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Multicentre evaluation of targeted and systematic biopsies using magnetic resonance and ultrasound image‐fusion guided transperineal prostate biopsy in patients with a previous negative biopsy
Author(s) -
Hansen Nienke L.,
Kesch Claudia,
Barrett Tristan,
Koo Brendan,
Radtke Jan P.,
Bonekamp David,
Schlemmer HeinzPeter,
Warren Anne Y.,
Wieczorek Kathrin,
Hohenfellner Markus,
Kastner Christof,
Hadaschik Boris
Publication year - 2017
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.13711
Subject(s) - medicine , prostate cancer , prostate , biopsy , magnetic resonance imaging , radiology , interquartile range , mcnemar's test , prostate biopsy , urology , cancer , statistics , mathematics
Objectives To evaluate the detection rates of targeted and systematic biopsies in magnetic resonance imaging (MRI) and ultrasound (US) image‐fusion transperineal prostate biopsy for patients with previous benign transrectal biopsies in two high‐volume centres. Patients and Methods A two centre prospective outcome study of 487 patients with previous benign biopsies that underwent transperineal MRI/US fusion‐guided targeted and systematic saturation biopsy from 2012 to 2015. Multiparametric MRI (mpMRI) was reported according to Prostate Imaging Reporting and Data System (PI‐RADS) Version 1. Detection of Gleason score 7–10 prostate cancer on biopsy was the primary outcome. Positive (PPV) and negative (NPV) predictive values including 95% confidence intervals (95% CIs) were calculated. Detection rates of targeted and systematic biopsies were compared using McNemar's test. Results The median (interquartile range) PSA level was 9.0 (6.7–13.4) ng/mL. PI‐RADS 3–5 mpMRI lesions were reported in 343 (70%) patients and Gleason score 7–10 prostate cancer was detected in 149 (31%). The PPV (95% CI) for detecting Gleason score 7–10 prostate cancer was 0.20 (±0.07) for PI‐RADS 3, 0.32 (±0.09) for PI‐RADS 4, and 0.70 (±0.08) for PI‐RADS 5. The NPV (95% CI) of PI‐RADS 1–2 was 0.92 (±0.04) for Gleason score 7–10 and 0.99 (±0.02) for Gleason score ≥4 + 3 cancer. Systematic biopsies alone found 125/138 (91%) Gleason score 7–10 cancers. In patients with suspicious lesions (PI‐RADS 4–5) on mpMRI, systematic biopsies would not have detected 12/113 significant prostate cancers (11%), while targeted biopsies alone would have failed to diagnose 10/113 (9%). In equivocal lesions (PI‐RADS 3), targeted biopsy alone would not have diagnosed 14/25 (56%) of Gleason score 7–10 cancers, whereas systematic biopsies alone would have missed 1/25 (4%). Combination with PSA density improved the area under the curve of PI‐RADS from 0.822 to 0.846. Conclusion In patients with high probability mpMRI lesions, the highest detection rates of Gleason score 7–10 cancer still required combined targeted and systematic MRI/US image‐fusion; however, systematic biopsy alone may be sufficient in patients with equivocal lesions. Repeated prostate biopsies may not be needed at all for patients with a low PSA density and a negative mpMRI read by experienced radiologists.