Role of Core Number and Location in Targeted Magnetic Resonance Imaging-Ultrasound Fusion Prostate Biopsy

Lu, Amanda; Syed, Jamil; Ghabili, Kamyar; Hsiang, Walter; Nguyen, Kevin A.; Leapman, Michael; Sprenkle, Preston

doi:10.1016/j.eururo.2019.04.008

Cited by 66 publications

(44 citation statements)

References 9 publications

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“…Several studies have suggested that the sampling of anterior lesions could be less accurate than that reported in peripheral lesions, and could lead to a higher risk of upgrading [16]. However, Lu et al recently noticed that the detection of significant cancer by TB did not differ by tumor location [7]. We used a standard transrectal route for all prostate biopsies; however, a transperineal TB approach might be relevant for these anterior tumors to improve both detection and GG prediction [19].…”

Section: Discussionmentioning

confidence: 96%

“…In other studies, the TB core number was decided at physician's discretion, and no clear consensus exists. Lu et al recently found that sampling of five cores missed substantially fewer cancers than two cores [7]. However, they did not assess that ideal core number as a function of MRI lesion characteristics such as maximum diameter of the lesion, number, and PIRADS score.…”

Section: Discussionmentioning

confidence: 99%

“…Actual prostate cancer guidelines recommend the realization of a multiparametric MRI prior to biopsies [1][2][3][4][5]. The ideal way to target remains unclear (in-bore, cognitive, or software-based fusion; transrectal; or transperineal approach) as well as the ideal targeted biopsy (TB) core number to be taken [6,7]. Moreover, no study has assessed the ideal TB core number for an adequate grade group prediction and to reduce the risk of final upgrading.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of the Minimal Targeted Biopsy Core Number per MRI Lesion for Improving Prostate Cancer Grading Prediction

Ploussard

Beauval

Renard-Penna

et al. 2020

JCM

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Background: To study the impact of MRI characteristics and of targeted biopsy (TB) core number on the final grade group (GG) prediction. Materials and Methods: The cohort was 478 consecutive patients who underwent radical prostatectomy (RP) after positive mpMRI (multiparametric magnetic resonance imaging) followed by fusion TB. Endpoints were the upgrading and concordance rates between TB and RP specimens. Results: Upgrading rate after TB was 40.6%. Patients with upgrading had lower PIRADS (Prostate Imaging-Reporting and Data System) scores (p < 0.001), smaller lesion size (p = 0.017), fewer TB cores (p < 0.001), and lower TB density (p = 0.015) compared with cases with grade concordance. There was a significant continuous improvement in upgrading rate when TB core number per lesion increased from 56.3% to 25.6% when <2 or ≥5 TB cores were taken, respectively (p = 0.002). The minimal TB number per lesion to reduce upgrading risk to approximately 30%was 4 in PIRADS 3, and 3 in PIRADS 4–5 cases. Conclusions: Grade group prediction by TB is significantly improved by higher PIRADS score, larger lesion size, and increased TB per lesion. At least four TB cores should be taken in PIRADS 3 score lesions, whereas three cores seem enough in PIRADS 4–5 cases to improve GG prediction and limit upgrading risk.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessment of the Minimal Targeted Biopsy Core Number per MRI Lesion for Improving Prostate Cancer Grading Prediction

Ploussard

Beauval

Renard-Penna

et al. 2020

JCM

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“…Biopsy considerations The morphology of the suspected peripheral zone lesion in the right apex is large; targeted cores of the lesion will most likely hit the lesion. To limit undersampling, up to five cores might be sufficient [50]. The morphology of the suspected peripheral zone lesion in the left apex is small.…”

Section: Combining Multivariable Risk Prediction Tools Including Mrimentioning

confidence: 99%

Personalizing prostate cancer diagnosis with multivariate risk prediction tools: how should prostate MRI be incorporated?

