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A prospective comparison of MRI‐US fused targeted biopsy versus systematic ultrasound‐guided biopsy for detecting clinically significant prostate cancer in patients on active surveillance
Author(s) -
Rosa Michael R.,
Milot Laurent,
Sugar Linda,
Vesprini Danny,
Chung Hans,
Loblaw Andrew,
Pond Gregory R.,
Klotz Laurence,
Haider Masoom A.
Publication year - 2015
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.24710
Subject(s) - medicine , biopsy , prostate cancer , cancer , cancer detection , radiology , prospective cohort study , ultrasound , prostate , nuclear medicine , pathology
Background In active surveillance (AS) patients: (i) To compare the ability of a multiparametric MRI (mpMRI)‐ultrasound biopsy system to detect clinically significant (CS) prostate cancer with systematic 12‐core biopsy (R‐TRUSBx), and (ii) To assess the predictive value of mpMRI with biopsy as the reference standard. Methods Seventy‐two men on AS prospectively underwent 3T mpMRI . MRI‐ultrasound fusion biopsy (UroNavBx) and R‐TRUSBx was performed. CS cancer was defined using two thresholds: 1) GS ≥ 7 (CS7) and 2) GS = 6 with >50% involvement (GS6). CS cancer detection rates and predictive values were determined. Results CS7 cancers were found in 19/72 (26%), 7 (37%) identified by UroNavBx alone, 2 (11%) by R‐TRUSBx alone ( P = 0.182). UroNav targeted biopsy was 6.3× more likely to yield a core positive for CS7 cancer compared with R‐TRUSBx (25% of 141 versus 4% of 874, P < 0.001). Upgrading of GS occurred in 15/72 patients (21%), 13 (87%) detected by UroNavBx and 10 (67%) by R‐TRUSBx. The NPV of mpMRI for CS7 cancer was 100%. MRI suspicion level significantly predicted CS cancer on multivariate analysis (OR 3.6, P < 0.001). Conclusion UroNavBx detected CS cancer with far fewer cores compared with R‐TRUSBx, and mpMRI had a perfect negative predictive value in this population. J. Magn. Reson. Imaging 2015;41:220–225. © 2014 Wiley Periodicals, Inc .