Feasibility study of MR-guided transgluteal targeted in-bore biopsy for suspicious lesions of the prostate at 3 Tesla using a freehand approach
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The aim of our study was (1) to establish an in-bore targeted biopsy of suspicious prostate lesions, avoiding bowel penetration using a transgluteal approach and (2) to assess operator setup, patient comfort and safety aspects in the clinical setting for freehand real-time MR-guidance established for percutaneous procedures in an open MR-scanner.
Material and methods
30 patients with suspect prostate lesions were biopsied in a cylindrical 3T-MRI system using a transgluteal approach in freehand technique. One to three biopsies were sampled using continuous dynamic imaging. Size, location and visibility of the lesion, intervention time, needle artefact size, interventional complications and histopathological diagnosis were recorded.
All biopsies were technically successful. Nineteen patients showed evidence of prostate carcinoma. Cancer detection rate was 50 % in patients with previously negative TRUS-biopsy. The average intervention time was 26 min including a learning curve as the time was 13 min by the end of the study. No antibiotic prophylaxis was performed as none of the patients showed signs of infection.
MR-guided targeted freehand biopsies of prostate lesions using a transgluteal approach are both technically feasible and time efficient in a standard closed-bore 3T-MR scanner as well as safe for the individual patient.
• Open-bore freehand interventional principles were adapted to closed-bore systems.
• Prostate MR-guided freehand biopsies were feasible in a clinical setting.
• A transgluteal approach provides a short and simplified work flow.
• An inoculation of the prostate with bowel flora is avoided.
• The intervention time is comparable to the stereotactic approach.
KeywordsProstate cancer Prostate biopsy Targeted biopsy Interventional MR Fluoroscopic guidance
This manuscript is dedicated to our friend and co-author Lukas Wien, who suddenly passed away. Lukas was an extraordinary and kind person and is missed sadly by all of us.
This study received funding by Philips Medical Healthcare.
Compliance with ethical standards
The scientific guarantor of this publication is Frank Fischbach, MD.
Conflict of interest
The authors of this manuscript declare relationships with the following companies:
Sascha Kruger and Bernhard Schnackenburg are employees of Philips Medical Healthcare.
Frank Fischbach, Katharina Fischbach and Jens Ricke received research grants from Philips Medical Healthcare.
The other authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• performed at one institution
- 6.Schoots IG, Roobol MJ, Nieboer D et al (2015) Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol 68:438–450CrossRefPubMedGoogle Scholar
- 7.Mariotti GC, Falsarella PM, Garcia RG et al (2017) Incremental diagnostic value of targeted biopsy using mpMRI-TRUS fusion versus 14-fragments prostatic biopsy: a prospective controlled study. Eur Radiol. https://doi.org/10.1007/s00330-017-4939-0
- 8.Wegelin O, van Melick HH, Hooft L et al (2017) Comparing Three Different Techniques for Magnetic Resonance Imaging-targeted Prostate Biopsies: A Systematic Review of In-bore versus Magnetic Resonance Imaging-transrectal Ultrasound fusion versus Cognitive Registration. Is There a Preferred Technique? Eur Urol 71:517–531CrossRefPubMedGoogle Scholar
- 9.Arsov C, Rabenalt R, Blondin D et al (2015) Prospective randomized trial comparing magnetic resonance imaging (MRI)-guided in-bore biopsy to MRI-ultrasound fusion and transrectal ultrasound-guided prostate biopsy in patients with prior negative biopsies. Eur Urol 68:713–720CrossRefPubMedGoogle Scholar
- 15.Vargas HA, Hötker AM, Goldman DA et al (2016) Updated prostate imaging reporting and data system (PIRADS v2) recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference. Eur Radiol 26:1606–1612CrossRefPubMedGoogle Scholar
- 23.Overduin CG, Jenniskens SF, Sedelaar JP, et al (2017) Percutaneous MR-guided focal cryoablation for recurrent prostate cancer following radiation therapy: retrospective analysis of iceball margins and outcomes. Eur Radiol 27:4828–36Google Scholar