New Biopsy Techniques and Imaging Features of Transrectal Ultrasound for Targeting PI-RADS 4 and 5 Lesions

2020

Precis Future Med

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Purpose: Recently, new magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) techniques and imaging features of Prostate Imaging and Report and Data System (PI-RADS) 4 or 5 have been reported. The aim of this study was to validate the outcomes of new TRUS-guided biopsy techniques for cancer detection in patients with PI-RADS 4 or 5. Methods: Between June 2018 and November 2018, 94 men underwent TRUS-guided biopsy after PI-RADS 4 (n = 59) or 5 (n = 35) was categorized as an index lesion on MRI. For PI-RADS 4 group, target biopsy was performed in 5 and combination biopsy (target and systematic biopsies) was in 54. For PI-RADS 5 group, target biopsy was performed in 19 and combination biopsy was in 16. Target to combination biopsy ratios and significant cancer detection rates (CDRs) were compared between the groups. Significant cancer was defined as a Gleason score ≥ 7 tumor. Standard reference was biopsy examination. Fisher's exact were used for statistical analysis. Results: Target to combination biopsy ratios was 5:54 in the PI-RADS 4 group and 19:16 in the PI-RADS 5 group (P < 0.0001). The significant CDR of the target biopsy were 42.4% (25/59) in the PI-RADS 4 group and 82.6% (29/35) in the PI-RADS 5 group (P = 0.0002). The significant CDR of combination biopsy was 44.1% (26/59) in the PI-RADS 4 group and 85.7% (30/35) in the PI-RADS 5 group (P < 0.0001). Conclusion: New TRUS biopsy techniques provides high significant CDR patients with PI-RADS 4 or 5. Therefore, TRUS should be performed prior to fusion or in-bore biopsy to determine if these categories are visible.

Section: Introductionmentioning

confidence: 99%

Validation of new TRUS biopsy techniques for PI-RADS 4 or 5

2020

Precis Future Med

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“…Tumor locations appear so different between MRI and TRUS because of the different scan axes. Axial MRI images are scanned along the perpendicular axis of the prostate urethra, whereas axial TRUS images are scanned along the oblique axis of the prostate urethra (6,7,10,17). For this reason, when PI-RADS 4 or 5 is closer to the anterior capsule, the tumor seems to be located more inferiorly on TRUS than on MRI.…”

Section: Discussionmentioning

confidence: 99%

“…Another technical tip for achieving good lesion depiction is to not compress the prostate until PI-RADS 4 or 5 is detected. Compression deforms the shape of the PI-RADS 4 or 5 but also obscures a small tumor because it is frequently embedded in the normal tissue (6,9,10,17).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several investigators reported the new TRUS features of peripheral or transition PI-RADS 4 or 5 lesions (6)(7)(8)(9)(10)(11). They also introduced new TRUS techniques, such as how to choose the imaging sequence, control image contrast, compress the prostate, and localize a tumor (6)(7)(8)(9)(10)(11). However, they did not determine whether being familiar with the new TRUS techniques and imaging features influenced on tumor targeting.…”

Section: Introductionmentioning

confidence: 99%

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New TRUS Techniques and Imaging Features of PI-RADS 4 or 5: Influence on Tumor Targeting

Chang

2021

Front. Oncol.

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PurposeTo determine if the new transrectal ultrasound (TRUS) techniques and imaging features contribute to targeting Prostate Imaging and Reporting and Data System (PI-RADS) 4 or 5.Materials and MethodsBetween December 2018 and February 2020, 115 men underwent cognitive biopsy by radiologist A, who was familiar with the new TRUS findings and biopsy techniques. During the same period, 179 men underwent magnetic resonance imaging–TRUS image fusion or cognitive biopsy by radiologist B, who was unfamiliar with the new biopsy techniques. Prior to biopsy, both radiologists knew MRI findings such as the location, size, and shape of PI-RADS 4 or 5. We recorded how many target biopsies were performed without systematic biopsy and how many of these detected higher Gleason score (GS) than those detected by systematic biopsy. The numbers of biopsy cores were also obtained. Fisher Exact or Mann–Whitney test was used for statistical analysis.ResultsFor PI-RADS 4, target biopsy alone was performed in 0% (0/84) by radiologist A and 0.8% (1/127) by radiologist B (p>0.9999). Target biopsy yielded higher GSs in 57.7% (30/52) by radiologist A and 29.5% (23/78) by radiologist B (p = 0.0019). For PI-RADS 5, target biopsy alone was performed in 29.0% (9/31) by radiologist A and 1.9% (1/52) by radiologist B (p = 0.0004). Target biopsy yielded higher GSs in 50.0% (14/28) by radiologist A and 18.2% (8/44) by radiologist B (p = 0.0079). Radiologist A sampled fewer biopsy cores than radiologist B (p = 0.0008 and 0.0023 for PI-RADS 4 and 5), respectively.ConclusionsPI-RADS 4 or 5 can be more precisely targeted if the new TRUS biopsy techniques are applied.

“…The biopsy operator was already familiar with the TRUS techniques and imaging features which were reported by Park and Park [14].…”

Section: Mri Sequences and Biopsy Techniquesmentioning

confidence: 99%

Is transrectal ultrasound-guided systematic biopsy necessary after PI-RADS 4 is targeted?

Kim

2021

Precis Future Med

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Purpose: Target biopsy is usually performed in Prostate Imaging Reporting and Data System (PI-RADS) 4. Still, it is unclear if adding systematic biopsy to target biopsy influences cancer detection. The aim was to assess the role of systematic biopsy for detecting significant cancer after PI-RADS 4 is targeted. Methods: Between March 2014 and November 2018, 182 men with PI-RADS 4 underwent transrectal ultrasound (TRUS)-guided biopsy. Systematic biopsy was added to target biopsy in 128 men (Group I) by May 2018 because PI-RADS 4 was not completely visible on TRUS, while it was done in 54 men (Group II) from June 2018 regardless of lesion visibility. Significant cancer detection rates (CDRs) were compared between the groups regarding target and systematic biopsies. Major complication rate was also compared. Significant cancer was defined as a Gleason score ≥ 7 tumor. Standard reference was biopsy examination. Fisher's exact were used for statistical analysis. Results: The significant CDRs were 21.9% (28/128) in the Group I and 38.9% (21/54) in the Group II (P = 0.0273). The significant cancers of Group I and II were missed in two (1.6%) and in one (1.9%) by target biopsy, respectively. Major complication rates of these groups were 0.8% (1/128) and 0% (0/54), respectively (P = 0.999). Conclusion: Systematic biopsy should be added to target biopsy even though PI-RADS 4 is clearly visible on ultrasound. A significant number of significant cancers are detected with systematic biopsy.