Ecografía de alta resolución prostática (microultrasonografía-ExactVuTM).

espanolOBJETIVO: El diagnostico del cancer de prostata (CaP) ha mejorado con la resonancia magnetica multiparametrica (RMmp) y nuevos biomarcadores mas especificos. No obstante, la RMmp tiene unas limitaciones: variabilidad, larga curva de aprendizaje y coste elevado. Por ello se hacen necesarios mas avances en el escenario diagnostico, y es aqui donde irrumpen los microultrasonidos de alta resolucion (MUS) 29 MHz. MATERIAL Y METODOS: Entre Feb 2017-2018; 96 pacientes con sospecha de CaP; recibieron biopsia prostatica transrectal guiada por MUS. Procedimiento realizado por 2 urologos a los que se oculto los resultados de la RMmp (disponible en 92%). Se empleo protocolo PRI-MUS; obteniendo 2 muestras de area sospechosa (PRIMUS >3) mas biopsia sistematica. Se anadieron muestras adicionales de areas PI-RADS >3. Se recogen datos de sensibilidad, especificidad y valor predictivo positivo (VPP) y negativo (VPN) para detectar CaP clinicamente significativo (CaPcs) (Gleason Score >7). RESULTADOS: La tasa de deteccion global de los MUS para CaPcs fue del 59,37%. Se registraron 171 cilindros positivos, de los cuales CaPcs fueron: 1,2% PRI-MUS 1, 16,3% PRI-MUS 2, 28% PRI-MUS 3, 39% PRI-MUS 4 y 15% PRI-MUS 5. La sensibilidad en la deteccion de CaPcs en PRI-MUS >3 fue del 82% con VPN 93%, pero con baja especificidad 39% y VPP del 19%. Comparando los 79 pacientes con RMmp; la sensibilidad por zona de los MUS fue del 82% frente al 30% de la RMmp, con un VPN del 93% frente al 88%. La especificidad y el VPP fueron superiores en la RMmp frente a MUS. CONCLUSIONES: Aunque la serie es preliminar, los MUS se presentan como una tecnica de imagen coste- efectiva, sencilla de aprender y con alta eficacia en la biopsia prostatica. La tasa de deteccion global de CaP duplica a la de los ultrasonidos convencionales; y ofrece alta sensibilidad y valor predictivo negativo en la deteccion de CaPcs frente a la RMmp. EnglishOBJECTIVE: Prostate cancer (PCa) diagnosis has improved with multiparametric magnetic resonance (mpMRI) and new more specific biomarkers. However, mpMRI has some limitations such as variability, long learning curve and high cost. More progress is needed in the PCa diagnosis scenario, and it is here where high resolution micro-ultrasound (MUS) imaging system emerge. MATERIAL AND METHODS: Retrospective study between February (2017-2018); including 96 patients with PCa suspicion, undergoing transrectal prostate biopsy guided by MUS. Procedure was performed by 2 urologists blinded to mpMRI results at first (92% available). PRI-MUS protocol was used to identify suspicious features. 2 core targeted biopsy of suspicious areas (PRIMUS >3) was completed first and then it was followed by a 12-core systematic biopsy and finally sampling of mpMRI targets if available. Data were collected reporting sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) to detect clinically significant PCa (csPCa) (Gleason score >7). RESULTS: Overall, MUS csPCa detection rate was 59.37%. 171 cores were registered, of them csPCa were distributed as follow: 1.2% PRI-MUS 1, 16.3% PRIMUS 2, 28% PRI-MUS 3, 39% PRI-MUS 4 and 15% PRIMUS 5. Sensitivity in csPCa detection for PRI-MUS >3 was 82% with 93% NPV, but with low 39% specificity and 19% PPV. Comparing 79 patients with mpMRI available; sensitivity by area of MUS was 82% versus 30% of mpMRI, with 93% NPV versus 88%. Specificity and PPV were higher in mpMRI in comparison to MUS. CONCLUSIONS: Although this is a preliminary series, MUS is presented as an attractive imaging technique, cost-effective, easy to learn and with high efficacy in image-guided prostate biopsy. Overall PCa detection rate increases over conventional ultrasound; and offers high sensitivity and NPV in csPCa detection over mpMRI but with lower specificity.