Accuracy of real‐time magnetic resonance imaging‐transrectal ultrasound fusion image‐guided transperineal target biopsy with needle tracking with a mechanical position‐encoded stepper in detecting significant prostate cancer in biopsy‐naïve men

Objective To evaluate the impact of magnetic resonance imaging/transrectal ultrasound fusion‐targeted prostate biopsy on the diagnosis of clinically significant prostate cancer using real‐time three‐dimensional ultrasound‐based organ‐tracking technology. Methods The present study was a retrospective review of 262 consecutive patients with prostate‐specific antigen of 7.1 ng/mL (interquartile range 4.0–19.8). All patients received pre‐biopsy magnetic resonance imaging and had a suspicious lesion for clinically significant prostate cancer. All patients underwent a combination of systematic biopsy (6 cores) and three‐dimensional ultrasound‐based magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (2 cores). The positive rate of any cancer, positive rate of clinically significant prostate cancer, Gleason score and maximum cancer core length were compared between systematic biopsy versus magnetic resonance imaging/transrectal ultrasound fusion‐targeted prostate biopsy. Results Overall, the positive rate of any cancer per patient was 61% (160/262) in systematic biopsy versus 79% (207/262) in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P < 0.0001); and that of clinically significant prostate cancer per patient was 46% (120/262) in systematic biopsy versus 70% (181/262) in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P < 0.0001). The positive rate of any cancer per core was 21.7% (330/1523) in systematic biopsy versus 68.6% (406/592) in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P < 0.0001), and that of clinically significant prostate cancer per core was 12.7% (193/1423) in systematic biopsy versus 60.3% (357/592) in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P < 0.0001). Adding systematic biopsy leads to 13 more cancer cases (5%). The distribution of Gleason score (6/7/8/9/10) was 59/71/23/6/1 in systematic biopsy versus 48/105/36/15/2 in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P = 0.005). The maximum cancer core length was 5 mm (0.5–16) in systematic biopsy versus 8 mm (1–19 mm) in magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy (P < 0.0001). Conclusions Three‐dimensional ultrasound‐based magnetic resonance imaging/transrectal ultrasound fusion‐targeted biopsy seems to be associated with a higher detection rate of clinically significant prostate cancer, with fewer cores than systematic random biopsy. However, significant cancer can still be detected by the systematic technique only. A combination of systematic biopsy with the targeted biopsy technique would avoid the underdiagnosis of clinically significant prostate cancer.

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“…Table shows the comparison of CDRs in the recent English reports in Japanese patients . The CDRs were available for all eight trials.…”

Section: Resultsmentioning

confidence: 99%

“…Shoji et al . compared transperineal TB and SBx in 250 patients to reveal CDRs for TB and SBx of 55% versus 25% . Hakozaki et al .…”

Section: Resultsmentioning

confidence: 99%

Magnetic resonance imaging/transrectal ultrasound fusion‐targeted prostate biopsy using three‐dimensional ultrasound‐based organ‐tracking technology: Initial experience in Japan

et al. 2019

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“…mpMRI. MRI examination was conducted as described in our previous study (17). Briefly, the MRI examination was performed using a 1.5-Tesla magnet (Signa HDx ® ; GE Healthcare Life Sciences, Little Chalfont, UK) with an 8-channel cardiac coil.…”

Section: Methodsmentioning

confidence: 99%

“…MRI-TRUS fusion image-guided prostate biopsy was performed with a BioJet ® system version 2.0 (D&K Technologies GmbH, Barum, Germany). The biopsy was performed as described previously (17). Targeted biopsies for cancer-suspicious lesions were initially performed, followed by 12-core systematic biopsies, using the transperineal method.…”

