Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know. Part 3: Targeted Biopsy

Venderink, Wulphert; Bomers, Joyce G. R.; Overduin, Christiaan G.; Padhani, Anwar R.; Lauw, Gijs R. de; Sedelaar, J.P. Michiel; Barentsz, Jelle O.

doi:10.1016/j.eururo.2019.10.009

Cited by 46 publications

(32 citation statements)

References 34 publications

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“…One of three experienced radiologists (experience: more than five years in the field of prostate MRI and biopsy) performed either the TRUS-guided targeted biopsy under cognitive registration (n = 233) or the MRI-TRUS fusion technique (n = 84). According to existing literature, there is no significant difference in cancer detection between cognitive registration and the MRI-TRUS fusion technique despite some debates [ 12 ]. One of two ultrasound scanners (IU22, Philips Healthcare; Aplio 500, Toshiba) was used for image guidance and an 18-gauge, 20-cm biopsy gun (ACECUT, TSK Laboratory) was used for tissue sampling.…”

Section: Methodsmentioning

confidence: 99%

Prostate Imaging-Reporting and Data System: Comparison of the Diagnostic Performance between Version 2.0 and 2.1 for Prostatic Peripheral Zone

et al. 2021

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Objective To compare the diagnostic performance between Prostate Imaging-Reporting and Data System version 2.0 (PI-RADSv2.0) and version 2.1 (PI-RADSv2.1) for clinically significant prostate cancer (csPCa) in the peripheral zone (PZ). Materials and Methods This retrospective study included 317 patients who underwent multiparametric magnetic resonance imaging and targeted biopsy for PZ lesions. Definition of csPCa was International Society of Urologic Pathology grade ≥ 2 cancer. Area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for csPCa were analyzed by two readers. The cancer detection rate (CDR) for csPCa was investigated according to the PI-RADS categories. Results AUC of PI-RADSv2.1 (0.856 and 0.858 for reader 1 and 2 respectively) was higher than that of PI-RADSv2.0 (0.795 and 0.747 for reader 1 and 2 respectively) (both p < 0.001). Sensitivity, specificity, PPV, NPV, and accuracy for PI-RADSv2.0 vs. PI-RADSv2.1 were 93.2% vs. 88.3% ( p = 0.023), 52.8% vs. 76.6% ( p < 0.001), 48.7% vs. 64.5% ( p < 0.001), 94.2% vs. 93.2% ( p = 0.504), and 65.9% vs. 80.4% ( p < 0.001) for reader 1, and 96.1% vs. 92.2% ( p = 0.046), 34.1% vs. 72.4% ( p < 0.001), 41.3% vs. 61.7% ( p < 0.001), 94.8% vs. 95.1% ( p = 0.869), and 54.3% vs. 78.9% ( p < 0.001) for reader 2, respectively. CDRs of PI-RADS categories 1–2, 3, 4, and 5 for PI-RADSv2.0 vs. PI-RADSv2.1 were 5.9% vs. 5.9%, 5.8% vs. 12.5%, 39.8% vs. 56.2%, and 88.9% vs. 88.9% for reader 1; and 4.5% vs. 4.1%, 6.1% vs. 11.1%, 32.5% vs. 53.4%, and 85.0% vs. 86.8% for reader 2, respectively. Conclusion Our data demonstrated improved AUC, specificity, PPV, accuracy, and CDRs of category 3 or 4 of PI-RADSv2.1, but decreased sensitivity, compared with PI-RADSv2.0, for csPCa in PZ.

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Section: Methodsmentioning

confidence: 99%

Prostate Imaging-Reporting and Data System: Comparison of the Diagnostic Performance between Version 2.0 and 2.1 for Prostatic Peripheral Zone

et al. 2021

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“…Second, whole-mount histopathology was not the reference specimen when the cancer detection rate was compared. Third, the rigid registration system did not allow us to make adjustments; even deformations happened to the prostate by the TRUS probe, although some anatomical landmarks can be used to make cognitive fusion at that time in our study [29]. Finally, the same patient was tested with SB and TB, and biopsy complications, such as hemorrhage and swelling of the rst conducted one-TB procedure might have negatively affected the SB.…”

Section: Discussionmentioning

confidence: 96%

Clinically Significant Prostate Cancer Detection with Various Prostate Sampling Schemes Based on Different csPCa Definitions

