Multiparametric Magnetic Resonance/Ultrasound Fusion Prostate Biopsy: Number and Spatial Distribution of Cores for Better Index Tumor Detection and Characterization

Porpiglia, Francesco; Luca, Stefano De; Passera, Roberto; Pascale, A. De; Amparore, Daniele; Cattaneo, Giovanni; Checcucci, Enrico; Cillis, Sabrina De; Garrou, D.; Manfredi, Matteo; Mele, F.; Bollito, Enrico; Fiori, Cristian

doi:10.1016/j.juro.2017.01.036

Cited by 56 publications

(37 citation statements)

References 24 publications

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“…Additional focal perilesional saturation with four cores has been suggested to reduce the risk of missing or undersampling the lesion [2]. Consistent with two recently published studies by Porpiglia et al [30,31] and Kenigsberg et al [30,31], our present study showed that a high diagnostic yield can be achieved for all different PI-RADS lesions with a median of two TBx cores per lesion. Rather than adhering to a fixed number of biopsy cores, we believe that individual biopsy operators should critically evaluate their own TBx outcomes with imaging and pathological feedback to determine how to optimise MRI-TRUS-fusion biopsy in their own hands.…”

Section: Discussionsupporting

confidence: 91%

Detection of clinically significant prostate cancer in biopsy‐naïve men: direct comparison of systematic biopsy, multiparametric MRI‐ and contrast‐ultrasound‐dispersion imaging‐targeted biopsy

et al. 2020

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To compare and evaluate a multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy (TBx) strategy, contrast-ultrasound-dispersion imaging (CUDI)-TBx strategy and systematic biopsy (SBx) strategy for the detection of clinically significant prostate cancer (csPCa) in biopsy-na€ ıve men. Patients and Methods A prospective, single-centre paired diagnostic study included 150 biopsy-na€ ıve men, from November 2015 to November 2018. All men underwent pre-biopsy mpMRI and CUDI followed by a 12-core SBx taken by an operator blinded from the imaging results. Men with suspicious lesions on mpMRI and/or CUDI also underwent MRI-TRUS fusion-TBx and/ or cognitive CUDI-TBx after SBx by a second operator. A non-inferiority analysis of the mpMRI-and CUDI-TBx strategies in comparison with SBx for International Society of Urological Pathology Grade Group [GG] ≥2 PCa in any core with a non-inferiority margin of 1 percentage point was performed. Additional analyses for GG ≥2 PCa with cribriform growth pattern and/or intraductal carcinoma (CR/IDC), and GG ≥3 PCa were performed. Differences in detection rates were tested using McNemar's test with adjusted Wald confidence intervals. Results After enrolment of 150 men, an interim analysis was performed. Both the mpMRI-and CUDI-TBx strategies were inferior to SBx for GG ≥2 PCa detection and the study was stopped. SBx found significantly more GG ≥2 PCa: 39% (56/142), as compared with 29% (41/142) and 28% (40/142) for mpMRI-TBx and CUDI-TBx, respectively (P < 0.05). SBx found significantly more GG = 1 PCa: 14% (20/142) compared to 1% (two of 142) and 3% (four of 142) with mpMRI-TBx and CUDI-TBx, respectively (P < 0.05). Detection of GG ≥2 PCa with CR/IDC and GG ≥3 PCa did not differ significantly between the strategies. The mpMRI-and CUDI-TBx strategies were comparable in detection but the mpMRI-TBx strategy had less false-positive findings (18% vs 53%). Conclusions In our study in biopsy-na€ ıve men, the mpMRI-and CUDI-TBx strategies had comparable PCa detection rates, but the mpMRI-TBX strategy had the least false-positive findings. Both strategies were inferior to SBx for the detection of GG ≥2 PCa, despite reduced detection of insignificant GG = 1 PCa. Both strategies did not significantly differ from SBx for the detection of GG ≥2 PCa with CR/IDC and GG ≥3 PCa.

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Section: Discussionsupporting

confidence: 91%

Detection of clinically significant prostate cancer in biopsy‐naïve men: direct comparison of systematic biopsy, multiparametric MRI‐ and contrast‐ultrasound‐dispersion imaging‐targeted biopsy

et al. 2020

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“…These studies also document low yields of sampling normal-appearing nonadjacent sextants that do not alter overall risk stratification in the majority of patients with a cancer diagnosis (Fig 2) (8,35,67). Multiple analyses indicate that when targeted biopsies are performed, additional cores (so-called focal saturation) increase biopsy yields (67,(69)(70)(71)(72); however, the optimal number of focal saturation biopsy cores remains undefined (8,69,70,73).…”

