Emerging trends in the use of ultrasound in urological cancers were discussed at the 4th EAU Section of Urological Imaging (ESUI15) with novel techniques such as “super-fast” and micro-ultrasound which provide detailed images to physicians.
Prof. Christian Pavlovich (USA) of the Brady Urological Institute at Johns Hopkins University discussed prostate cancer detection (PCa) using prostate micro-ultrasound. He noted that systematic biopsies are problematic and often leads to false negative rates and the detection of clinically insignificant disease, which prompts the need for improved real-time imaging systems.
His team carried out a pilot study wherein 25 men scheduled for radical prostatectomy were scanned with both conventional ultrasound and micro-ultrasound transrectal systems.
“We found that cancer detection and cancer identification were twice as good as with conventional ultrasound. There are huge limitations in terms of cancer detection in ultrasound but maybe we could double that. So were not expecting to see every cancer but hopefully we can see the majority of significant cancers,” said Pavlovich.
Overall results showed that sensitivity improved from 38% to 65%, and specificity improved from 65% to 72%. In terms of side-effects, Pavlovich said it is a very tolerated transrectal ultrasound probe. “There is no difference in the toxicity or harm of the micro-ultrasound compared to conventional ultrasound. The frequencies are all approved by the FDA for use even in fetal imaging. And the probe is similar to standard probe. So we don’t see any issue at all in terms of safety or toxicity,” added Pavlovich.
The team is now conducting a 2,000-patient, randomized trial in the biopsy set which includes men with or without known cancer. The selected patients will either get the conventional ultrasound or the new micro-ultrasound.
Meanwhile, physicist Mickael Tanter (FR) spoke on superfast ultrasound and described the benefits of ultrafast imaging. “Ultrafast Doppler enables very sensitive Doppler imaging, and leads to ultrasonic analogs of MRI Diffusion Tensor imaging. Ultrafast ultrasound will become the first deep imaging modality at microscopic scale,” Tanter said in his closing remarks.