Wang

Chen

Wang

et al. 2021

Preprint

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Background Combining targeted biopsy (TB) with systematic biopsy (SB) is currently recommended as the first-line biopsy method by the European Association of Urology (EAU) guidelines in patients diagnosed with prostate cancer (PCa) with an abnormal magnetic resonance imaging (MRI). The combined SB and TB indeed detected an additional number of patients with clinically significant prostate cancer (csPCa); however, it did so at the expense of a concomitant increase in biopsy cores. Our study aimed to evaluate if ipsilateral SB (ipsi-SB) + TB or contralateral SB (contra-SB) + TB could achieve almost equal csPCa detection rates as SB + TB using fewer cores based on a different csPCa definition.Methods Patients with at least one positive prostate lesion were prospectively diagnosed by MRI. The combination of TB and SB was conducted in all patients. We compared the csPCa detection rates of the following four hypothetical biopsy sampling schemes with those of SB + TB: SB, TB, ipsi-SB + TB, and contra-SB + TB. Results The study enrolled 279 men. The median core of SB, TB, ipsi-SB + TB, and contra-SB + TB was 10, 2, 7 and 7, respectively; they all differed significantly from SB + TB (P < 0.001). ipsi-SB + TB detected significantly more patients with csPCa than contra-SB + TB based on the EAU guidelines (P = 0.042). ipsi-SB + TB and contra-SB + TB detected almost equal number of csPCa on the basis of the Epstein criteria (P = 1.000). Compared with SB + TB, each remaining method detected significantly fewer patients with csPCa regardless of the definition (P < 0.001) except ipsi-SB + TB, which achieved an almost equivalent csPCa detection rate to that of SB + TB on the grounds of D1 (P = 0.066).Conclusions ipsi-SB + TB could detect significantly more patients with csPCa than contra-SB + TB and acquire an almost equivalent csPCa detection rate to that of SB + TB using significantly fewer cores when csPCa was defined as International Society for Urological Pathology (ISUP) 2 or higher.

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“…In addition, SB, which may improve CDR when combined with TB, cannot be performed during IB-TB. Given these limitations, some authors advocate the use of IB-TB specifically for very small lesions, and/or repeat biopsy when clinical suspicion is high but prior TB are negative [37].…”

Section: In-bore Versus Cognitive Fusion Versus Software-guided Fusiomentioning

confidence: 99%

Comparative Effectiveness of Techniques in Targeted Prostate Biopsy

Sugano

Kaneko

Yip

et al. 2021

Cancers

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In this review, we evaluated literature regarding different modalities for multiparametric magnetic resonance imaging (mpMRI) and mpMRI-targeted biopsy (TB) for the detection of prostate cancer (PCa). We identified studies evaluating systematic biopsy (SB) and TB in the same patient, thereby allowing each patient to serve as their own control. Although the evidence supports the accuracy of TB, there is still a proportion of clinically significant PCa (csPCa) that is detected only in SB, indicating the importance of maintaining SB in the diagnostic pathway, albeit with additional cost and morbidity. There is a growing subset of data which supports the role of TB alone, which may allow for increased efficiency and decreased complications. We also compared the literature on transrectal (TR) vs. transperineal (TP) TB. Although further high-level evidence is necessary, current evidence supports similar csPCa detection rate for both approaches. We also evaluated various TB techniques such as cognitive fusion biopsy (COG-TB) and in-bore biopsy (IB-TB). COG-TB has comparable detection rates to software fusion, but is operator-dependent and may have reduced accuracy for smaller lesions. IB-TB may allow for greater precision as lesions are directly targeted; however, this is costly and time-consuming, and does not account for MRI-invisible lesions.

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Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know. Part 3: Targeted Biopsy

Cited by 46 publications

References 34 publications

Prostate Imaging-Reporting and Data System: Comparison of the Diagnostic Performance between Version 2.0 and 2.1 for Prostatic Peripheral Zone

Prostate Imaging-Reporting and Data System: Comparison of the Diagnostic Performance between Version 2.0 and 2.1 for Prostatic Peripheral Zone

Clinically Significant Prostate Cancer Detection with Various Prostate Sampling Schemes Based on Different csPCa Definitions

Comparative Effectiveness of Techniques in Targeted Prostate Biopsy

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