Transperineal US-MRI Fusion-Guided Biopsy for the Detection of Clinical Significant Prostate Cancer: A Systematic Review and Meta-Analysis Comparing Cognitive and Software-Assisted Technique

Abstract

Introduction: We aimed to find potential differences in clinically significant prostate cancer (csPCa) detection rates between transperineal software-assisted fusion biopsy (saFB) and cognitive fusion biopsies (cFB). Methods: A systematic review of the literature was performed to identify comparative studies using PubMed, EMBASE, and Scopus according to the PICOS criteria. Cancer detection and complication rates were pooled using the Cochran–Mantel–Haenszel method with the random effect model and reported as odds ratios (ORs), 95% confidence intervals (CI), and p-values. A meta-analysis was performed using Review Manager (RevMan) 5.4 software by Cochrane Collaboration. The quality assessment of the included studies was performed using the Cochrane Risk of Bias tool, using RoB 2 for randomized studies and ROBINS-I for retrospective and nonrandomized ones. Results: Eight studies were included for the meta-analysis, including 1149 cases in software-based and 963 cases in cognitive fusion biopsy. The detection rates of csPCa were similar between the two groups (OR 1.01, 95% CI 0.74–1.37, p = 0.95). Study heterogeneity was low (I2 55%). Conclusion: There is no actual evidence of the superiority of saFB over cFB in terms of the csPCa detection rate. Operator experience and software availability can drive the choice of one fusion technique over the other.

Residents and Consultants Have Equal Outcomes When Performing Transrectal Fusion Biopsies: A Randomized Clinical Trial

“…Pirola et al recently performed a systematic review and meta-analysis to compare cognitive vs. software fusion biopsy. According to the eight studies evaluated, the detection rates of csPCa were similar between the two groups (OR 1.01, 95% CI 0.74-1.37, p = 0.95) and study heterogeneity was low (I 2 55%) [42]. The literature on the subject is very vast, and hundreds of papers are being published on the topic.…”

The learning curve and experience of a novel multi-modal image fusion targeted transperineal prostate biopsy technique using electromagnetic needle tracking under local anesthesia

“…The multi-modal image fusion targeted transperineal prostate biopsy based on mpMRI mainly includes mpMRI-TRUS cognitive fusion, in-bore fusion and AI software fusion. The cognitive fusion targeted biopsy process is greatly influenced by subjective factors and the surgeon’s level of film reading, which may lead to missed diagnosis ( 23 , 24 ). In this study, mpMRI images and TRUS images are intelligently elastic fused with the help of the software provided by the multi-modal AI image fusion ultrasound system, which reduces the operator’s requirements for mpMRI images reading ability and improves the accuracy of targeted puncture.…”

MRI–Ultrasound Fused Approach for Prostate Biopsy—How It Is Performed

“…[51] Image fusion biopsy techniques have demonstrated improved accuracy over cognitive fusion in several single-institution studies [52][53][54]. In recent meta-analyses and numerous single institutional studies, however, there have been no demonstrated significant differ-ences between cognitive biopsy and image fusion techniques in terms of csPCa detection rates [36,38,[55][56][57][58][59]. Despite similar detection rates, image fusion biopsy has been shown to have improved detection rates of anterior and transition zone lesions, while cognitive fusion has been shown to have improved detection of lesions at the base, suggesting a potential complementary effect of these techniques [27,36,56,57].…”