vittorio Fasulo More articles by this author Nicola Frego More articles by this author Roberto Contieri More articles by this author Alessandro Uleri More articles by this author Alberto Saita More articles by this author Rodolfo Hurle More articles by this author Massimo Lazzeri More articles by this author Paolo Casale More articles by this author Rozzano More articles by this author Giorgio Guazzoni More articles by this author Nicolò Buffi More articles by this author Giovanni Lughezzani More articles by this author Expand All Advertisement PDF DownloadLoading ...