Targeted MRI-guided prostate biopsy: are two biopsy cores per MRI-lesion required?

Schimmöller, Lars; Quentin, Michael; Blondin, D.; Dietzel, Frederic; Hiester, Andreas; Schleich, Christoph; Thomas, Colleen S.; Robert, René; Gabbert, Helmut E.; Albers, Peter; Antoch, Gerald; Arsov, Christian

doi:10.1007/s00330-016-4266-x

Cited by 23 publications

(14 citation statements)

References 30 publications

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“…However, a recent study found limited benefit when taking a second biopsy core per target lesion with MRI in-bore biopsy [17]. In our TR and TP cohorts, we found PCa diagnosed with an additional targeted biopsy core in about 20–30% of cases, indicating that at least two targeted biopsy cores might be reasonable.…”

Section: Discussionmentioning

confidence: 59%

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Evaluation of MRI/Ultrasound Fusion-Guided Prostate Biopsy Using Transrectal and Transperineal Approaches

Tewes

Peters

Tiemeyer

et al. 2017

BioMed Research International

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Purpose To evaluate transrectal (TR) and transperineal (TP) approaches for MRI/ultrasound (MRI/US) fusion-guided biopsy to detect prostate cancer (PCa). Materials and Methods 154 men underwent multiparametric MRI and MRI/US fusion-guided biopsy between July 2012 and October 2016. 79/154 patients were biopsied with a TR approach and 75/154 with a TP approach. MRI was retrospectively analyzed according to PI-RADS version 2. PI-RADS scores were compared with histopathological results. Descriptive statistics, accuracy, and negative and positive predictive values were calculated. Histopathological results of first, second, and third MRI targeted biopsy cores were compared to evaluate the impact of one verus multiple targeted cores. Results Detection rates of PCa were 39% for TR biopsy and 75% for TP biopsy. Sensitivity/specificity for tumor detection with PI-RADS ≥ 4 were 81/69% for TR biopsy and 86/84% for TP biopsy. In 31% for TR biopsy and 19% for TP biopsy, PCa was found in the second or third MRI targeted biopsy core only. Conclusion MRI/US fusion-guided biopsy may be conducted with the TR as well as the TP approach with high accuracy, giving more flexibility for diagnosis and the option for focal treatment of PCa.

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Section: Discussionmentioning

confidence: 59%

“…A recent study by Schimmoller et al found only minor benefit when taking a second targeted biopsy core in a cohort of 290 patients who underwent in-bore MRI-guided prostate biopsy [17]. …”

Section: Introductionmentioning

confidence: 99%

Evaluation of MRI/Ultrasound Fusion-Guided Prostate Biopsy Using Transrectal and Transperineal Approaches

Tewes

Peters

Tiemeyer

et al. 2017

BioMed Research International

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“…First, it is important to be able to reliably confirm location of the target. Second, once the target location has been determined and the biopsy needle has been placed, it is desirable to confirm the accurate needle position [17]. In this paper we investigate the potential application of DWI for intra-procedural confirmation of the target location.…”

Section: Introductionmentioning

confidence: 99%

Segmented diffusion-weighted imaging of the prostate: Application to transperineal in-bore 3T MR image-guided targeted biopsy

Fedorov

Tuncalı

Panych

et al. 2016

Magnetic Resonance Imaging

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Objective-To evaluate the applicability of using single-shot and multi-shot segmented diffusion-weighted imaging (DWI) techniques to support biopsy target localization in a cohort of targeted MRI-guided prostate biopsy patients.Materials and Methods-Single-shot echo-planar diffusion-weighted imaging (SS-DWI) and multi-shot segmented (MS-DWI) were performed intra-procedurally on a 3 Tesla system in a total of 35 men, who underwent in-bore prostate biopsy inside the scanner bore. Comparisons between SS-DWI and MS-DWI were performed with (in 16 men) and without (in 19 men) parallel coil acceleration (iPAT) for SS-DWI. Overall image quality and artifacts were scored by a radiologist and scores were compared with the Wilcoxon Mann-Whitney rank test. Correlation between the presence of air and image quality scores was evaluated with Spearman statistics. To quantify distortion, the anteroposterior prostate dimension was measured in SS and MS b=0 diffusion-and T 2 -weighted images. Signal-to-noise ratio was estimated in a phantom experiment. Agreement and accuracy of targeting based on retrospective localization of restricted diffusion areas in DWI was evaluated with respect to the targets identified using multiparametric MRI (mpMRI).Results-Compared to SS-DWI without iPAT, the average image quality score in MS-DWI improved from 2.0 to 3.3 (p<0.005) and the artifact score improved from 2.3 to 1.4 (p<0.005). When iPAT was used in SS-DWI, the average image quality score in MS-DWI improved from 2.6 to 3.3 (p<0.05) and the artifact score improved from 2.1 to 1.4 (p<0.01). Image quality (ρ=−0.74, p<0.0005) and artifact scores (ρ=0.77, p<0.0005) both showed strong correlation with the presence of air in the rectum for the SS-DWI sequence without iPAT. These correlations remained Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. HHS Public Access Author ManuscriptAuthor Manuscript Author ManuscriptAuthor Manuscript significant when iPAT was enabled (ρ=−0.52, p<0.05 and ρ=0.64, p<0.01). For the comparison MS-DWI vs SS-DWI without iPAT, median differences between diffusion-and T 2 -weighted image gland measurements were 1.1 (0.03-10.4) mm and 4.4 (0.5-22.7) mm, respectively. In the SS-DWI-iPAT cohort, median gland dimension differences were 2.7 (0.4-5.9) mm and 4.2 (0.7-8.9) mm, respectively. Out of the total of 89 targets identified in mpMRI, 20 had corresponding restricted diffusion areas in SS-DWI and 28 in MS-DWI. No statistically significant difference was observed between the distances for the targets in the target-concordant SS-and MS-DWI restricted diffusion areas (5.5 mm in SS-DWI...

