From novice to expert: analyzing the learning curve for MRI-transrectal ultrasonography fusion-guided transrectal prostate biopsy

Mager, René; Brandt, Maximilian Peter; Borgmann, Hendrik; Gust, K.; Haferkamp, Axel; Kurosch, M.

doi:10.1007/s11255-017-1642-7

Cited by 32 publications

(38 citation statements)

References 28 publications

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“…Meng et al [57] reported a 26% increase in csPCa detection in 1500 men receiving repeat biopsy. Mager et al [58] attempted in demonstrating the presence of the learning curve effect proposing the MRI-TBx quotient, defined as the ratio between the number of positive targeted cores and the total number of targeted cores. The authors showed a significant learning process, in both detection-quotient and biopsy times; for a novice performer, sufficient learning occurred after 42 procedures, reaching a flattening after 63 biopsies.…”

Section: Radiologist and Urologist Experiencementioning

confidence: 99%

Factors Influencing Variability in the Performance of Multiparametric Magnetic Resonance Imaging in Detecting Clinically Significant Prostate Cancer: A Systematic Literature Review

Stabile

Giganti

Kasivisvanathan

et al. 2020

European Urology Oncology

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Context: There is a lack of comprehensive data regarding the factors that influence the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) to detect and localize clinically significant prostate cancer (csPCa). Objective: To systematically review the current literature assessing the factors influencing the variability of mpMRI performance in csPCa diagnosis. Evidence acquisition: A computerized bibliographic search of Medline/PubMed database was performed for all studies assessing magnetic field strength, use of an endorectal coil, assessment system used by radiologists and inter-reader variability, experience of radiologists and urologists, use of a contrast agent, and use of computer-aided diagnosis (CAD) tools in relation to mpMRI diagnostic accuracy. Evidence synthesis: A total of 77 articles were included. Both radiologists' reading experience and urologists'/radiologists' biopsy experience were the main factors that influenced diagnostic accuracy. Therefore, it is mandatory to indicate the experience of the interpreting radiologists and biopsy-performing urologists to support the reliability of the findings. The most recent Prostate Imaging Reporting and Data System (PI-RADS) guidelines are recommended for use as the main

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Section: Radiologist and Urologist Experiencementioning

confidence: 99%

Factors Influencing Variability in the Performance of Multiparametric Magnetic Resonance Imaging in Detecting Clinically Significant Prostate Cancer: A Systematic Literature Review

Stabile

Giganti

Kasivisvanathan

et al. 2020

European Urology Oncology

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“…When comparing the learning curves of the two urologists, we did not observe any significant difference between the first and last cases performed by both of them. A similar report by Mager et al (19) compared the learning curve of an expert urologist to a novice urologist. Their findings also show no statistical difference between the expert and the novice at the end of their learning curve regarding the CDR.…”

Section: Discussionmentioning

confidence: 97%

Analyzing the learning curves of a novice and an experienced urologist for transrectal magnetic resonance imaging-ultrasound fusion prostate biopsy

Căta¹,

Praet²,

Andraș³

et al. 2021

Transl Androl Urol

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Background:The aim of the current study was to evaluate and compare the learning curves of transrectal magnetic resonance imaging-ultrasound fusion biopsy for two urologists with different backgrounds (Operator 1: experienced, self-trained and Operator 2: novice, trained by a mentor/MRI reading courses).Methods: A cohort of 400 patients who underwent fusion prostate biopsy in our department was analyzed.The learning curves were assessed in terms of overall and clinically significant prostate cancer (PCa) detection rates, percentage of positive biopsy cores/targeted and the percentage of PCa tissue on positive targeted cores.Results: Increasing trends were observed for both urologists in terms of all biopsy outcomes during the study time. For the novice urologist, a significant increase was observed for overall PCa detection rate, but not for clinically significant disease (25.44%, P=0.04/15%, P=0.145). Operator 1 showed an increasing diagnosis yield of clinically significant disease up to 104 cases. Similar cancer detection rates were observed when comparing the first and last biopsies performed by both operators. Multivariate analysis adjusted for age, PSA, prostate volume, lesion diameter and PIRADS score showed an increase of PCa detection with 51% for every 52 biopsies performed (P=0.022).Conclusions: When starting with magnetic resonance imaging-ultrasound fusion prostate biopsy, mentoring and prostate magnetic resonance imaging reading training allow a novice urologist to demonstrate a good initial PCa detection rate. After about 52 cases, he reached a stable PCa and clinically significant PCa detection rate, that was similar to that of an experienced urologist.

