Value of systematic biopsy added to target biopsy for detecting significant cancer in men with Prostate Imaging and Reporting and Data System 5

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.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Chang

2021

Front. Oncol.

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“…Radiologists and urologists need to be familiar with the following biopsy techniques for lesion detection on TRUS ( Table 3 ). First, prostate compression should be minimized to improve tumor detection during TRUS ( Figure 2 , Figure 4 , Figure 6 , Figure 7 and Figure 8 ) [ 24 , 25 , 26 , 28 , 29 ]. When a transducer is introduced into the rectum, the prostate is likely to be deformed into a banana shape ( Figure 3 and Figure 5 ).…”

Section: Trus Biopsy Techniquesmentioning

confidence: 99%

“…Currently, radiologists and urologists use TRUS to perform a cognitive fusion or image fusion biopsy following an MRI scan [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. However, they often do not know how to make TRUS protocols, how to read imaging findings, and how to perform biopsy techniques for lesion detection and targeting [ 24 , 25 , 26 , 27 , 28 , 29 ]. TRUS scans are of great importance for taking a precise biopsy when cognitive fusion or imaging fusion is performed.…”

Section: Introductionmentioning

confidence: 99%

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How to Improve TRUS-Guided Target Biopsy following Prostate MRI

2021

Cancers

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TRUS is a basic imaging modality when radiologists or urologists perform cognitive fusion or image fusion biopsy. This modality plays the role of the background images to add to an operator’s cognitive function or MRI images. Operators need to know how to make TRUS protocols for lesion detection or targeting. Tumor location, size, and shape on TRUS are different from those on MRI because the scan axis is different. TRUS findings of peripheral or transition tumors are not well known to radiologists and urologists. Moreover, it remains unclear if systematic biopsy is necessary after a tumor is targeted. The purpose of this review is to introduce new TRUS protocols, new imaging features, new biopsy techniques, and to assess the necessity of systematic biopsy for improving biopsy outcomes.

Transrectal ultrasound features and biopsy outcomes of transition PI-RADS 5

Chung

2021

Acta Radiol

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Background Transition Prostate Imaging and Reporting and Data System (PI-RADS) 5 is easily detected owing to typical magnetic resonance imaging features. However, it is unclear as to how transition PI-RADS 5 appears on transrectal ultrasound (TRUS). Purpose To assess TRUS features of transition PI-RADS 5 and outcomes of TRUS-guided target biopsy. Material and Methods Between March 2014 and November 2018, 186 male patients underwent TRUS-guided biopsy of PI-RADS 5. Of them, 82 and 104were transition and peripheral PI-RADS 5, respectively. Transition and peripheral PI-RADS 5 were compared according to echogenicity (hyperechoic or hypoechoic) and hypoechoic rim (present or absent). Each tumor was targeted with TRUS based on TRUS features. Significant (Gleason score ≥7) and insignificant (Gleason score 6) cancer detection rates (CDRs) were compared between transition and peripheral PI-RADS 5. Standard reference was biopsy examination. Fisher’s exact test was used for statistical analysis. Results Transition PI-RADS 5 was hyperechoic in 89.0% (73/82) and had a hypoechoic rim in 97.6% (80/82), whereas peripheral PI-RADS 5 was hypoechoic in 99.0% (103/104) and had a hypoechoic rim in 26.9% (28/104) (both, P<0.0001). The significant CDRs of transition and peripheral PI-RADS 5 were 56.1% (46/82) and 65.4% (68/104), respectively ( P=0.2263). However, the insignificant CDRs of these categories were 22.0% (18/82) and 8.7% (9/104), respectively ( P=0.0123). Conclusion Transition PI-RADS 5 tends to have hyperechoic echogenicity and a hypoechoic rim. These findings help to target the transition PI-RADS 5 using TRUS. However, transition PI-RADS 5 is confirmed more frequently as insignificant cancer than peripheral PI-RADS 5.