Prostate biopsy using transrectal ultrasonography; the optimal number of cores regarding cancer detection rate and complications

Background: Transrectal ultrasound guided biopsy of the prostate is the most common modality used to diagnose prostate cancer. Objectives: The aim of this study was to evaluate the optimal number of cores at prostate biopsy, which have the most diagnostic value with least adverse effects. Patients and Materials: Transrectal ultrasonography (TRUS) guided biopsy was performed in 180 patients suspicious for prostate cancer due to either abnormal rectal examination or elevated PSA. The patients were divided randomly into three groups of six-core, twelvecore and eighteen-core biopsies. The detection rate of prostate cancer in each group with the rate of post biopsy urinary infection and prostatitis were compared. Results: Prostate cancer was diagnosed in 8 (13.3), 21 (35) and 24 (40) patients in six, twelve and eighteen core biopsy groups, respectively. Urinary tract infection and prostatitis occurred in 17 (28.3), 23 (38.3) and 35 (58.3) patients in six, twelve and eighteen core biopsy groups, respectively. Considering the detection rate of prostate cancer, there was a significant difference between 6 and 12 core biopsy groups (P = 0.006) and 12-core biopsies detected more cases of prostate cancer, but there was no significant difference between 12 and 18 core biopsy groups (P = 0.572). Considering the infection rate, there was no significant difference between 6 and 12 core biopsy groups (P = 0.254), but there was a significant difference between 12 and 18 core biopsy groups (P = 0.028) and infectious complications occurred more frequently in 18-core biopsy group. Conclusions: The best balance between detection rate of prostate cancer and infectious complications of biopsies achieved in twelve-core biopsy protocol. Twelve-core biopsy enhances the rate of prostate cancer detection with minimum adverse effects. © 2015, Tehran University of Medical Sciences and Iranian Society of Radiology

Diagnostic accuracy of coronary calcium score less than 100 in excluding coronary artery disease

Background: Coronary artery calcium score (CACS) is a quantitative assessment of calcifications and an established predictor of cardiovascular events. Objectives: In this study, we evaluated the diagnostic accuracy, negative predictive value (NPV), positive predictive value (PPV), specificity and sensitivity of CACS less than 100 in predicting significant coronary artery stenosis in patients with risk of coronary artery disease (CAD) in a vessel-based analysis. Patients and Methods: A cross sectional study was carried out on a study population of 2527 consecutive stable patients with symptoms suggestive of CAD who were referred for coronary computed tomographic angiography (CCTA). We performed 1343 studies with 256 slice machine in Shahid Rajaee hospital and the other studies were carried out with 64 slice machine in Imam Khomeini hospital and the calcium score was quantified according to the Agatston method. Results: At the cutoff point of 100 for coronary calcium scoring, therewashigh specificity (87), high sensitivity (79), high efficiency (84), high PPV (79), and high NPV (87) in the diagnosis of significant stenosis in the whole heart. The frequency of zero calcium scoring was 59 in normal or nonsignificant stenosis and 7.6 in significant stenosis in the whole heart. Calcium scoring increased with greater severity of the arterial stenosis (P values < 0.001). Conclusion: We conclude that coronary calcium scoring provided useful information in the management of patients. In CACS less than 100, it has a NPV of 87 in excluding significant stenosis in patients with the risk of CAD but it does not have enough diagnostic accuracy for surely excluding coronary stenosis, so we should perform a combination of CACS and coronary CT angiography for patients. � 2016, Tehran University of Medical Sciences and Iranian Society of Radiology