Magnetic Resonance Imaging-Ultrasound Fusion Biopsy for Prediction of Final Prostate Pathology

Abstract

PURPOSE To explore the impact of MRI-ultrasound (MRI-US) fusion prostate biopsy on prediction of final surgical pathology. MATERIALS AND METHODS 54 consecutive men undergoing radical prostatectomy at UCLA after Artemis fusion biopsy (Eigen, Grass Valley, CA) were included in this prospective IRB-approved pilot study. Using MRI-US fusion, tissue was obtained from a 12-point systematic grid (mapping biopsy, MBx) and from regions of interest detected by multi-parametric MRI (targeted biopsy, TBx). A single radiologist read all MRIs, and a single pathologist independently re-reviewed all biopsy and whole-mount pathology, blinded to prior interpretation and matched specimen. Gleason score (GS) concordance between biopsy and prostatectomy was the primary endpoint. RESULTS Mean age was 62 years, with median PSA 6.2 ng/ml. Final GS at prostatectomy was 6 (13%), 7 (70%), and 8–9 (17%). A tertiary pattern was detected in 17 (31%) men. 32/45 (71%) high-suspicion (image grade 4–5) MRI targets contained prostate cancer (CaP). The per-core cancer detection rate was 20% by MBx and 42% by TBx. The highest Gleason pattern at prostatectomy was detected by MBx in 54%, TBx in 54%, and the combination in 81% of cases. 17% were upgraded from fusion biopsy to final pathology; one case (2%) was downgraded. The combination of TBx and MBx was needed to obtain the best predictive accuracy. CONCLUSIONS In this pilot study, MR-US fusion biopsy allowed for prediction of final prostate pathology with greater accuracy than that reported previously using conventional methods (81% versus 40–65%). If confirmed, these results would have important clinical implications.

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

“…This effect was also shown by the higher c value in the combination of both biopsy methods compared with both fusion PBx and systematic PBx alone. These results are similar to those of previous studies reporting a concordance of GS between targeted PBx and RP specimens in 57-90% of cases [10,12,16].…”

“…A pilot study with 54 patients conducted by Le et al [12] showed that the combination of targeted and systematic PBx resulted in the best prediction of highest Gleason pattern and GS. In that study, however, targeted PBx had a higher specificity and a higher AUC than systematic PBx alone or combination PBx.…”

“…Few studies have correlated the findings of mpMRI and targeted PBx with the final histopathology of the RP specimen [9][10][11][12][13].…”

EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

“…Many single-centre studies suggest that multiparametric MRI (mpMRI) can reliably detect aggressive tumours with a negative (NPV) and positive predictive value (PPV) ranging from 63 to 98% and from 34 to 68%, respectively [28]. The combination of systematic and targeted biopsies (MRI-Tbx) may also better predict the final GS [29]. As a result, some authors proposed performing systematic mpMRI before prostate biopsy [30,31].…”

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

“…The question of whether FTB alone should be performed is under debate, since it has been described that FTB using MRI and TRUS fusion misses from 5 to 17% of PC, suggesting use of a combined FTB and 12-core systematic biopsy to obtain the best predictive accuracy [17,20,21] . Siddiqui et al [17] reported a prospective study of a large cohort of 1003 men, which showed that targeted biopsy diagnosed 30% more high-risk cancers versus standard biopsy and 17% fewer low-risk cancers.…”