Prostate Cancer Detection by Novice Micro-Ultrasound Users Enrolled in a Training Program
Objective: Micro-ultrasound is an imaging modality used to visualize and target prostate cancer during transrectal
or transperineal biopsy. We evaluated the effectiveness of a micro-ultrasound training program and estimated the
learning curve for prostate biopsy.
Methods: A training program registry was assessed for the rate of clinically significant prostate cancer (csPCa,
grade group ≥ 2), negative predictive value, and specificity at each stage of the program. Nine metrics of biopsy quality
were evaluated in 4 stages for each practitioner. Non-linear fitting and logistic regression models were used to evaluate
the time-course of these metrics over training.
Results: Thirteen practitioners from 8 institutions completed stages 1 to 3 of the program, and 9 completed all 4
stages. Over 1190 micro-ultrasound biopsy procedures were performed. Detection of csPCa increased from 40% to
57% from stage 1 to stage 4 (P < 0.01). Stage 4 “expert” level was independently associated with higher detection of
csPCa when correcting for overall risk factors (OR 1.95; P = 0.03). Limitations include the retrospective analysis and
variation in biopsy protocols.
Conclusion: The micro-ultrasound training program was effective in improving biopsy quality and rate of csPCa
detection. The presented learning curve provides an initial guide for acquiring expertise with real-time microultrasound
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