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Primary magnetic resonance imaging/ultrasonography fusion‐guided biopsy of the prostate
Author(s) -
Maxeiner Andreas,
Kittner Beatrice,
Blobel Conrad,
Wiemer Laura,
Hofbauer Sebastian L.,
Fischer Thomas,
Asbach Patrick,
Haas Matthias,
Penzkofer Tobias,
Fuller Florian,
Miller Kurt,
Cash Hannes
Publication year - 2018
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.14212
Subject(s) - medicine , prostate cancer , magnetic resonance imaging , interquartile range , prostate , biopsy , transrectal ultrasonography , prostate biopsy , radiology , nuclear medicine , cancer
Objective To examine the performance of a primary magnetic resonance imaging ( MRI )/ultrasonography ( US ) fusion‐guided targeted biopsy ( TB ), and in combination with an added systematic biopsy ( SB ). Patients and Methods Analysis of 318 consecutive biopsy‐naïve men with suspicious multiparametric MRI (mp MRI ; Prostate Imaging Reporting and Data System [ PI ‐ RADS ] score ≥3) undergoing transrectal TB and 10‐core SB between January 2012 and December 2016. The indication for performing mp MRI was based on clinical parameters and decided by the treating urologist before admission. TB was performed with a sensor‐based MRI / US fusion‐guided platform. Clinically significant prostate cancer was defined as Gleason score ≥4 + 3 = 7 (International Society of Urological Pathology Grade [ ISUP ] grade 3) or maximum cancer core length of ≥6 mm. Results A median (interquartile range) of 14 (13–14) biopsies per case were taken. The overall cancer detection rate ( CDR ) was 77% (245/318). The TB alone detected 67% of prostate cancers and the SB alone detected 70%. The PI ‐ RADS dependent CDR for the combination of TB / SB were 38% (21/55), 78% (120/154) and 95% (104/109) for PI ‐ RADS scores of 3/4/5, respectively. Clinically significant prostate cancer was diagnosed by the combination of TB and SB in 195 men (61%) and by TB alone in 163 cases (51%). The number of missed or underestimated prostate cancers with a Gleason score ≥8 for TB alone was 31 (10%, P < 0.001) and 21 (7%, P < 0.001) for SB alone in comparison with the results of the combination of TB and SB . The rate of insignificant prostate cancer was comparable for the combination of TB and SB and TB alone (50/318, 16% vs 50/318, 16%). Conclusions Pre‐biopsy mp MRI is of incremental value in increasing the detection of clinically significant prostate cancer in biopsy‐naïve patients with suspicion of prostate cancer. Combining TB with SB further improved the diagnostic accuracy without increasing the rate of insignificant prostate cancer.