The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer
Abstract
Objectives The aim of this prospective study was to evaluate the sensitivity of the sextant biopsy protocol compared with a more extensive procedure for the detection of prostate cancer and to define a biopsy model with the minimal number of biopsies necessary to maintain diagnostic accuracy. Methods A total of 512 consecutive patients with suspected prostate cancer were examined with transrectal ultrasound (TRUS) and underwent TRUS-guided core biopsy. All patients had 8 or 10 standardized biopsy samples taken, with the number depending on the size of the gland. Additional biopsy samples were taken from hypoechoic or hyperechoic lesions located outside the predetermined location for the standardized biopsies (ie, target biopsies). The sensitivity of the detection of cancer for different combinations of biopsy samples was analyzed and compared with that of our model with 8 to 10 biopsies. Results In all, 276 cancers were detected, of which 88 (32%) had an isoechoic appearance. Sensitivity was 59% for focal lesions detected by TRUS, 85% to 97% for different combinations of systematic biopsy samples, and 93% to 98% for a combination of systematic and target biopsy samples. The sensitivity for the standard sextant protocol was 85%. By adding target biopsies, the sensitivity increased to 93%. Conclusions The standard sextant protocol leaves 15% of cancers undetected compared with results obtained from a more extensive biopsy procedure. By combining systematic and target sampling,…
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Systematic sextant TRUS biopsies have poor imaging quality and lack sharp contrast between cancer and normal tissue, resulting in false-negative rates of up to 30%.
“but for systematic sextant biopsies, its poor imaging quality and lack of sharp contrast between cancer and normal tissue results in false-negative rates of up to 30% (10).”
From A review of deep learning-based deformable medical image registration (2022) · cites this paper as [10]
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A review of deep learning-based deformable medical image registration
Zou, J., Gao, B., Song, Y., & Qin, J. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2022.1047215 · Cited by 91 · see citing works
“For transrectal ultrasound-guided (TRUS) prostate biopsy, it is the most effective way to diagnose prostate cancer, with the advantages of real-time detection, simplicity, and low cost, but for systematic sextant biopsies, its poor imaging quality and lack of sharp contrast between cancer and normal tissue results in…”
Background
- Authors
- Norberg, M., Egevad, L., Holmberg, L., Sparén, P., Norlén, B. J., & Busch, C.
- Affiliations
- Uppsala University Hospital (SE)
- Corresponding author
- Norberg, M.
- Venue
- Urology
- Publisher
- Elsevier BV
- Published
- 1997-10
- Volume
- 50
- Issue
- 4
- Pages
- 562-566
- ISSN
- 0090-4295 (ISSN-L)
- OpenAlex
- W1989978030
- Cited by
- 423
- References
- 0
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 2 · 2022: 10 · 2021: 4 · 2020: 9 · 2019: 10 · 2018: 2 · 2017: 8 · 2016: 14 · 2015: 17 · 2014: 20 · 2013: 19 · 2012: 12
- FWCI
- 13.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Urology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Keywords
- prostate cancer, sextant biopsy, transrectal ultrasound-guided biopsy, targeted biopsy, biopsy sensitivity, systematic biopsy, hypoechoic lesions
- MeSH terms
- Adult, Aged, Aged, 80 and over, Biopsy, Needle, Clinical Protocols, Humans, Male, Middle Aged, Prospective Studies, Prostatic Neoplasms, Sensitivity and Specificity, Ultrasonography, Reproducibility of Results
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