Critical Evaluation of Magnetic Resonance Imaging Targeted, Transrectal Ultrasound Guided Transperineal Fusion Biopsy for Detection of Prostate Cancer

Kuru, Timur H.; Roethke, Matthias; Seidenader, Jonas; Simpfendörfer, Tobias; Boxler, Silvan; Alammar, Khalid; Rieker, Philip; Popeneciu, Valentín; Roth, Wilfried; Pahernik, Sascha; Schlemmer, Heinz Peter; Hohenfellner, Markus; Hadaschik, Boris

doi:10.1016/j.juro.2013.04.043

Cited by 170 publications

(111 citation statements)

References 27 publications

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“…In addition, the high biopsy density of TTPM can lead to hematuria (50%), erectile dysfunction (26%) and acute urinary retention (3%), although the morbidity is temporary [18]. This has to be weighed against another important advantage of the transperineal approach which is the negligible risk (<0.5%) of sepsis compared to the transrectal route (2-4%) [19].…”

Section: Discussionmentioning

confidence: 99%

Transperineal template prostate‐mapping biopsies: an evaluation of different protocols in the detection of clinically significant prostate cancer

et al. 2015

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ObjectivesTo determine whether modified transperineal template prostate mapping (TTPM) biopsy protocols, altering the template or the biopsy density, have sensitivity and negative predictive value equal to full 5mm TTPM. Materials and MethodsRetrospective analysis of an institutional registry including treatment-naïve men undergoing 5mm TTPM analysed in 20 zones fashion. The value of three modified strategies was assessed by comparing the information provided by selected zones against full 5mm TTPM.Strategy 1 did not consider the findings of anterior areas; strategies 2 and 3 simulated a reduced biopsy density by excluding intervening zones. A bootstrapping technique was employed to calculate reliable estimates of sensitivity and negative predictive value of these three strategies with respect to detection of clinically significant disease (maximum cancer core length >/= 4mm and/or Gleason score >/= 3+4).Results 391 men with median age 62 years (IQR 58-67) were included. Median PSA and PSA density were 6.9 ng/ml (IQR 4.8-10) and 0.17 (IQR 0.12-0.25), respectively. A median of 6 cores (IQR 2-9) out of 48 taken per man (IQR 33-63) were positive for prostate cancer. No cancer was detected in 67 men (17%), whilst low, intermediate and high risk disease was identified in 78 (20%), 80 (21%) and 166 (42%), respectively. Strategy 1, 2 and 3 had sensitivities of 78% (95% CI 73-84%), 85% (95% CI 80-90%) and 84% (95% CI 79-89%), respectively. The negative predictive values of the three strategies was at 73% (95% CI 67-80%), 80% (95% CI 74-86%) and 79% (95% CI 72-84%), respectively. ConclusionAltering the template or decreasing sampling density has a substantial negative impact on the ability of TTPM to rule out clinically significant disease. This should be considered when modified TTPM strategies are performed to select men for tissue-preserving approaches, and when modified TTPM are employed to validate new diagnostic tests.

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Section: Discussionmentioning

confidence: 99%

Transperineal template prostate‐mapping biopsies: an evaluation of different protocols in the detection of clinically significant prostate cancer

et al. 2015

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“…Secondly, the same group clinically evaluated the benefit of trocar point needles for image-guided prostate biopsy compared with standard beveled needles in 24 men who underwent MRI-targeted fusion-guided transrectal prostate biopsy (TPB). 12 For this study as a primary end point, the authors use a scored scale (1 ¼ worse to 5 ¼ best) for operator using the following criteria: (1) accuracy of matching between planned and performed biopsy with PTE; (2) histologic quality of the sample; (3) elegance or the easiness to take the biopsy in proper time, planned position, and best histologic quality. The histologic sample quality was assessed by a blinded pathologist.…”

Section: Discussionmentioning

confidence: 99%

Deflection Analysis of Different Needle Designs for Prostate Biopsy and Focal Therapy

