Accuracy of elastic fusion biopsy in daily practice: Results of a multicenter study of 2115 patients

Abstract

Objectives To assess the accuracy of Koelis fusion biopsy for the detection of prostate cancer and clinically significant prostate cancer in the everyday practice. Methods We retrospectively enrolled 2115 patients from 15 institutions in four European countries undergoing transrectal Koelis fusion biopsy from 2010 to 2017. A variable number of target (usually 2–4) and random cores (usually 10–14) were carried out, depending on the clinical case and institution habits. The overall and clinically significant prostate cancer detection rates were assessed, evaluating the diagnostic role of additional random biopsies. The cancer detection rate was correlated to multiparametric magnetic resonance imaging features and clinical variables. Results The mean number of targeted and random cores taken were 3.9 (standard deviation 2.1) and 10.5 (standard deviation 5.0), respectively. The cancer detection rate of Koelis biopsies was 58% for all cancers and 43% for clinically significant prostate cancer. The performance of additional, random cores improved the cancer detection rate of 13% for all cancers (P < 0.001) and 9% for clinically significant prostate cancer (P < 0.001). Prostate cancer was detected in 31%, 66% and 89% of patients with lesions scored as Prostate Imaging Reporting and Data System 3, 4 and 5, respectively. Clinical stage and Prostate Imaging Reporting and Data System score were predictors of prostate cancer detection in multivariate analyses. Prostate‐specific antigen was associated with prostate cancer detection only for clinically significant prostate cancer. Conclusions Koelis fusion biopsy offers a good cancer detection rate, which is increased in patients with a high Prostate Imaging Reporting and Data System score and clinical stage. The performance of additional, random cores seems unavoidable for correct sampling. In our experience, the Prostate Imaging Reporting and Data System score and clinical stage are predictors of prostate cancer and clinically significant prostate cancer detection; prostate‐specific antigen is associated only with clinically significant prostate cancer detection, and a higher number of biopsy cores are not associated with a higher cancer detection rate.

A cohort of transperineal electromagnetically tracked magnetic resonance imaging/ultrasonography fusion‐guided biopsy: assessing the impact of inter‐reader variability on cancer detection

“…A recent large multicentre study examining detection of clinically significant PCa in 640 men undergoing imagefusion transperineal biopsy found that the addition of nontargeted systematic transperineal biopsies only detected an additional 0.8-1.1% of clinically significant PCa when combined with image-fusion TBx [31]. Comparing transperineal template saturation biopsy to transperineal TBx (BiopSee â system), Radtke et al [32] showed that 7% of GS [32,34,35]. Based on these findings, while transperineal TBx and other fusionbased TBx platforms appear to improve the sensitivity of SBx for the detection of higher-risk cancers, there would still be an unacceptable level of missed clinically significant disease using TBx alone; therefore, we continue to advocate the combination of targeted with systematic biopsies at this time.…”

Feasibility and safety of targeted focal microwave ablation of the index tumor in patients with low to intermediate risk prostate cancer: Results of the FOSTINE trial

“…Median duration of the surgical procedure was of 82 [44-170] min, including a median time of 16 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] and 2 [2][3][4][5][6] min for MRI-ultrasound fusion and targeting, and microwave application, respectively (Fig 3). Microwave ablation was set at 15W for 3 min, 15W for 2 min, and 10W for 2 min, in 3 (30%), 5 (50%), and 2 (20%) patients, respectively.…”

“…Interest in FT has recently been renewed owing to improved biopsy and imaging techniques, allowing a more comprehensive management of the index tumor. The ability of magnetic resonance imaging (MRI) to detect significant cancer foci [4][5][6][7][8][9], together with the reliability of organ-based tracking (OBT) MRI-ultrasound fusion [10][11][12], now allows clinicians to detect and target the index tumor precisely: Performing an elastic fusion between MRI and ultrasound images can create a precise three-dimensional mapping of the prostate, accurately showing the index tumor. OBT enables physicians to guide and to distribute, in a realtime fashion, the biopsy cores in three-dimensions.…”

Towards real‐time free‐hand biopsy navigation

“…When using the cited guidance systems, in order to map MRI targets to the US data, urologists have first to segment the prostate on the first acquired US volume (named panorama or reference volume). Moreover, during the intraoperative phase, the guidance software provided by the platform, also estimates the 3D/3D rigid transform between the reference volume and volumes acquired whole along the biopsy procedure using a widely evaluated image-based registration [7,14]. This transform will be considered as the ground truth T GT for this evaluation.…”