Retrospective comparison of direct in-bore magnetic resonance imaging (MRI)-guided biopsy and fusion-guided biopsy in patients with MRI lesions which are likely or highly likely to be clinically significant prostate cancer

Abstract

PurposeTo compare clinically significant prostate cancer (csPCa) detection rates between magnetic resonance imaging (MRI)–transrectal ultrasound (TRUS) fusion-guided prostate biopsy (FGB) and direct in-bore MRI-guided biopsy (MRGB).MethodsWe performed a comparison of csPCa detection rates between FGB and MRGB. Included patients had (1) at least one prior negative TRUS biopsy; (2) a Prostate Imaging Reporting and Data System (PI-RADS) 4 or 5 lesion and (3) a lesion size of ≥8 mm measured in at least one direction. We considered a Gleason score ≥7 being csPCa. Descriptive statistics with 95% confidence intervals (CI) were used to determine any differences.ResultsWe included 51 patients with FGB (59 PI-RADS 4 and 41% PI-RADS 5) and 227 patients with MRGB (34 PI-RADS 4 and 66% PI-RADS 5). Included patients had a median age of 69 years (IQR, 65–72) and a median PSA level of 11.0 ng/ml (IQR, 7.4–15.1) and a median age of 67 years (IQR, 61–70), the median PSA 12.8 ng/ml (IQR, 9.1–19.0) within the FGB and the MRGB group, respectively. Detection rates of csPCA did not differ significantly between FGB and MRGB, 49 vs. 61%, respectively.ConclusionWe did not detect significant differences between FGB and MRGB in the detection of csPCa. The differences in detection ratios between both biopsy techniques are narrow with an increasing lesion size. This study warrants further studies to optimize selection of best biopsy modality.

The Role of MRI-TRUS Fusion Biopsy in the Diagnosis of Clinical Significant Prostate Cancer (CsPca)

“…No significant difference in the overall and Cs PCa detection rates was observed between the two groups; the first constituted of 104 patients that were subjected to fusion biopsy (39 and 32%, respectively, for the PCa and Cs PCa detection rate), while an in-bore biopsy was performed on the other 106 patients (37 and 29%, respectively, for the PCa and Cs PCa detection rate). This is in agreement with the study performed by Vanderink et al according to which there is no significant difference in the detection rate between the two biopsy techniques [24].…”

In-Bore Versus Fusion MRI–Targeted Biopsy of PI-RADS Category 4 and 5 Lesions: A Retrospective Comparative Analysis Using Propensity Score Weighting

“…the study given relatively small numbers in the two cohorts. Conversely, Venderink et al [12] found the positive biopsy rate was significantly higher for any cancer detected by in-bore biopsy (85%; 193/227 patients) compared to fusion (67%; 34/51), and Costa et al [13] found the clinically significant prostate cancer detection rate was significantly higher for in-bore (61%; 63/103) than for fusion (47%; 141/300). The superiority of the in-bore approach in these two studies aligns with our findings.…”

“…Despite the important developments favoring MRI-targeted biopsy over systematic biopsy, few studies have directly compared in-bore and fusion MRItargeted biopsy, likely because most centers perform one or the other but not both. Further, the available studies [12,13], including one randomized controlled trial [14], comparing the precision of in-bore and fusion biopsies are conflicting.…”

Value of systematic biopsy added to target biopsy for detecting significant cancer in men with Prostate Imaging and Reporting and Data System 5

“…The significant CDR of the target biopsy in the group I is not inferior to those in previously reported papers using MRI-TRUS fusion or in-bore MRI-guided biopsy. They have showed that their CDRs ranged from 62% to 85% in PI-RADS 5 [8,10,15,16]. However, PI-RADS 1 or 2 does not have significant cancer 100% even though this category is very unlikely or unlikely to have it [1][2][3].…”