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MRI/TRUS fusion vs. systematic biopsy: intra-patient comparison of diagnostic accuracy for prostate cancer using PI-RADS v2

Abstract

Objective

To evaluate the efficacy of multiparametric magnetic resonance/transrectal ultrasound fusion (MRI/TRUS fusion) biopsy versus systematic biopsy and its association with PI-RADS v2 categories in patients with suspected prostate cancer.

Materials and methods

122 patients undergoing both MRI/TRUS fusion and systematic biopsy, with suspicion of prostate cancer, with suspicious findings on MRI based on PI-RADS v2, were included between April 2016 and March 2017. Comparison of tumor detection rates using each technique and combined techniques was performed for all lesions as well as those that are traditionally difficult to access (i.e., anterior lesions).

Results

Prostate cancer was detected in 83/122 patients (68%) with 74.6% clinically significant lesions (Gleason 3 + 4 or greater). There was a statistically significant difference in presence of clinically significant prostate cancer in PI-RADS v2 categories of 3, 4, and 5 (20%, 52% and 77%, respectively, p < 0.001). Fusion biopsy was positive in a significantly higher percentage of patients versus systematic biopsy (56% versus 48%, respectively, p < 0.05). The fusion biopsy alone was positive in 20%. Of 34 patients with anterior lesions on MRI, 44% were detected only by fusion biopsy, with a joint yield of 71%. In patients with previous negative systematic biopsies, 48.7% lesions were found by fusion biopsy with 20.5% being exclusively positive by this method. The percentage of positive cores for fusion biopsies was significantly higher than for systematic biopsies (26% vs. 12.3%, p < 0.001).

Conclusion

The incorporation of MRI/TRUS fusion biopsy significantly improves the detection rate of prostate cancer versus systematic biopsy, particularly for anterior lesions.

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References

  1. Chun FK, Steuber T, Erbersdobler A, Currlin E, Walz J, Schlomm T, Haese A, Heinzer H, McCormack M, Huland H, Graefen M, Karakiewicz PI (2006) Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology. Eur Urol 49 (5):820-826. https://doi.org/10.1016/j.eururo.2005.11.007

    Article  PubMed  Google Scholar 

  2. Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66 (1):7-30. https://doi.org/10.3322/caac.21332

    Article  PubMed  Google Scholar 

  3. Kattan MW, Eastham JA, Stapleton AM, Wheeler TM, Scardino PT (1998) A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer. J Natl Cancer Inst 90 (10):766-771. https://doi.org/10.1093/jnci/90.10.766

    CAS  Article  PubMed  Google Scholar 

  4. Partin AW, Mangold LA, Lamm DM, Walsh PC, Epstein JI, Pearson JD (2001) Contemporary update of prostate cancer staging nomograms (Partin Tables) for the new millennium. Urology 58 (6):843-848. https://doi.org/10.1016/s0090-4295(01)01441-8

    CAS  Article  PubMed  Google Scholar 

  5. Harvey P, Basuita A, Endersby D, Curtis B, Iacovidou A, Walker M (2009) A systematic review of the diagnostic accuracy of prostate specific antigen. BMC Urol 9:14. https://doi.org/10.1186/1471-2490-9-14

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. Schroder FH, van der Maas P, Beemsterboer P, Kruger AB, Hoedemaeker R, Rietbergen J, Kranse R (1998) Evaluation of the digital rectal examination as a screening test for prostate cancer. Rotterdam section of the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst 90 (23):1817–1823. https://doi.org/10.1093/jnci/90.23.1817

  7. Pinthus JH, Witkos M, Fleshner NE, Sweet J, Evans A, Jewett MA, Krahn M, Alibhai S, Trachtenberg J (2006) Prostate cancers scored as Gleason 6 on prostate biopsy are frequently Gleason 7 tumors at radical prostatectomy: implication on outcome. J Urol 176 (3):979–984; discussion 984. https://doi.org/10.1016/j.juro.2006.04.102

  8. Costa DN, Pedrosa I, Donato F, Jr., Roehrborn CG, Rofsky NM (2015) MR Imaging-Transrectal US Fusion for Targeted Prostate Biopsies: Implications for Diagnosis and Clinical Management. Radiographics 35 (3):696-708. doi:10.1148/rg.2015140058

    Article  PubMed  Google Scholar 

  9. Berglund RK, Masterson TA, Vora KC, Eggener SE, Eastham JA, Guillonneau BD (2008) Pathological upgrading and up staging with immediate repeat biopsy in patients eligible for active surveillance. J Urol 180 (5):1964–1967; discussion 1967–1968. https://doi.org/10.1016/j.juro.2008.07.051

