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Precision of MRI/ultrasound-fusion biopsy in prostate cancer diagnosis: an ex vivo comparison of alternative biopsy techniques on prostate phantoms

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Abstract

Purpose

Comparing the accuracy of MRI/ultrasound-guided target-biopsy by transrectal biopsy (TRB) with elastic versus rigid image fusion versus transperineal biopsy (TPB) with rigid image fusion in a standardized setting.

Methods

Target-biopsy of six differently sized and located lesions was performed on customized CIRS 070L prostate phantoms. Lesions were only MRI-visible. After prior MRI for lesion location, one targeted biopsy per lesion was obtained by TRB with elastic image fusion with Artemis™ (Eigen, USA), TRB with rigid image fusion with real-time virtual sonography (Hitachi, Japan) and TPB with rigid image fusion with a brachytherapy approach (Elekta, Sweden), each on a phantom of 50, 100 and 150 ml prostate volume. The needle trajectories were marked by contrast agent and detected in a postinterventional MRI.

Results

Overall target detection rate was 79.6% with a slight superiority for the TPB (83.3 vs. 77.8 vs. 77.8%). TRB with elastic image fusion showed the highest overall precision [median distance to lesion center 2.37 mm (0.14–4.18 mm)], independent of prostate volume. Anterior lesions were significantly more precisely hit than transitional and basal lesions (p = 0.034; p = 0.015) with comparable accuracy for TRB with elastic image fusion and TPB. In general, TRB with rigid image fusion was inferior [median 3.15 mm (0.37–10.62 mm)], particularly in small lesions.

Conclusion

All biopsy techniques allow detection of clinically significant tumors with a median error of 2–3 mm. Elastic image fusion appears to be the most precise technique, independent of prostate volume, target size or location.

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Acknowledgements

Prostate phantoms were funded by the Viktor-and-Sigrid-Dulger-foundation (Heidelberg, Germany). We thank Dr. Volker Seitz for his critical review of the manuscript.

Authors’ contribution

NW and MR were involved in project development, data collection and data analysis, manuscript writing; FPS collected and analyzed the data; DH and MP collected the data; JvH and MSM edited the manuscript.

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Authors and Affiliations

  1. Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    N. Westhoff, F. P. Siegel, J. von Hardenberg, M. S. Michel & M. Ritter

  2. Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

    D. Hausmann

  3. Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

    M. Polednik

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  1. N. Westhoff
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Correspondence to N. Westhoff.

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This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study formal consent is not required.

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Westhoff, N., Siegel, F.P., Hausmann, D. et al. Precision of MRI/ultrasound-fusion biopsy in prostate cancer diagnosis: an ex vivo comparison of alternative biopsy techniques on prostate phantoms. World J Urol 35, 1015–1022 (2017). https://doi.org/10.1007/s00345-016-1967-3

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  • DOI: https://doi.org/10.1007/s00345-016-1967-3

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