Lesion location agreement between prostatic multiparametric magnetic resonance, cognitive fusion biopsy and radical prostatectomy piece

Abstract

Introduction: Prostatic multiparametric magnetic resonance (mpMRI) allows for guided prostate biopsy (PB).Objective: To evaluate localization agreement between mpMRI lesions and histology obtained by cognitive PB and radical prostatectomy (RP) surgical specimen (SS). Methods: Out of 115 consecutive cognitive biopsied patients, 37 with positive PB were studied. Sample was characterized regarding age, prostatic volume, PI-RADS, location of lesion on mpMRI, lesion dimension, total number of fragments obtain by PB, number of fragments directed to the lesion, number of fragments with prostatic adenocarcinoma (PCa) and ISUP classification. The relationship between mpMRI and SS piece was analysed in 15 patients who underwent RP. Results: Regarding agreement between mpMRI and PB, agreement of location was observed in 26 (70.3%); 7 (18.9%) presented PCa positive fragments in the suspected zone plus others in the same lobe; 3 (8.1%) in the suspected zone plus the contralateral lobe and 1 (2.7%) had no PCa in the suspected zone but had bilateral PCa. The total number of fragments with PCa was lower in cases with agreement between mpMRI and PB (p < 0.05). Regarding agreement between mpMRI and SS, 5 cases (33.3%) presented the same location as described by mpMRI, 5 (33.3%) showed ipsilateral lesions in other zones of the prostate; 4 (26.7%) presented extensive bilateral lesions on all prostate zones and 1 (6.7%) showed previously unknown contralateral lesions. None of the factors studied related mpMRI and RP (p > 0.05). Conclusions: Localization agreement of mpMRI vs PB and mpMRI vs SS was present in 26/37 (70.3%) and 5/15 (33.3%), respectively. That suggests the existence of other lesions (multifocality) not identified on mpMRI.

Magnetic resonance imaging target fusion biopsy vs. transrectal ultrasound-guided biopsy - A comparative study of ISUP score upgrading risk in the final radical prostatectomy specimen

“…Other variables, such as the specific number, extent, location and PIRADS classification of suspicious lesions on mpMRI, and their respective association with the PCa diagnosis in both biopsy cores and surgical specimens were not assessed in our study. However, Lourenço et al suggest that PCa multifocality can be an indicator of ISUP upgrading risk in patients who were discordant in mpMRI location of the suspicious lesions either in the cognitive fusion biopsy cores or PR specimens (30). Nevertheless, we believe that this study reinforces the key role of MRI as a diagnostic and staging tool in PCa.…”

mpMRI PI-RADS score 3 lesions diagnosed by reference vs affiliated radiological centers: Our experience in 950 cases

“…In conclusion, PI-RADS 3 lesions exhibited aggressive features in a not negligible proportion of cases but a quality control of mpMRI by experienced radiologists improve the accuracy of the procedure; a second opinion is mandatory especially in men enrolled in AS protocols in whom clinical parameters (5,24,25) and mpMRI (26)(27)(28) are recommended to reduce the number of scheduled repeated prostate biopsies.…”

Attitudes and perceptions towards multiparametric magnetic resonance imaging of the prostate: A national survey among Italian urologists

“…Of note, the adoption of visualcognitive guidance was significantly lower in Northern Italy and in centers where more than 20 radical prostatectomies are performed monthly. Of note, the modality of lesion targeting during prostate biopsy represents a controversial and evolving issue (27)(28)(29). Beyond technical aspects, tumor multifocality is frequently involved in the discrepancies between findings from mp-MRI, prostate biopsy, and surgical specimens (29).…”

“…Of note, the modality of lesion targeting during prostate biopsy represents a controversial and evolving issue (27)(28)(29). Beyond technical aspects, tumor multifocality is frequently involved in the discrepancies between findings from mp-MRI, prostate biopsy, and surgical specimens (29). Although MRI-guidance may represent a promising technique of biopsy guidance, it is still considered a time-consuming and expensive procedure and further investigations are needed to identify the ideal candidates (30).…”