Section: Methodsmentioning

confidence: 99%

Novel application of three-dimensional shear wave elastography in the detection of clinically significant prostate cancer

et al. 2018

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Abstract. The present study evaluated three-dimensional shear wave elastography (3D SWE) in the detection of clinically significant prostate cancer. Clinically significant prostate cancer was defined by a minimum of one biopsy core with a Gleason score of 3+4 or 6 with a maximum cancer core length >4 mm. Patients with serum prostate-specific antigen levels of 4.0-20.0 ng/ml who were suspected of having prostate cancer from multi-parametric magnetic resonance imaging (mpMRI) were prospectively recruited. The 3D SWE was performed pre-biopsy, after which patients underwent MRI-transrectal ultrasound image-guided targeted biopsies for cancer-suspicious lesions and 12-core systematic biopsies. The pathological biopsy results were compared with the mpMRI and 3D SWE images. A total of 12 patients who were suspected of having significant cancer on mpMRI were included. The median pre-biopsy PSA value was 5.65 ng/ml. Of the 12 patients, 10 patients were diagnosed as having prostate cancer. In the targeted biopsy lesions, there was a significant difference in Young's modulus between the cancer-detected area (median 64.1 kPa, n=20) and undetected area (median 30.8 kPa, n=8; P<0.0001). On evaluation of receiver operating characteristics, a cut-off value of the Young's modulus of 41.0 kPa was used for the detection of clinically significant cancer, with which the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of cancer detection were 58, 97, 86 and 87%, respectively. When combining this cut-off tissue elasticity value with Prostate Imaging Reporting and Data System (PI-RADS) scores, the sensitivity, specificity, positive predictive value and negative predictive value of cancer detection were improved to 70, 98, 91 and 92%, respectively. In the cancer-detected lesions, a significant correlation was identified between the tissue elasticity value of the lesions and Gleason score (r=0.898, P<0.0001). In conclusion, PI-RADS combined with measurement of Young's modulus by 3D SWE may improve the diagnosis of clinically significant prostate cancer.

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“…MRI-TRUS fusion biopsy device "BioJet ® " was approved by FDA after the evaluation of the accuracy with phantoms. We reported the BioJet ® experience of the usefulness of the precise diagnosis of the clinically significant cancer [15]. In the 30 patients from whom whole-mount specimens were taken, we found 43 clinically significant cancers, of which 41 (95%) had been detected by both the targeted and systematic biopsies.…”

Section: Introductionmentioning

confidence: 99%

The Role of the Magnetic Resonance Imaging for the Accurate Management of Focal Therapy with High-Intensity Focused Ultrasound for the Localized Prostate Cancer

Shoji¹,

Miyajima²

2018

High-Resolution Neuroimaging - Basic Physical Principles and Clinical Applications

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The concept of the currently attracted focal therapy is to treat clinical significant cancer with minimal invasion of health-related functions such as urethra, sphincter, neurovascular bundle, and bladder neck. The patients' criteria have been decided with pathologic tumor features characterized according to a combination of cancer core length and Gleason grade with prostate biopsy. Because the area involved in a single treatment using high-intensity focused ultrasound (HIFU) is extremely small, only minor temperature changes are observed outside of the focal zone. HIFU has been considered as an attractive therapeutic modality for the focal treatment of the prostate with the aim of curing the cancer while preserving continence and erectile function. Clinical trials of focal ablation of prostate cancer with HIFU have been reported. In our protocol, magnetic resonance imaging (MRI) has played a major role in the diagnosis of the spatial location of the significant cancer, treatment planning, and the evaluation of the treatment efficacy and recurrence after the treatment. In the chapter in "MR Imaging," we want to present the role of MRI in the accurate management of focal therapy with HIFU for the localized prostate cancer.

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Accuracy of real‐time magnetic resonance imaging‐transrectal ultrasound fusion image‐guided transperineal target biopsy with needle tracking with a mechanical position‐encoded stepper in detecting significant prostate cancer in biopsy‐naïve men

Abstract: Although targeted biopsies are superior to systematic biopsies in detecting significant cancers, systematic biopsies maintain an important role in the diagnosis of prostate cancer in biopsy-naïve men.

Cited by 34 publications

References 26 publications

Magnetic resonance imaging/transrectal ultrasound fusion‐targeted prostate biopsy using three‐dimensional ultrasound‐based organ‐tracking technology: Initial experience in Japan

Magnetic resonance imaging/transrectal ultrasound fusion‐targeted prostate biopsy using three‐dimensional ultrasound‐based organ‐tracking technology: Initial experience in Japan

Novel application of three-dimensional shear wave elastography in the detection of clinically significant prostate cancer

The Role of the Magnetic Resonance Imaging for the Accurate Management of Focal Therapy with High-Intensity Focused Ultrasound for the Localized Prostate Cancer

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