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Contrast-enhanced ultrasound with dispersion analysis for the localization of prostate cancer: correlation with radical prostatectomy specimens

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Abstract

Purpose

To determine the value of two-dimensional (2D) contrast-enhanced ultrasound (CEUS) imaging and the additional value of contrast ultrasound dispersion imaging (CUDI) for the localization of clinically significant prostate cancer (csPCa).

Methods

In this multicentre study, subjects scheduled for a radical prostatectomy underwent 2D CEUS imaging preoperatively. CUDI maps were generated from the CEUS recordings. Both CEUS recordings and CUDI maps were scored on the likelihood of presenting csPCa (any Gleason ≥ 4 + 3 and Gleason 3 + 4 larger than 0.5 mL) by five observers and compared to radical prostatectomy histopathology. An automated three-dimensional (3D) fusion protocol was used to match imaging with histopathology. Receiver operator curve (ROC) analysis was performed per observer and imaging modality.

Results

133 of 216 (62%) patients were included in the final analysis. Average area under the ROC for all five readers for CEUS, CUDI and the combination was 0.78, 0.79 and 0.78, respectively. This yields a sensitivity and specificity of 81 and 64% for CEUS, 83 and 56% for CUDI and 83 and 55% for the combination. Interobserver agreement for CEUS, CUDI and the combination showed kappa values of 0.20, 0.18 and 0.18 respectively.

Conclusion

The sensitivity and specificity of 2D CEUS and CUDI for csPCa localization are moderate. Despite compressing CEUS in one image, CUDI showed a similar performance to 2D CEUS. With a sensitivity of 83% at cutoff point 3, it could become a useful imaging procedure, especially with 4D acquisition, improved quantification and combination with other US imaging techniques such as elastography.

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Acknowledgements

This research project was supported by a grant from the Dutch Cancer Society (KWF Kankerbestrijding grant UVA 2013-5941). This study was performed within the framework of CTMM, The Center for Translational Molecular Medicine, PCMM project (Grant 03O-203).

Funding

This study was funded by a grant from the Dutch Cancer Society (KWF Kankerbestrijding grant UVA 2013-5941). This study was performed within the framework of CTMM, the Center for Translational Molecular Medicine, PCMM project (Grant 03O-203).

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Author notes

  1. Arnoud W. Postema and Maudy Gayet contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Urology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Arnoud W. Postema, Christophe K. Mannaerts, Harrie P. Beerlage & Hessel Wijkstra

  2. Department of Urology, Jeroen Bosch Hospital, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, ‘s Hertogenbosch, The Netherlands

    Maudy C. W. Gayet & Amir Kajtazovic

  3. Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands

    Maudy C. W. Gayet, Ruud J. G. van Sloun, Rogier R. Wildeboer, Stefan G. Schalk, Harrie P. Beerlage, Massimo Mischi & Hessel Wijkstra

  4. Department of Pathology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    C. Dilara Savci-Heijink

  5. Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    Henk van der Poel

  6. Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands

    Peter F. A. Mulders

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  1. Arnoud W. Postema
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Contributions

AWP: data collection and management, data analysis, manuscript writing/editing. MG: data collection and management, data analysis, manuscript writing/editing. RJGS: data collection, data analysis. RRW: data collection, data analysis. CKM: data collection. CDS-H: data collection. SGS: data collection. AK: manuscript writing and editing. HP: data collection. PFAM: project development. HPB: project development, manuscript editing. MM: project development, manuscript editing. HW: project development, manuscript editing.

Corresponding author

Correspondence to Maudy C. W. Gayet.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Medisch Ethische Toetsingscommissie AMC and Medisch Ethische Toetsingscommissie Brabant) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Postema, A.W., Gayet, M.C.W., van Sloun, R.J.G. et al. Contrast-enhanced ultrasound with dispersion analysis for the localization of prostate cancer: correlation with radical prostatectomy specimens. World J Urol 38, 2811–2818 (2020). https://doi.org/10.1007/s00345-020-03103-4

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