Learning Curve of Transperineal MRI/US Fusion Prostate Biopsy: 4-Year Experience

Abstract

This study aimed to evaluate the learning curve of transperineal magnetic resonance imaging (MRI)/ultrasound (US) fusion biopsy in a team composed of a single surgeon, a single radiologist, and a single pathologist. We prospectively enrolled 206 patients undergoing MRI/US fusion prostate biopsy and divided them into four cohorts by the year of biopsy. We analyzed temporal changes in clinically significant prostate cancer (csPC) detection rate, percentage of positive cores on biopsy, and Gleason upgrading rate after radical prostatectomy. The csPC detection rate by MRI/US fusion targeted biopsy (TB) increased significantly (from 35.3% to 60.0%, p = 0.01). With increased experience, the csPC detection rates for small (≤1 cm) and anterior target lesions gradually increased (from 41.2% to 51.6%, p = 0.5; from 54.5% to 88.2%, p = 0.8, respectively). The percentage of positive cores on TB increased significantly (from 18.4% to 44.2%, p = 0.001). The Gleason upgrading rate gradually decreased (from 22.2% to 11.1%, p = 0.4). In conclusion, with accumulated experience and teamwork, the csPC detection rate by TB significantly increased. Multidisciplinary team meetings and a free-hand biopsy technique were the key factors for overcoming the learning curve.

Impact of operator expertise on transperineal free-hand mpMRI-fusion-targeted biopsies under local anaesthesia for prostate cancer diagnosis: a multicenter prospective learning curve

“…also have shown an impact of operators’ expertise on cancer detection rate, but possibly more pronounced for transrectal than for transperineal fusion biopsies with a steep phase of about 60 cases [ 18 ]. Hsieh et al reported that TPFBx under general anaesthesia learning curve shows significant improvement over a 4-year period [ 26 ]. Meng and coll.…”

“…To address these issues, we have investigated the LCs through several independent statistical methods on prospectively acquired data: CPGs fractions and medians trends, logistic/linear regression and CUSUM analyses; this overcomes the limitation imposed by arbitrarily defined group segmentation of other similar reports and enhances the robustness of our findings [ 19 , 28 ]. Our work is not devoid of limitations: no central MRI review was performed and heterogeneity in imaging was not assessed; the number of operators, their previous experience and the disease prevalence were different amongst included centres; the length of the biopsy series considered for each operator is limited, and therefore our results might reflect mainly the early phase of the learning curve; a single fusion biopsy platform (Esaote) was employed; no analysis on biopsy needle trajectory, percentage of tumour on positive cores, ratio of upgrading at final pathology was performed [ 22 , 26 ].…”

Growth Patterns of Prostate Cancers Undetected by Prostate 3T Multiparametric MRI

“…However, no endorectal coil was used. The scanning protocol was performed as described previously (19,20), and images were interpreted by two radiologists. The T2WI was used for contouring the prostate and targeted lesions, and then a 3-D model of the prostate targeted lesions was built using a BioJet (D&K Technologies GmbH, Barum, Germany) or bkFusion (BK Medical, Herlev, Denmark) system.…”

Role of Perilesional Sampling of Patients Undergoing Fusion Prostate Biopsies

“…Prostate biopsies represent the cornerstone of prostate cancer (PCa) diagnoses, with over one million procedures having been performed in Europe and in the United States [ 1 , 2 ]. Prostate biopsies are usually performed under local anesthesia either transrectally or transperineally [ 3 , 4 ]. Although several studies have demonstrated the superiority of the trans-perineal route over the transrectal route in terms of the detection rate and complications, the transrectal route is still the most widely used one [ 5 ].…”