  10. Duffield AS, Lee TK, Miyamoto H, Carter HB, Epstein JI (2009) Radical prostatectomy findings in patients in whom active surveillance of prostate cancer fails. J Urol 182 (5):2274-2278. https://doi.org/10.1016/j.juro.2009.07.024

    Article  PubMed  PubMed Central  Google Scholar 

  11. Matlaga BR, Eskew LA, McCullough DL (2003) Prostate biopsy: indications and technique. J Urol 169 (1):12-19. https://doi.org/10.1097/01.ju.0000041828.84343.53

    Article  PubMed  Google Scholar 

  12. Franiel T, Stephan C, Erbersdobler A, Dietz E, Maxeiner A, Hell N, Huppertz A, Miller K, Strecker R, Hamm B (2011) Areas suspicious for prostate cancer: MR-guided biopsy in patients with at least one transrectal US-guided biopsy with a negative finding--multiparametric MR imaging for detection and biopsy planning. Radiology 259 (1):162-172. https://doi.org/10.1148/radiol.10101251

    Article  PubMed  Google Scholar 

  13. Taira AV, Merrick GS, Galbreath RW, Andreini H, Taubenslag W, Curtis R, Butler WM, Adamovich E, Wallner KE (2010) Performance of transperineal template-guided mapping biopsy in detecting prostate cancer in the initial and repeat biopsy setting. Prostate Cancer Prostatic Dis 13 (1):71-77. https://doi.org/10.1038/pcan.2009.42

    CAS  Article  PubMed  Google Scholar 

  14. Yacoub JH, Verma S, Moulton JS, Eggener S, Aytekin O (2012) Imaging-guided prostate biopsy: conventional and emerging techniques. Radiographics 32 (3):819-837. https://doi.org/10.1148/rg.323115053

    Article  PubMed  Google Scholar 

  15. Hambrock T, Somford DM, Hoeks C, Bouwense SA, Huisman H, Yakar D, van Oort IM, Witjes JA, Futterer JJ, Barentsz JO (2010) Magnetic resonance imaging guided prostate biopsy in men with repeat negative biopsies and increased prostate specific antigen. J Urol 183 (2):520-527. https://doi.org/10.1016/j.juro.2009.10.022

    CAS  Article  PubMed  Google Scholar 

  16. Cornud F, Delongchamps NB, Mozer P, Beuvon F, Schull A, Muradyan N, Peyromaure M (2012) Value of multiparametric MRI in the work-up of prostate cancer. Curr Urol Rep 13 (1):82-92. https://doi.org/10.1007/s11934-011-0231-z

    CAS  Article  PubMed  Google Scholar 

  17. Padhani AR, Miles KA (2010) Multiparametric imaging of tumor response to therapy. Radiology 256 (2):348-364. https://doi.org/10.1148/radiol.10091760

    Article  PubMed  Google Scholar 

  18. Langer DL, van der Kwast TH, Evans AJ, Trachtenberg J, Wilson BC, Haider MA (2009) Prostate cancer detection with multi-parametric MRI: logistic regression analysis of quantitative T2, diffusion-weighted imaging, and dynamic contrast-enhanced MRI. J Magn Reson Imaging 30 (2):327-334. https://doi.org/10.1002/jmri.21824

    Article  PubMed  Google Scholar 

  19. Scheenen TW, Rosenkrantz AB, Haider MA, Futterer JJ (2015) Multiparametric Magnetic Resonance Imaging in Prostate Cancer Management: Current Status and Future Perspectives. Invest Radiol 50 (9):594-600. https://doi.org/10.1097/rli.0000000000000163

    CAS  Article  PubMed  Google Scholar 

  20. Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, Collaco-Moraes Y, Ward K, Hindley RG, Freeman A, Kirkham AP, Oldroyd R, Parker C, Emberton M, group Ps (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389 (10071):815-822. https://doi.org/10.1016/S0140-6736(16)32401-1

    Article  PubMed  Google Scholar 

  21. Haider MA, van der Kwast TH, Tanguay J, Evans AJ, Hashmi AT, Lockwood G, Trachtenberg J (2007) Combined T2-weighted and diffusion-weighted MRI for localization of prostate cancer. AJR Am J Roentgenol 189 (2):323-328. https://doi.org/10.2214/ajr.07.2211

    Article  PubMed  Google Scholar 

  22. de Rooij M, Hamoen EH, Futterer JJ, Barentsz JO, Rovers MM (2014) Accuracy of multiparametric MRI for prostate cancer detection: a meta-analysis. AJR Am J Roentgenol 202 (2):343-351. https://doi.org/10.2214/ajr.13.11046