Section: Patient Implications After Intermediate-or High-likelihood Mmentioning

confidence: 99%

PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway

Padhani¹,

Barentsz²,

Villeirs³

et al. 2019

Radiology

175

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he current version of the Prostate Imaging Reporting and Data System (PI-RADS) was formulated on experience gained from PI-RADS version 1, accumulated scientific evidence, and expert consensus (1). The release of PI-RADS version 2.1 is expected to further improve observer variability (2). A recent publication evaluated multiple clinical studies, systematic analyses, and professional guidelines on their use of multiparametric MRI in prostate cancer detection (3). It showed that the test performance of multiparametric MRI-directed biopsy in the detection of prostate cancer is superior to that of systematic transrectal US-guided biopsy. High-level evidence has now established multiple benefits of MRI-directed biopsy over systematic transrectal US-guided biopsy of the prostate (4). These benefits include (a) a reduction in the number of men who need to undergo biopsy (5-9); (b) a reduction in the number of diagnoses of clinically insignificant cancers that are unlikely to cause harm (4,10), with the potential to reduce overtreatment, treatment-related complications, and active surveillance rates (6); (c) improved detection of clinically significant prostate cancers, particularly in patients with prior negative transrectal US-guided biopsy findings (4,10); and (d) improved risk stratification of diagnosed cancers owing to greater precision in tumor grade and volume determinations, which helps direct disease management. All these advantages can be achieved with fewer targeted biopsy cores per patient, potentially reducing biopsy-related morbidity (6,8,11). The purpose of this article is to focus on how multiparametric MRI results can positively impact the health of men suspected of having clinically significant prostate cancer. Who Should Undergo MRI before Biopsy? Patients chosen for MRI before biopsy include biopsynaive men with elevated serum prostate-specific antigen (PSA) levels, abnormal digital rectal examination findings, or both, and men who are deemed to have persistent elevated risk of harboring clinically significant cancers despite prior negative or nonexplanatory systematic transrectal US biopsy findings. Indications for MRI should be based on the recommendations for screening and early diagnosis of the National Comprehensive Cancer Network and the European Association of Urology (12,13). Accordingly, biopsy-naive men with lower than average risk of prostate cancer should not undergo prostate biopsy or MRI. However, limiting the options to prespecified PSA thresholds is not recommended, as there are many factors (eg, symptoms, age, race, family history, PSA kinetics, digital rectal examination findings) that in

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“…In the present study, TB cores were taken from the central area of MRI-suspicious lesions, because a higher prevalence of cancer with higher grades was expected in the central area of the targets rather than in their peripheral area. 6 Among the men with TBmissed SC and upgrading, however, 29% (6/21) and 33% (16/49) were diagnosed by SB cores inside targets, respectively, which were sampled from peripheral areas of targets in most cases. Although further spatial analysis of MRI-identified but TB-missed cancers is necessary, TB that samples both the central and peripheral areas of targets could improve clinically important cancer detection.…”

Section: Discussionmentioning

confidence: 94%

“…5 In the MRI and TB era, SB detects MRI-missed cancer from outside targets and MRI-identified cancer from inside targets incidentally. When TB is further improved technically and strategically, MRI-identified but TB-missed cancer from inside targets would decrease, 6 and the detection of MRI-missed adverse pathology, such as SC and upgrading only from outside targets, would become the main role of SB. In the present study, we explored the characteristics of patients with clinically important pathology only from outside targets, to tailor prostate biopsy to the individual in accordance with MRI findings.…”

Section: Introductionmentioning

confidence: 99%

Value of extra‐target prostate biopsy for the detection of magnetic resonance imaging‐missed adverse pathology according to the Prostate Imaging Reporting and Data System scores: Spatial analysis using magnetic resonance–ultrasound fusion images

et al. 2020

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Objectives To clarify who benefits from extra‐target sampling of systematic prostate biopsy to detect magnetic resonance imaging‐missed significant cancer and upgrading, when concurrently carried out with magnetic resonance imaging–ultrasound fusion targeted biopsy. Methods Targeted biopsy and systematic biopsy were carried out in 301 men with Prostate Imaging Reporting and Data System scores ≥3. All score ≥3 regions were designated as targets. According to patients’ highest Prostate Imaging Reporting and Data System scores, spatial relations between targets and biopsy‐proven cancer were investigated to identify magnetic resonance imaging‐missed pathology. Results Overall, targeted biopsy and systematic biopsy detected significant cancer in 56.5% and 46.5%, respectively (P < 0.001). Significant cancer was detected only by systematic biopsy in 7.0%, and only outside targets in 5.0%. Upgrading by systematic biopsy was observed in 16.3%, and occurred outside targets in 11.0%. On multivariate analysis, the highest Prostate Imaging Reporting and Data System 4 was predictive for significant cancer only outside targets (odds ratio 5.81, P = 0.002) and for upgrading derived from outside targets (odds ratio 2.64, P = 0.012). According to the scores of 3, 4 and 5, significant cancer was identified only outside targets in 1.0%, 11.2% and 2.9%, respectively (P = 0.003 for Prostate Imaging Reporting and Data System 3 vs 4; P = 0.019 for Prostate Imaging Reporting and Data System 4 vs 5), and upgrading occurred in 6.1%, 18.4% and 8.6%, respectively (P = 0.009 and 0.040). Conclusions Men with the highest Prostate Imaging Reporting and Data System score 4 receive the largest benefit from extra‐target biopsy for magnetic resonance imaging‐missed significant cancer detection and upgrading. In men with a score of 3, less adverse pathology is missed without extra‐target biopsy. These findings suggest prostate biopsy strategy could be tailored according to Prostate Imaging Reporting and Data System scores.

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Multiparametric Magnetic Resonance/Ultrasound Fusion Prostate Biopsy: Number and Spatial Distribution of Cores for Better Index Tumor Detection and Characterization

Abstract: Approaching magnetic resonance imaging/transrectal ultrasound fusion targeted biopsy with a single core might be inadequate. Rather, taking 2 cores in the center of the index lesion may provide more accurate cancer detection and optimize the chances of finding the highest Gleason pattern.

Cited by 56 publications

References 24 publications

Detection of clinically significant prostate cancer in biopsy‐naïve men: direct comparison of systematic biopsy, multiparametric MRI‐ and contrast‐ultrasound‐dispersion imaging‐targeted biopsy

Detection of clinically significant prostate cancer in biopsy‐naïve men: direct comparison of systematic biopsy, multiparametric MRI‐ and contrast‐ultrasound‐dispersion imaging‐targeted biopsy

PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway

Value of extra‐target prostate biopsy for the detection of magnetic resonance imaging‐missed adverse pathology according to the Prostate Imaging Reporting and Data System scores: Spatial analysis using magnetic resonance–ultrasound fusion images

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