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Direct comparison of multiparametric magnetic resonance imaging ( MRI ) results with final histopathology in patients with proven prostate cancer in MRI /ultrasonography‐fusion biopsy
Author(s) -
Borkowetz Angelika,
Platzek Ivan,
Toma Marieta,
Renner Theresa,
Herout Roman,
Baunacke Martin,
Laniado Michael,
Baretton Gustavo,
Froehner Michael,
Zastrow Stefan,
Wirth Manfred
Publication year - 2016
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13461
Subject(s) - medicine , prostate cancer , magnetic resonance imaging , prostatectomy , prostate , histopathology , biopsy , genitourinary system , radiology , transrectal ultrasonography , nuclear medicine , cancer , pathology
Objective To compare multiparametric magnetic resonance imaging (mp MRI ) of the prostate and histological findings of both targeted MRI /ultrasonography‐fusion prostate biopsy ( PB x) and systematic PB x with final histology of the radical prostatectomy ( RP ) specimen. Patients and Methods A total of 105 patients with prostate cancer ( PC a) histopathologically proven using a combination of fusion Pbx and systematic PB x, who underwent RP , were investigated. All patients had been examined using mp MRI , applying the European Society of Urogenital Radiology criteria. Histological findings from the RP specimen were compared with those from the PB x. Whole‐mount RP specimen and mp MRI results were directly compared by a uro‐pathologist and a uro‐radiologist in step‐section analysis. Results In the 105 patients with histopathologically proven PC a by combination of fusion PB x and systematic PB x, the detection rate of PC a was 90% (94/105) in fusion PB x alone and 68% (72/105) in systematic PB x alone ( P = 0.001). The combination PB x detected 23 (22%) Gleason score ( GS ) 6, 69 (66%) GS 7 and 13 (12%) GS ≥8 tumours. Fusion PB x alone detected 25 (26%) GS 6, 57 (61%) GS 7 and 12 (13%) GS ≥8 tumours. Systematic PB x alone detected 17 (24%) GS 6, 49 (68%) GS 7 and 6 (8%) GS ≥8 tumours. Fusion PB x alone would have missed 11 tumours (4% [4/105] of GS 6, 6% [6/105] of GS 7 and 1% [1/105] of GS ≥8 tumours). Systematic PB x alone would have missed 33 tumours (10% [10/105] of GS 6, 20% [21/105] of GS 7 and 2% [2/105] of GS ≥8 tumours). The rates of concordance with regard to GS between the PB x and RP specimen were 63% ( n = 65), 54% ( n = 56) and 75% ( n = 78) in fusion, systematic and combination PB x (fusion and systematic PB x combined), respectively. Upgrading of the GS between PB x and RP specimen occurred in 33% ( n = 34), 44% ( n = 46) and 18% ( n = 19) in fusion, systematic and combination PB x, respectively. γ‐correlation for detection of any cancer was 0.76 for combination PB x, 0.68 for fusion PB x alone and 0.23 for systematic PB x alone. In all, 84% ( n = 88) of index tumours were identified by mp MRI ; 86% ( n = 91) of index lesions on the mp MRI were proven in the RP specimen. Conclusions Fusion PB x of tumour‐suspicious lesions on mp MRI was associated with a higher detection rate of more aggressive PC a and a better tumour prediction in final histopathology than systematic PB x alone; however, combination PB x had the best concordance for the prediction of GS . Furthermore, the additional findings of systematic PB x reflect the multifocality of PC a, therefore, the combination of both biopsy methods would still represent the best approach for the prediction of the final tumour grading in PC a.