    Article  PubMed  Google Scholar 

  23. Hu JC, Chang E, Natarajan S, Margolis DJ, Macairan M, Lieu P, Huang J, Sonn G, Dorey FJ, Marks LS (2014) Targeted prostate biopsy in select men for active surveillance: do the Epstein criteria still apply? J Urol 192 (2):385-390. https://doi.org/10.1016/j.juro.2014.02.005

    Article  PubMed  PubMed Central  Google Scholar 

  24. van der Leest M, Cornel E, Israel B, Hendriks R, Padhani AR, Hoogenboom M, Zamecnik P, Bakker D, Setiasti AY, Veltman J, van den Hout H, van der Lelij H, van Oort I, Klaver S, Debruyne F, Sedelaar M, Hannink G, Rovers M, Hulsbergen-van de Kaa C, Barentsz JO (2019) Head-to-head Comparison of Transrectal Ultrasound-guided Prostate Biopsy Versus Multiparametric Prostate Resonance Imaging with Subsequent Magnetic Resonance-guided Biopsy in Biopsy-naive Men with Elevated Prostate-specific Antigen: A Large Prospective Multicenter Clinical Study. Eur Urol 75 (4):570-578. https://doi.org/10.1016/j.eururo.2018.11.023

    Article  PubMed  Google Scholar 

  25. Kam J, Yuminaga Y, Kim R, Aluwihare K, Macneil F, Ouyang R, Ruthven S, Louie-Johnsun M (2018) Does magnetic resonance imaging-guided biopsy improve prostate cancer detection? A comparison of systematic, cognitive fusion and ultrasound fusion prostate biopsy. Prostate international 6 (3):88-93. https://doi.org/10.1016/j.prnil.2017.10.003

    Article  PubMed  Google Scholar 

  26. Siddiqui MM, Rais-Bahrami S, Turkbey B, George AK, Rothwax J, Shakir N, Okoro C, Raskolnikov D, Parnes HL, Linehan WM, Merino MJ, Simon RM, Choyke PL, Wood BJ, Pinto PA (2015) Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. Jama 313 (4):390-397. https://doi.org/10.1001/jama.2014.17942

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  27. Portalez D, Mozer P, Cornud F, Renard-Penna R, Misrai V, Thoulouzan M, Malavaud B (2012) Validation of the European Society of Urogenital Radiology scoring system for prostate cancer diagnosis on multiparametric magnetic resonance imaging in a cohort of repeat biopsy patients. Eur Urol 62 (6):986-996. https://doi.org/10.1016/j.eururo.2012.06.044

    Article  PubMed  Google Scholar 

  28. Pinto PA, Chung PH, Rastinehad AR, Baccala AA, Jr., Kruecker J, Benjamin CJ, Xu S, Yan P, Kadoury S, Chua C, Locklin JK, Turkbey B, Shih JH, Gates SP, Buckner C, Bratslavsky G, Linehan WM, Glossop ND, Choyke PL, Wood BJ (2011) Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging. J Urol 186 (4):1281-1285. https://doi.org/10.1016/j.juro.2011.05.078

    Article  PubMed  PubMed Central  Google Scholar 

  29. Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, Margolis D, Schnall MD, Shtern F, Tempany CM, Thoeny HC, Verma S (2016) PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. Eur Urol 69 (1):16-40. https://doi.org/10.1016/j.eururo.2015.08.052

    Article  PubMed  Google Scholar 

  30. Presti JC (2007) Prostate biopsy: current status and limitations. Rev Urol 9 (3):93-98

    PubMed  PubMed Central  Google Scholar 

  31. Leyh-Bannurah SR, Kachanov M, Beyersdorff D, Tian Z, Karakiewicz PI, Tilki D, Fisch M, Maurer T, Graefen M, Budaus L (2020) Minimum Magnetic Resonance Imaging-Ultrasound Fusion Targeted Biopsy Cores Needed for Prostate Cancer Detection: Multivariable Retrospective, Lesion Based Analyses of Patients Treated with Radical Prostatectomy. J Urol 203 (2):299-303. https://doi.org/10.1097/JU.0000000000000527

    Article  PubMed  Google Scholar 

  32. Ploussard G, Beauval JB, Renard-Penna R, Lesourd M, Manceau C, Almeras C, Gautier JR, Loison G, Portalez D, Salin A, Soulie M, Tollon C, Malavaud B, Roumiguie M (2020) Assessment of the Minimal Targeted Biopsy Core Number per MRI Lesion for Improving Prostate Cancer Grading Prediction. Journal of clinical medicine 9 (1). https://doi.org/10.3390/jcm9010225