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“… 21 Furthermore, in a randomized controlled trial comparing systematic biopsy versus systematic biopsy plus MRI-guided cognitive targeted biopsy of the prostate, mpMRI-guided cognitive biopsy of the prostate significantly improved the detection of clinically significant prostate cancer. 22 Compared to the literature on “learning curve” associated with targeted prostate biopsy by fusion-targeted prostate biopsy, 23 24 25 to our knowledge, the evidence outlining the learning curve and risk of operator-related targeting errors for cognitive biopsy of the prostate is lacking, with only one reported small single-surgeon series evaluating the learning curve which proposed the need for further studies. 26 We developed and piloted a coordinate-based approach to support cognitive targeted prostate biopsies, demonstrating comparable clinically significant cancer detection rates to other published series.…”

Section: Discussionmentioning

confidence: 99%

Developing a coordinate-based strategy to support cognitive targeted prostate biopsies and correlative spatial-histopathological outcome analysis

et al. 2021

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Lack of investment for magnetic resonance (MR) fusion systems is an obstacle to deliver targeted prostate biopsies within the prostate cancer diagnostic pathway. We developed a coordinate-based method to support cognitive targeted prostate biopsies and then performed an audit on cancer detection and the location of lesions. In each patient, the prostate is considered as two separate hemiprostates, and each hemiprostate is divided into 4 × 4 × 4 units. Each unit is therefore defined by a three-dimensional coordinate. We prospectively applied our coordinates approach to target 106 prostatic lesions in 93 men. Among 45 (of 106; 42.5%) lesions positive for cancer, 27 lesions (60.0%) harbored clinically significant disease. PSA density was significantly higher in patients with proven cancer (median: 0.264 ng ml −2 ) when compared to the noncancer group (median: 0.145 ng ml −2 ; P = 0.003, Wilcoxon rank-sum test). Lesions with Prostate Imaging-Reporting and Data System (PIRADS) score of 5 were found to have a cancer incidence of 65.2%, while PIRADS 4 and 3 lesions have a lower risk of cancer detection, as expected, at 37.3% and 31.3%, respectively. The probability of a lesion being cancerous in our series significantly decreases as we go from the “apex-to-base” dimension (odds ratio [OR]: 2.62, 95% confidence interval [CI]: 1.55–4.44, P = 0.00034). Our analysis also indicates that the probability of cancer decreases as the prostate volume increases (OR: 1.03, 95% CI: 1.01–1.05, P = 0.00327). Based on this feasibility study, the use of coordinates to guide cognitive targeted prostate biopsies warrants future validation study in additional centers.

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From novice to expert: analyzing the learning curve for MRI-transrectal ultrasonography fusion-guided transrectal prostate biopsy

Abstract: The present study revealed the individual learning curve of a novice in MRI/TRUS fusion biopsy and demonstrated significant learning progress regarding targeted biopsy detection quotient and biopsy time.

Cited by 32 publications

References 28 publications

Factors Influencing Variability in the Performance of Multiparametric Magnetic Resonance Imaging in Detecting Clinically Significant Prostate Cancer: A Systematic Literature Review

Factors Influencing Variability in the Performance of Multiparametric Magnetic Resonance Imaging in Detecting Clinically Significant Prostate Cancer: A Systematic Literature Review

Analyzing the learning curves of a novice and an experienced urologist for transrectal magnetic resonance imaging-ultrasound fusion prostate biopsy

Developing a coordinate-based strategy to support cognitive targeted prostate biopsies and correlative spatial-histopathological outcome analysis

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