Magnetic Resonance Imaging/Ultrasound–Fusion Biopsy Significantly Upgrades Prostate Cancer Versus Systematic 12-core Transrectal Ultrasound Biopsy

• Published in: European urology Vol. 64; no. 5; pp. 713 - 719
• Main Authors: Siddiqui, M. Minhaj, Rais-Bahrami, Soroush, Truong, Hong, Stamatakis, Lambros, Vourganti, Srinivas, Nix, Jeffrey, Hoang, Anthony N., Walton-Diaz, Annerleim, Shuch, Brian, Weintraub, Michael, Kruecker, Jochen, Amalou, Hayet, Turkbey, Baris, Merino, Maria J., Choyke, Peter L., Wood, Bradford J., Pinto, Peter A.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01.11.2013; Elsevier
• Subjects: Aged; Biological and medical sciences; Biopsy, Large-Core Needle; Gynecology. Andrology. Obstetrics; Humans; Image Interpretation, Computer-Assisted; Image-guided biopsy; Image-Guided Biopsy - methods; Magnetic resonance imaging; Magnetic Resonance Imaging, Interventional; Male; Male genital diseases; Medical sciences; Middle Aged; Multimodal Imaging; Neoplasm Grading; Nephrology. Urinary tract diseases; Predictive Value of Tests; Prognosis; Prospective Studies; Prostate cancer; Prostatic Neoplasms - pathology; Prostatic neoplasms/diagnosis; Prostatic neoplasms/ultrasonography; Targeted biopsy; Tumors; Tumors of the urinary system; Ultrasonography, Interventional; Urinary tract. Prostate gland; Urology; Targeted biopsy; Prostatic neoplasms/diagnosis; Prostatic neoplasms/ultrasonography; Image-guided biopsy; Magnetic resonance imaging; Prostatic neoplasms/pathology; Prostate cancer; Prostate tumor; Nephrology; Prostatic neoplasms; Targeting; Prostate disease; ultrasonography; Image; Urology; Diagnosis; Male genital diseases; Ultrasound; Sonography; Urinary system disease; Malignant tumor; Nuclear magnetic resonance imaging; Guidance; Anatomic pathology; Biopsy; Echography; Medical imagery; Comparative study; Cancer
• ISSN: 0302-2838; 1873-7560; 1421-993X; 1873-7560
• DOI: 10.1016/j.eururo.2013.05.059

Gleason scores from standard, 12-core prostate biopsies are upgraded historically in 25−33% of patients. Multiparametric prostate magnetic resonance imaging (MP-MRI) with ultrasound (US)-targeted fusion biopsy may better sample the true gland pathology. The rate of Gleason score upgrading from an MRI/US-fusion-guided prostate-biopsy platform is compared with a standard 12-core biopsy regimen alone. There were 582 subjects enrolled from August 2007 through August 2012 in a prospective trial comparing systematic, extended 12-core transrectal ultrasound biopsies to targeted MRI/US-fusion-guided prostate biopsies performed during the same biopsy session. The highest Gleason score from each biopsy method was compared. An MRI/US-fusion-guided platform with electromagnetic tracking was used for the performance of the fusion-guided biopsies. A diagnosis of prostate cancer (PCa) was made in 315 (54%) of the patients. Addition of targeted biopsy led to Gleason upgrading in 81 (32%) cases. Targeted biopsy detected 67% more Gleason ≥4+3 tumors than 12-core biopsy alone and missed 36% of Gleason ≤3+4 tumors, thus mitigating the detection of lower-grade disease. Conversely, 12-core biopsy led to upgrading in 67 (26%) cases over targeted biopsy alone but only detected 8% more Gleason ≥4+3 tumors. On multivariate analysis, MP-MRI suspicion was associated with Gleason score upgrading in the targeted lesions (p<0.001). The main limitation of this study was that definitive pathology from radical prostatectomy was not available. MRI/US-fusion-guided biopsy upgrades and detects PCa of higher Gleason score in 32% of patients compared with traditional 12-core biopsy alone. Targeted biopsy technique preferentially detects higher-grade PCa while missing lower-grade tumors. Magnetic resonance imaging/ultrasound-fusion guided biopsies upgraded Gleason score in 32% of prostate cancer cases and led to a 67% rate of increased diagnosis of high-grade tumors versus 12-core biopsy alone. Targeted biopsy missed diagnosis of lower-grade tumors in 36% of cases.