  33. Lu AJ, Syed JS, Ghabili K, Hsiang WR, Nguyen KA, Leapman MS, Sprenkle PC (2019) Role of Core Number and Location in Targeted Magnetic Resonance Imaging-Ultrasound Fusion Prostate Biopsy. Eur Urol 76 (1):14-17. https://doi.org/10.1016/j.eururo.2019.04.008

    Article  PubMed  Google Scholar 

  34. Volkin D, Turkbey B, Hoang AN, Rais-Bahrami S, Yerram N, Walton-Diaz A, Nix JW, Wood BJ, Choyke PL, Pinto PA (2014) Multiparametric magnetic resonance imaging (MRI) and subsequent MRI/ultrasonography fusion-guided biopsy increase the detection of anteriorly located prostate cancers. BJU international 114 (6b):E43-E49. https://doi.org/10.1111/bju.12670

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  35. Ouzzane A, Puech P, Lemaitre L, Leroy X, Nevoux P, Betrouni N, Haber GP, Villers A (2011) Combined multiparametric MRI and targeted biopsies improve anterior prostate cancer detection, staging, and grading. Urology 78 (6):1356-1362. https://doi.org/10.1016/j.urology.2011.06.022

    Article  PubMed  Google Scholar 

  36. Wegelin O, van Melick HHE, Hooft L, Bosch J, Reitsma HB, Barentsz JO, Somford DM (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 (4):517–531. https://doi.org/10.1016/j.eururo.2016.07.041

  37. Barkovich EJ, Shankar PR, Westphalen AC (2019) A Systematic Review of the Existing Prostate Imaging Reporting and Data System Version 2 (PI-RADSv2) Literature and Subset Meta-Analysis of PI-RADSv2 Categories Stratified by Gleason Scores. AJR Am J Roentgenol 212 (4):847-854. https://doi.org/10.2214/AJR.18.20571

    Article  PubMed  Google Scholar 

  38. Sheridan AD, Nath SK, Syed JS, Aneja S, Sprenkle PC, Weinreb JC, Spektor M (2018) Risk of Clinically Significant Prostate Cancer Associated With Prostate Imaging Reporting and Data System Category 3 (Equivocal) Lesions Identified on Multiparametric Prostate MRI. AJR Am J Roentgenol 210 (2):347-357. https://doi.org/10.2214/AJR.17.18516

    Article  PubMed  Google Scholar 

  39. Gortz M, Radtke JP, Hatiboglu G, Schutz V, Tosev G, Guttlein M, Leichsenring J, Stenzinger A, Bonekamp D, Schlemmer HP, Hohenfellner M, Nyarangi-Dix JN (2019) The Value of Prostate-specific Antigen Density for Prostate Imaging-Reporting and Data System 3 Lesions on Multiparametric Magnetic Resonance Imaging: A Strategy to Avoid Unnecessary Prostate Biopsies. European urology focus. https://doi.org/10.1016/j.euf.2019.11.012

    Article  PubMed  Google Scholar 

  40. Baco E, Rud E, Eri LM, Moen G, Vlatkovic L, Svindland A, Eggesbo HB, Ukimura O (2016) A Randomized Controlled Trial To Assess and Compare the Outcomes of Two-core Prostate Biopsy Guided by Fused Magnetic Resonance and Transrectal Ultrasound Images and Traditional 12-core Systematic Biopsy. Eur Urol 69 (1):149-156. https://doi.org/10.1016/j.eururo.2015.03.041

    Article  PubMed  Google Scholar 

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Funding

This project was performed at the Departments of Radiology at Clínica Alemana de Santiago (Santiago, Chile) and Duke University Medical Center (Durham, NC). There is no external or internal funding for this project.

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Correspondence to Rajan T. Gupta.

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Fernando González, MD, Andrés Labra, MD, Claudio Silva, MD, Gerhard Franz, MD, Rodrigo Pinochet, MD—none. Rajan T. Gupta, MD—Consultant, Invivo Corp.

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Labra, A., González, F., Silva, C. et al. MRI/TRUS fusion vs. systematic biopsy: intra-patient comparison of diagnostic accuracy for prostate cancer using PI-RADS v2. Abdom Radiol 45, 2235–2243 (2020). https://doi.org/10.1007/s00261-020-02481-y

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  • DOI: https://doi.org/10.1007/s00261-020-02481-y

Keywords

  • Prostate cancer
  • Prostate MRI
  • PI-RADS
  • MRI/TRUS fusion