Stone

Mouraviev

Schechter³

et al. 2016

Technol Cancer Res Treat

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Objective: The biopsy needles currently used were designed for a transrectal biopsy and are known to experience significant deflection from the point of entry into the gland to the needle tip. Methods: Five designs were selected for testing: 18-gauge Bard, 15-gauge lancet tip needle with 12 vet-point cannula, and trocar tip needle with 12 , 15 , and 20 vet-point cannulas. The 15-gauge needle was designed to take a variable specimen sample between 20 and 60 mm, whereas the Bard needle specimen bed was fixed at 20 mm. The needles were bench tested on a spring-loaded platform and fired into gelatin matrix with modulus of elasticity similar to human prostate. Results: The Bard device with lancet tip needle deflected an average of 0.9 mm (range 0.3-1.3 mm) and 1.9(range 0.6 -2.8 ). Increasing needle diameter from 18-gauge Bard to 15-gauge variable with the same lancet tip needle design resulted in an average deflection across the 3 test lengths of 0.9 mm (range 0-2.0 mm) and 0.9 (range 0 -2.0 ) with no significant difference. On the contrary, the use of the 3-point trocar tip needles with 12, 15 , and 20 vet-point cannulas demonstrated significant reduction in the extent of deflection in both millimeters and degrees. There was no deflection at the 2-and 4-cm shots for both spring loads and preloads for the 3 vet tip angles tested. At 6 cm, the 20 vet tip performed the best. Conclusion: We proposed a mechanism that provides more accurate prostate sampling by combining a 3-point trocar tip on the needle with a 20 vet tip on the cutting cannula. Using the phantom, mimicking prostate gland tissue density, no deflection was revealed between 20-and 60-mm biopsy lengths, which should permit a straight sample in the majority of prostate glands and improve cancer localization for focal therapy planning.

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“…21 However, current reported figures for the NPV for mpMRI range from 60% to 100%. 19,22,23 This variation depends on the studied population, the MRI protocol, the definitions of significant cancer, and the method of analysis. Another variable is the experience of the radiologist reporting the MRI.…”

Section: -12mentioning

confidence: 99%

Investigating the ability of multiparametric MRI to exclude significant prostate cancer prior to transperineal biopsy

Serrao

Barrett

Wadhwa

et al. 2015

CUAJ

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Introduction: We characterized false negative prostate magnetic resonance imaging (MRI) reporting by using histology derived from MRI-transrectal ultrasound (TRUS)-guided transperineal (MTTP) fusion biopsies.Methods: In total, 148 consecutive patients were retrospectively reviewed. Men underwent multiparametric MRI (mpMRI), reported by a consultant/attending radiologist in line with European Society of Urogenital Radiology (ESUR) standards. MTTP biopsy of the lesions was performed according to the Ginsburg recommendations. Cases with an MRI-histology mismatch were identified and underwent a second read by an experienced radiologist. A third review was performed with direct histology comparison to determine a true miss from an MRI-occult cancer. Statistical analysis was performed with McNemar's test. Results: False negative lesions were identified in 29 MRI examinations (19.6%), with a total of 46 lesions. Most false negative lesions (21/46) were located in the anterior sectors of the prostate. The second read led to a significant decrease of false-negative lesions with 7/29 further studies identified as positive on a patientby-patient basis (24.1% of studies, p = 0.016) and 11/46 lesions (23.9%; p = 0.001). Of these, 30 lesions following the first read and 23 lesions after the second read were considered significant cancer according to the University College London criteria. However, on direct comparison with histology, most lesions were MRI occult. Conclusion: We demonstrate that MRI can fail to detect clinically relevant lesions. Improved results were achieved with a second read but despite this, a number of lesions remain MRI-occult. Further advances in imaging are required to reduce false negative results. IntroductionCurrent methods for risk stratification of prostate cancer, including serum prostate-specific antigen (PSA) and transrectal ultrasound (TRUS)-guided biopsies, are limited by sampling error and low sensitivity and specificity.1-3 TRUSbiopsy can lead to inaccurate grading of 32% to 42% of cancers, 4-6 and may fail to detect 30% to 50% of cancers, particularly tumours in the anterior portion of the prostate. 7-12The improvement in multiparametric magnetic resonance imaging (mpMRI) in detecting prostate cancer has led to its recommendation in high-risk patients following a negative TRUS biopsy.13 MRI can then be used to guide subsequent biopsy either cognitively, in-bore (direct MRI-targeting), or by using MRI-TRUS fusion techniques.14-17 The latter combines anatomical MRI localization with the real-time guidance of ultrasound. Repeat biopsy is often undertaken by the transperineal (TP) route as this offers potential advantages over a transrectal route, including better sampling of the anterior and apical regions of the prostate, reduced false negative results, and a sterile approach. 18 mpMRI has the potential to accurately exclude prostate cancer and reduce biopsy burden. 19,20 To achieve this, it must have a high negative predictive value (NPV) on a patient-by-patient basis and maintain ...

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Critical Evaluation of Magnetic Resonance Imaging Targeted, Transrectal Ultrasound Guided Transperineal Fusion Biopsy for Detection of Prostate Cancer

Cited by 170 publications

References 27 publications

Transperineal template prostate‐mapping biopsies: an evaluation of different protocols in the detection of clinically significant prostate cancer

Transperineal template prostate‐mapping biopsies: an evaluation of different protocols in the detection of clinically significant prostate cancer

Deflection Analysis of Different Needle Designs for Prostate Biopsy and Focal Therapy

Investigating the ability of multiparametric MRI to exclude significant prostate cancer prior to transperineal biopsy

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