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Incremental diagnostic value of targeted biopsy using mpMRI-TRUS fusion versus 14-fragments prostatic biopsy: a prospective controlled study

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Abstract

Objectives

To compare the incremental diagnostic value of targeted biopsy using real-time multiparametric magnetic resonance imaging and transrectal ultrasound (mpMRI-TRUS) fusion to conventional 14-cores biopsy.

Patients and Methods

Uni-institutional, institutional review board (IRB) approved prospective blinded study comparing TRUS-guided random and targeted biopsy using mpMRI-TRUS fusion, in 100 consecutive men. We included men with clinical-laboratorial suspicious for prostate cancer and Likert score ≥ 3 mp-MRI. Patients previously diagnosed with prostate cancer were excluded. All patients were submitted to 14-cores TRUS-guided biopsy (mpMRI data operator-blinded), followed by targeted biopsy using mpMRI-TRUS fusion.

Results

There was an overall increase in cancer detection rate, from 56% with random technique to 62% combining targeted biopsy using mpMRI-TRUS fusion; incremental diagnosis was even more relevant for clinically significant lesions (Gleason ≥ 7), diagnosing 10% more clinically significant lesions with fusion biopsy technique. Diagnosis upgrade occurred in 5 patients that would have negative results in random biopsies and had clinically significant tumours with the combined technique, and in 5 patients who had the diagnosis of significant tumours after fusion biopsy and clinically insignificant tumours in random biopsies(p=0.0010).

Conclusions

Targeted biopsy using mpMRI-TRUS fusion has incremental diagnostic value in comparison to conventional random biopsy, better detecting clinically significant prostate cancers.

Key Points

• mpMRI-TRUS targeted biopsy increases overall cancer detection rate, but not statistically significant.

• mpMRI-TRUS targeted biopsy actually improves the diagnosis of clinically significant PCa.

• There was no evidence to acquire the mpMRI-TRUS fusion cores alone.

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Abbreviations

mpMRI:

Multiparametric magnetic resonance imaging

TRUS:

transrectal ultrasound

IRB:

Institutional review board

PCa:

Prostate cancer

PSA:

prostatic-specific antigen

PI-RADS:

Prostate Imaging Reporting and Data System

MRI:

magnetic resonance imaging

US:

ultrasound

FB:

fusion biopsy

RB:

random biopsy

START:

Standards of Reporting for MRI-targeted Biopsy Studies

T2WI:

T2-weighted imaging

DWI:

diffusion-weighted imaging

DCE:

dynamic contrast-enhanced imaging

H&E:

haematoxylin and eosin

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Authors and Affiliations

  1. Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil, 05652-000

    Guilherme C. Mariotti, Priscila M. Falsarella, Rodrigo G. Garcia & Marcos R. G. Queiroz

  2. Av. Albert Einstein, 627, São Paulo, SP, 05652-900, Brazil

    Priscila M. Falsarella

  3. Department of Urology, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil, 05652-000

    Gustavo C. Lemos

  4. Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil, 05652-000

    Ronaldo H. Baroni

Authors
  1. Guilherme C. Mariotti
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  2. Priscila M. Falsarella
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  3. Rodrigo G. Garcia
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  4. Marcos R. G. Queiroz
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  5. Gustavo C. Lemos
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  6. Ronaldo H. Baroni
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Corresponding author

Correspondence to Priscila M. Falsarella.

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Guarantor

The scientific guarantor of this publication is Ronaldo Hueb Baroni.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

Elivane da Silva Victor kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective• diagnostic study• performed at one institution

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Mariotti, G.C., Falsarella, P.M., Garcia, R.G. et al. Incremental diagnostic value of targeted biopsy using mpMRI-TRUS fusion versus 14-fragments prostatic biopsy: a prospective controlled study. Eur Radiol 28, 11–16 (2018). https://doi.org/10.1007/s00330-017-4939-0

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  • DOI: https://doi.org/10.1007/s00330-017-4939-0

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