Transperineal Prostate Biopsy Using a Cone-shaped Double-hole Method with Dual-plane Probe Guidance

My research focuses on developing a minimally invasive micro ultrasound-guided prostate biopsy technique. Key questions include improving procedure time, accuracy, patient comfort, and reducing infection rates and recovery times. My protocol offers a minimally invasive, fast biopsy with reduced procedure time, enhanced accuracy, lower pain, zero infection rate, and quick recovery, all while maintaining high diagnostic precision using micro ultrasound.

Our results raise questions about optimizing micro ultrasound for other organ biopsies, improving real-time imaging accuracy, and exploring long-term patient outcomes with minimally invasive techniques in prostate cancer diagnosis. To begin, set the ultrasound machine to preset prostate biopsy conditions. Adjust the depth based on the patient's imaging data, ensuring at least one centimeter beyond the prostate's largest dimension is visible.

Set the central frequency of the transducer to six megahertz to balance image resolution and tissue penetration. Set the frame rate to a maximum of 22 hertz for smooth and real-time imaging during the biopsy procedure. Maintain the thermal index below one throughout the procedure, to minimize the risk of tissue heating.

Set the mechanical index between 0.6 and one based on the patient's anatomy and tissue characteristics, to reduce the mechanical impact on soft tissues. Initially set the gain between 50%and 70%Fine-tune the gain during the procedure to enhance the contrast and visibility of prostate tissues while minimizing background noise. Conduct a preliminary scan of the prostate using both longitudinal and transverse ultrasound planes to locate regions of interest, or ROI, such as nodules or abnormal echo patterns.

Perform a systematic biopsy, with biopsies spaced evenly across the prostate's non-ROI areas, to minimize the risk of iatrogenic tumor seeding. Insert an 18-gauge biopsy needle through the anesthetized perineal region under ultrasound guidance. Ensure that the needle enters the prostate in the transverse plane for cross-sectional imaging.

Maintain the ultrasound probe in a fixed position to stabilize imaging, and guide the needle along its pre-designated path. For non-targeted biopsies, advance the needle at a perpendicular angle relative to the ultrasound beam to minimize entry into normal prostate tissue. If the needle is not clearly visualized, adjust the ultrasound probe slightly and rotate it by small increments to achieve the best view of the needle path.

If the needle deviates, gently retract the needle and adjust the entry angle while keeping the tip within the designated target area. Use the dual-plane ultrasound system to monitor the needle trajectory from both longitudinal and transverse views, making gradual adjustments as necessary. Once the biopsy needle is correctly positioned, fire the biopsy gun to collect tissue samples from the peripheral and transition zones.

For areas with suspicious lesions, perform two to three biopsy passes per region to maximize detection accuracy. Apply proper tissue pressure on the biopsy site to minimize bleeding. The table presents a statistical summary comparing two pain assessment methods, the modified method and the traditional method.

Pain scores were significantly lower in patients undergoing the modified method compared to the traditional method, with 351 out of 526 patients reporting zero pain points, while only 90 out of 501 patients reported zero pain points in the traditional method. A comparison of procedural time and detection rates between modified and traditional methods is presented here. The modified biopsy method had a significantly shorter procedural time compared to the traditional method, indicating improved efficiency.

Additionally, the modified method demonstrated a higher prostate cancer detection rate, compared to the traditional method with 375 positive detections out of 526 samples versus 175 positive detections out of 501 samples.