Schoots

Padhani

2019

World J Urol

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Risk-based patient selection for systematic biopsy in prostate cancer diagnosis has been adopted in daily clinical practice, either by clinical judgment and PSA testing, or using multivariate risk prediction tools. The use of multivariable risk prediction tools can significantly reduce unnecessary systematic biopsies, without compromising the detection of clinically significant disease. Increasingly multi-parametric magnetic resonance imaging (MRI) is performed, not only in men with a persistent suspicion of prostate cancer after prior negative systematic biopsy, but also at initial screening before the first biopsy. The combination of MRI and multivariate risk prediction tools could potentially enhance prostate cancer diagnosis using multivariate MRI incorporated risk-based models to decide on the need for prostate MRI, but also using MRI results to adjusted risk-based models, and to guide MRI-directed biopsies. In this review, we discuss the diagnostic work-up for clinically significant prostate cancer, where the combination of MRI and multivariate risk prediction tools is integrated, and how together they can contribute to personalized diagnosis.Keywords Prostate cancer · Biopsy · Magnetic resonance imaging (MRI) · Risk stratification · Multivariate risk prediction · Risk calculator · NomogramThe following relevant activities related to the submitted work: Ivo G. Schoots is a full panel member of the EAU-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer, and a full panel member of the PI-RADS Steering committee. Anwar R. Padhani is Co-Chair of the PI-RADS Steering committee.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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“… 4 , 5 However, the ideal number of biopsy cores to be obtained from each lesion with regard to the type and characteristics of the lesion remains controversial, and there is no consensus in the literature regarding this controversy, which is a major concern in clinical practice. 6 , 7 , 8 , 9 As a matter of fact, however, obtaining an insufficient number of biopsy cores from suspicious lesions may lead to false negative results, whereas obtaining an excessive number of biopsy cores may result in additional complications, reduced patient comfort, and workforce and time loss. 10 , 11 …”

Section: Introductionmentioning

confidence: 99%

What is the ideal number of biopsy cores per lesion in targeted prostate biopsy?

Sönmez

Demirtaş

Tombul

et al. 2020

Prostate International

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Background The number of cores to be obtained in targeted biopsy (TB) is important. This study aimed to evaluate the TB outcomes in suspicious prostate lesions classified according to the Prostate Imaging Reporting and Data System (PI-RADS) and to determine the ideal number of biopsy cores per lesion. Methods This retrospective study included patients who underwent multiparametric magnetic resonance imaging–guided fusion prostate biopsy owing to increased serum prostate-specific antigen (PSA) levels and suspicious digital rectal examination outcomes in our institute. Patients with PI-RADS <3 lesions, PSA levels >10 ng/ml, and a prior diagnosis of prostate cancer (PCa) (active surveillance) were excluded from the study. The number of biopsy cores to be obtained from each lesion was determined by the clinician. Results The study included a total of 418 patients and 684 lesions. Among PI-RADS 3 lesions, clinically significant PCa (sPCa) detection rate was similar in the lesions from which 2 and 3 cores were obtained (9.1% and 10.0%, respectively), whereas it was relatively higher in the lesions from which 4 biopsy cores were obtained (18.5%). Among PI-RADS 4 lesions, sPCa detection rate was similar in the lesions from which 3 and 4 cores were obtained (35.6% and 32.3%, respectively), whereas it was relatively lower in the lesions from which 2 biopsy cores were obtained (17.9%). Among PI-RADS 5 lesions, however, sPCa detection rate was similar in the lesions from which 2, 3, or 4 cores were obtained (47.6%, 46.0%, 48.9%, respectively). Conclusion The results indicated that the ideal number of cores to be obtained from each suspicious lesion in TB depends on the characteristics of the lesions. Accordingly, while obtaining 2–3 biopsy cores could be adequate in PI-RADS 4 and 5 lesions, which have a serious risk of cancer, a minimum of 4 biopsy cores should be obtained from PI-RADS 3 lesions to ensure accurate histopathological results. Clinical trial number ( ClinicalTrials.gov ) NCT03936296 .

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Role of Core Number and Location in Targeted Magnetic Resonance Imaging-Ultrasound Fusion Prostate Biopsy

Cited by 66 publications

References 9 publications

Assessment of the Minimal Targeted Biopsy Core Number per MRI Lesion for Improving Prostate Cancer Grading Prediction

Assessment of the Minimal Targeted Biopsy Core Number per MRI Lesion for Improving Prostate Cancer Grading Prediction

Personalizing prostate cancer diagnosis with multivariate risk prediction tools: how should prostate MRI be incorporated?

What is the ideal number of biopsy cores per lesion in targeted prostate biopsy?

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