The best prostate biopsy sampling system-fusion and systematic biopsy: A single center experience.

BACKGROUND: Prostate cancer is the second most commonly diagnosed cancer in men. The diagnostic accuracy in prostate cancer can be increased by employing a preliminary multiparametric MRI followed by a fusion-targeted biopsy. METHODS: To compare the diagnostic accuracy of fusion-targeted biopsy with the standard systematic biopsy in prostate cancer patients, we enrolled 139 patients on which we performed 139 prostate biopsies consisting of three targeted samples followed by 12 regular systematic samples. Based on histology, we analyzed the diagnostic performance of the two methods. RESULTS: Both methods were equally good at detecting clinically significant cancer (83.3%, 50/60), while systematic biopsy detected more clinically insignificant cancers. However, the best diagnostic performance is obtained by combining the two methods. CONCLUSION: The two methods are best seen as synergistic, and the addition of fusion biopsy can be used to detect more clinically significant prostate cancers than systematic biopsy alone.

The role of directional power Doppler in early detection of the onset of neoangiogenesis in a case of small hyperechoic renal lesion.

CASE REPORT: A small hyperechoic renal mass was detected in a 57 year old female. This renal mass was further characterized by the absence of peripheral or intratumoral vascularity using directional power Doppler (dpD); however, there were intralesion spots colored after Levovist (pattern 1, according to Jinzaki). By computer tomography (CT) scan, the renal mass was considered a benign lesion. Three months later, no changes were detected using ultrasonography (US), while there was evidence of a focal intra-lesion neovascular zone using dpD (pattern 1 of Jinzaki). Magnetic resonance imaging (MRI) did not display evidence for malignancy. After six months, the MRI considered the mass an angiomyolipoma (AML). However, a vascular pattern around and inside the mass (pattern 4 of Jinzaki) was evident by using US-dpD and a percutaneous renal biopsy revealed a renal cell carcinoma. CONCLUSION: This case suggests that directional power Doppler is useful for the detection of small hyperechoic renal masses considered benign by both CT scan and MRI, since dpD allows for early detection of the onset and development of neo-vascular structures. Therefore, directional power Doppler sonography would be useful in the follow up of renal masses which mimic benign lesions.