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Association of training level and outcome of software-based image fusion-guided targeted prostate biopsies

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Abstract

Purpose

The aim of this study was to assess the impact of experience on the outcome of image fusion-guided prostate biopsies performed by urologists working at a high-volume medical center.

Methods

The first 210 consecutive fusion biopsies were analyzed following installation of the software-based biopsy platform Artemis™ (Eigen, USA). The impact of training was measured in terms of changes in prostate cancer detection rates and biopsy duration over time. We sought to identify a threshold of experience for urologists, which predicts higher detection rates of targeted biopsies. The influence of various factors on prostate cancer detection rates was evaluated using bi- and multivariate analysis.

Results

Twenty-two urologists (n = 9 senior urologists, n = 13 urological residents) performed targeted biopsies followed by systematic 12-core biopsies. Overall, targeted biopsies yielded a positive result in 39.6% of 260 suspicious MRI lesions. A subgroup analysis of the six urologists who performed more than ten biopsies was then conducted, and their level of experience (i.e., performance of more than eight biopsies) was found to be associated with higher detection rates than those with less experience (49.0% and 23.0%, respectively; p < 0.001) in the targeted biopsies. Experience was likewise a significant and independent predictor of a cancer-positive targeted biopsy (p = 0.002). Experienced senior physicians did not outperform residents in their targeted biopsy results. Further, biopsy duration correlated negatively (r = − 0.5931, p < 0.001) with the total number of biopsies performed for all subgroups during the period of assessment.

Conclusions

Experience is an important predictor of the rate of detection in targeted biopsies using software-based biopsy platforms with semi-robotic assistance. Moreover, the performance of just a few procedures appears sufficient to increase biopsy effectiveness significantly. Lastly, supervision by experts is recommended during the training phase.

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Author notes

  1. Patrick Honeck and Manuel Ritter contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68165, Germany

    Niklas Westhoff, Henning Haumann, Maximilian Christian Kriegmair, Jost von Hardenberg, Maurice Stephan Michel, Patrick Honeck & Manuel Ritter

  2. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68165, Germany

    Johannes Budjan

  3. Institute of Pathology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68165, Germany

    Stefan Porubsky

Authors
  1. Niklas Westhoff
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  2. Henning Haumann
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  4. Jost von Hardenberg
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  7. Maurice Stephan Michel
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  8. Patrick Honeck
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Contributions

Study concept and design: NW, MCK, MR; Acquisition of data: HH, NW, JB, SP; Analysis and interpretation of data: NW, HH, MCK, MR; Drafting of the manuscript: NW; Critical revision of the manuscript: MCK, JH, JB, SP, MSM, PH, MR; Statistical analysis: NW, MCK.

Corresponding author

Correspondence to Niklas Westhoff.

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Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical approval

This study was approved by the institutional ethical review board (2018-878R-MA).

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Westhoff, N., Haumann, H., Kriegmair, M.C. et al. Association of training level and outcome of software-based image fusion-guided targeted prostate biopsies. World J Urol 37, 2119–2127 (2019). https://doi.org/10.1007/s00345-018-2605-z

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  • DOI: https://doi.org/10.1007/s00345-018-2605-z

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