Impact of Surgeon’s Experience in Rigid versus Elastic MRI/TRUS-Fusion Biopsy to Detect Significant Prostate Cancer Using Targeted and Systematic Cores

Abstract

Multiparametric magnetic resonance imaging (mpMRI) and MRI/ultrasound fusion-targeted prostate biopsy (FB) have excellent sensitivity in detecting significant prostate cancer (sPC). FB platforms can be distinguished by rigid (RTB) or elastic image registration (ETB). We compared RTB and ETB by analyzing sPC detection rates of both RTB and ETB at different stages of the surgeons’ learning curve. Patients undergoing RTB between 2015–2017 (n = 502) were compared to patients undergoing ETB from 2017–2019 (n = 437). SPC detection rates were compared by Chi-square-test on patient-basis. Combination of transperineal systematic biopsy and each TB served as reference and sub-analyses were performed for different grades of surgeon’s experience. In the RTB subgroup, 233 men (46%) had sPC, compared to 201 (46%) in the ETB subgroup. RTB alone detected 94% of men with sPC and ETB 87% (p = 0.02). However, for at least intermediate-experienced surgeons (>100 FB), no differences occurred between RTB and ETB. In the total cohort, at least intermediate-experienced surgeons detected significantly more sPC (10%, p = 0.008) than novices. Thus, targeted transperineal MRI/TRUS-FB with a RTB registration system showed a similar sPC detection rate to ETB in experienced surgeons but a superior sPC detection rate to ETB in the total cohort. Low-experienced surgeons seem to benefit from RTB.

A Systematic Review of the Current Status of Magnetic Resonance–Ultrasound Images Fusion Software Platforms for Transperineal Prostate Biopsies

“…Of the 30 articles, 21 studies were conducted prospectively (none randomized) [ 21 , 22 , 24 , 27 , 28 , 29 , 30 , 32 , 33 , 34 , 35 , 38 , 39 , 40 , 41 , 42 , 43 , 48 , 49 , 50 ] and nine retrospectively [ 23 , 25 , 26 , 31 , 36 , 37 , 44 , 45 , 47 ].…”

“…Eight series were multicenter [ 21 , 24 , 25 , 26 , 34 , 35 , 40 , 49 ] while the remaining 22 were from a single center [ 22 , 23 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 36 , 37 , 38 , 39 , 40 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 50 ]. Overall, the characteristics and biopsy results of 11,313 patients were analyzed.…”

“…Likert 1–2: 12 lesions, Likert 3: 111 lesions, Likert 4: 195 lesions and Likert 5: 162 lesions. Information regarding the result of the DRE has been reported by 10 articles [ 24 , 30 , 31 , 32 , 36 , 37 , 40 , 41 , 43 , 50 ] with an average abnormal DRE of 22% (5–35).…”

“…The study population included two articles [ 42 , 45 ] on patients with naïve biopsy, three articles [ 34 , 35 , 48 ] on patients with previous negative biopsy, twelve articles [ 22 , 23 , 24 , 26 , 28 , 30 , 32 , 33 , 36 , 41 , 43 , 44 ] on patients with naïve biopsy and previous negative biopsy, eleven studies [ 27 , 29 , 31 , 37 , 38 , 39 , 40 , 46 , 47 , 49 , 50 ] on patients with naïve biopsy and previous negative biopsy and patients in active surveillance (AS) and finally, two articles by Jacewicz et al [ 21 , 25 ] on patients with no prior biopsy, patients with prior negative biopsy, AS, focal therapy (FT) control, and SBRT recurrence. These data are presented in Table 3 .…”

“…All resonances performed prior to the biopsies were carried out via 1.5 or 3.0 Tesla resonators scans and interpreted using the PI-RADS score Version 1.0 in 1 article [ 34 ], version 2.0 in 26 studies [ 21 , 22 , 23 , 24 , 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 46 , 47 , 48 , 50 ], and version 2.1 in 1 article [ 45 ]. In two series [ 26 , 49 ], the reading of the resonance was carried out using the Likert scale.…”