Direct comparison of multiparametric magnetic resonance imaging (MRI) results with final histopathology in patients with proven prostate cancer in MRI/ultrasonography‐fusion biopsy

Abstract

ObjectiveTo compare multiparametric magnetic resonance imaging (mpMRI) of the prostate and histological findings of both targeted MRI/ultrasonography-fusion prostate biopsy (PBx) and systematic PBx with final histology of the radical prostatectomy (RP) specimen. Patients and MethodsA total of 105 patients with prostate cancer (PCa) histopathologically proven using a combination of fusion Pbx and systematic PBx, who underwent RP, were investigated. All patients had been examined using mpMRI, applying the European Society of Urogenital Radiology criteria. Histological findings from the RP specimen were compared with those from the PBx. Whole-mount RP specimen and mpMRI results were directly compared by a uro-pathologist and a uro-radiologist in step-section analysis. ResultsIn the 105 patients with histopathologically proven PCa by combination of fusion PBx and systematic PBx, the detection rate of PCa was 90% (94/105) in fusion PBx alone and 68% (72/105) in systematic PBx alone (P = 0.001). The combination PBx detected 23 (22%) Gleason score (GS) 6, 69 (66%) GS 7 and 13 (12%) GS ≥8 tumours. Fusion PBx alone detected 25 (26%) GS 6, 57 (61%) GS 7 and 12 (13%) GS ≥8 tumours. Systematic PBx alone detected 17 (24%) GS 6, 49 (68%) GS 7 and 6 (8%) GS ≥8 tumours. . The rates of concordance with regard to GS between the PBx and RP specimen were 63% (n = 65), 54% (n = 56) and 75% (n = 78) in fusion, systematic and combination PBx (fusion and systematic PBx combined), respectively. Upgrading of the GS between PBx and RP specimen occurred in 33% (n = 34), 44% (n = 46) and 18% (n = 19) in fusion, systematic and combination PBx, respectively. c-correlation for detection of any cancer was 0.76 for combination PBx, 0.68 for fusion PBx alone and 0.23 for systematic PBx alone. In all, 84% (n = 88) of index tumours were identified by mpMRI; 86% (n = 91) of index lesions on the mpMRI were proven in the RP specimen. ConclusionsFusion PBx of tumour-suspicious lesions on mpMRI was associated with a higher detection rate of more aggressive PCa and a better tumour prediction in final histopathology than systematic PBx alone; however, combination PBx had the best concordance for the prediction of GS. Furthermore, the additional findings of systematic PBx reflect the multifocality of PCa, therefore, the combination of both biopsy methods would still represent the best approach for the prediction of the final tumour grading in PCa. KeywordsMRI/ultrasound-fusion biopsy, prostate cancer, multiparametric MRI, prostatectomy specimen, systematic biopsy, direct comparison

Getting to the right biopsy in the right patient at the right time

“…As in the current study , use of transperineal biopsy can detect cancer in up to 30% of tumours that would otherwise be missed on extended template TRUS biopsy . Although attempts to reach anterior lesions from the transrectal approach may be feasible , the transperineal approach is felt to provide better sampling in comparison .…”

Evaluation of Transperineal Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy Compared to Transrectal Systematic Biopsy in the Prediction of Tumour Aggressiveness in Patients with Previously Negative Biopsy

“…Previous studies also demonstrated that fusPbx showed a better concordance of tumour grading in RP specimen than sysPbx. However, comPbx outperforms fusPbx and sysPbx alone [5,[16][17][18][19]. Based on these data, comPbx should be offered to patients with previous negative sysPbx.…”

“…Furthermore, prospective data are needed to clarify this issue in a re-biopsy cohort as well. Second, we did not perform a direct comparison of mpMRI and whole-mount prostatectomy specimen as previously described [17]. Data of this study are based only on the reported GS of biopsy and RP specimen; however, we performed the comparison in only 41% of patients with proven PCa.…”

“…In addition, fusPbx has shown a higher concordance of tumour grading compared to that of the radical prostatectomy (RP) specimen [16][17][18][19]. Therefore, fusPbx represents a more accurate tool in terms of prediction of tumour aggressiveness.…”

Gleason Score within Prostate Abnormal Areas Defined by Multiparametric Magnetic Resonance Imaging Did Not Vary According to the PIRADS Score

“…It has been shown that MRI-TRUS image fusion is able to locate the lesion that harbors the highest Gleason grade [10] . Recently, Borkowetz A et al [11] showed that in lesions classified as PI-RADS ≥ 4, significantly more PCa with GS ≥ 7 was detected than in lesions classified as PI-RADS ≤ 3 (90% [77/85] vs. 53% [46/85]; p <0.005). Nevertheless, their work has not explored in great detail the Gleason score 6 (3 + 3), 7 (3 + 4), 7 (4 + 3), and ≥ 8 (4 + 4) according to the PI-RADS scoring.…”