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“…There is growing evidence that missed cancer rates of in-bore MRI guided biopsies are low, ranging from 6% to 10% (42,43). …”

Section: Evidence Synthesismentioning

confidence: 99%

“…A recent study by Schimmöller et al (43) has retrospectively evaluated the utility of two targeted biopsy cores per mpMRI-lesion within in-bore guided biopsy in 290 men. They demonstrated that taking only one biopsy core per lesion using the in-bore approach does not significantly affect the final Gleason classification when compared to 2 cores.…”

Section: Evidence Synthesismentioning

confidence: 99%

A critical comparison of techniques for MRI-targeted biopsy of the prostate

Giganti¹,

Moore²

2017

Transl. Androl. Urol.

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MRI-targeted biopsy is a promising technique that offers an improved detection of clinically significant prostate cancer over standard non-targeted biopsy. It is established that prostate MRI is of use in both the primary and repeat biopsy setting for the detection of significant prostate cancer. There are three approaches to targeting biopsies to areas of interest seen on prostate MRI. They each rely on the acquisition and reporting of a diagnostic quality multi-parametric MRI scan used to identify areas of interest, and the subsequent use of those diagnostic quality images in combination with real-time images of the prostate during the biopsy procedure. The three techniques are: visual registration of the MRI images with a real-time ultrasound image; software-assisted fusion of the MRI images and the real-time ultrasound images, and in-bore biopsy, which requires registration of a diagnostic quality MRI scan with a real time interventional MRI image. In this paper we compare the three techniques and evaluate those studies where there is a direct comparison of more than one MRI-targeting technique. PubMed was searched from inception to November 2016 using the search terms (cognitive registration OR visual registration OR fusion biopsy OR in-bore biopsy OR targeted biopsy) AND (prostate cancer OR prostate adenocarcinoma OR prostate carcinoma OR prostatic carcinoma OR prostatic adenocarcinoma) AND (MRI OR NMR OR magnetic resonance imaging OR mpMRI OR multiparametric MRI). The initial search included 731 abstracts. Eleven full text papers directly compared two or more techniques of MRI-targeting, and were selected for inclusion. The detection of clinically significant prostate cancer varied from 0% to 93.3% for visual registration, 23.2% to 100% for software-assisted registration and 29% to 80% for in-bore biopsy. Detection rates for clinically significant cancer are dependent on the prevalence of cancer within the population biopsied, which in turn is determined by the selection criteria [biopsy naïve, previous negative biopsy, prostate specific antigen (PSA) selection criteria, presence of a lesion on MRI]. Cancer detection rates varied more between study populations than between biopsy approaches. Currently there is no consensus on which type of MRI-targeted biopsy performs better in a given setting. Although there have been studies supporting each of the three techniques, substantial differences in methodology and reporting the findings make it difficult to reliably compare their outcomes.

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Targeted MRI-guided prostate biopsy: are two biopsy cores per MRI-lesion required?

Cited by 23 publications

References 30 publications

Evaluation of MRI/Ultrasound Fusion-Guided Prostate Biopsy Using Transrectal and Transperineal Approaches

Evaluation of MRI/Ultrasound Fusion-Guided Prostate Biopsy Using Transrectal and Transperineal Approaches

Segmented diffusion-weighted imaging of the prostate: Application to transperineal in-bore 3T MR image-guided targeted biopsy

A critical comparison of techniques for MRI-targeted biopsy of the prostate

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