Why Does Magnetic Resonance Imaging-Targeted Biopsy Miss Clinically Significant Cancer?

Williams, Cheyenne; Ahdoot, Michael; Daneshvar, Michael; Hague, Christian; Wilbur, Andrew R; Gomella, Patrick T.; Shih, Joanna H.; Khondakar, Nabila; Yerram, Nitin; Mehralivand, Sherif; Gurram, Sandeep; Siddiqui, M. Minhaj; Pinsky, Paul F.; Parnes, Howard L.; Merino, María J.; Wood, Bradford J.; Türkbey, Barış; Pinto, Peter A.

doi:10.1097/ju.0000000000002182

Cited by 42 publications

(29 citation statements)

References 31 publications

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“…Despite advances, the contributing role of SB to TB remains a matter of debate. [1,4,6]. Advocates of CB proclaim an increased value for the true tumor grading and extent, which leads to a decreased likelihood of misdiagnosis and enables tailored disease management [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Current role of systematic biopsy in diagnosis of clinically significant prostate cancer in primary combined MRI-targeted biopsy: a high-volume single-center study

et al. 2022

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Purpose Additive systematic biopsy (SB) contributes to prostate cancer (PCA) detection in MRI-targeted biopsy (TB). However, the reasons for this are not yet clear. We compared the performance of TB, SB and the combined approach (CB) in biopsy-naive men to determine the added value of SB for tumor grading and spatial tumor distribution. Methods Two hundred and fifty-nine men with PI-RADS 3–5 graded lesions who underwent CB were enrolled. Data were prospectively collected, and cancer detection rates (CDR) were compared at patient and lesion level. Gleason grade up- and down-grading from biopsy to prostatectomy specimens (n = 56; 21.6%) were determined. Clinically significant cancer (csPCA) was defined as Gleason grade ≥ 2. Results CDR by CB based on PI-RADS categories 3, 4 and 5 for PCA were 24%, 72% and 98% and 17%, 64% and 96% for csPCA. CB detected more PCA and csPCA than TB (p < 0.001). However, TB showed higher efficiency, defined as CDR per biopsy core, for PCA and csPCA in PI-RADS 4–5 rated patients (p < 0.001). Concordance between biopsy and prostatectomy grading was highest in CB with misdiagnosis of csPCA in 25% of men. TB missed cancer attributed to the index lesion in 10.2% and underestimated csPCA in 7%. In these cases, 76% of csPCA were detected and 85% were upgraded to csPCA by SB in adjacent sectors. Conclusion SB cannot be safely abundant without increased diagnostic uncertainty. When TB missed csPCA, SB detected it close to the MRI-target lesion. Therefore, perifocal biopsies could potentially replace 12-core SB with increased efficiency in taking manageable risks.

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Section: Introductionmentioning

confidence: 99%

“…A specific explanation for the improved performance by additional SB is not yet clear. SB might compensate for targeting errors, MRI invisible cancer and under-sampling of the target approach considering the multifocality of PCA lesions [ 6 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Current role of systematic biopsy in diagnosis of clinically significant prostate cancer in primary combined MRI-targeted biopsy: a high-volume single-center study

et al. 2022

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“…However, only few studies have investigated the reasons for MRI-targeted biopsy failures. Williams et al [22] observed that MRI-invisible lesions and MRI lesions missed by the radiologist represent, respectively, 41.5% and 7.3% of these failures.…”

Section: Discussionmentioning

confidence: 99%

Assessing the Role of High-resolution Microultrasound Among Naïve Patients with Negative Multiparametric Magnetic Resonance Imaging and a Persistently High Suspicion of Prostate Cancer

Avolio¹,

Lughezzani²,

Fasulo³

et al. 2023

European Urology Open Science

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“…The usage of quantitative imaging biomarkers could improve targeting. This is notably important in the case of prostate carcinoma, where the spatial conditions mean that a solely MRI-guided biopsy does not always include clinically significant prostate cancer [ 109 ]. For example, combining prostate-specific antigen density and MRI for prostate biopsy planning allows the optimization of biopsy planning [ 110 ].…”

Section: Application and Evidence For Novel Imaging Biomarkers For Im...mentioning

confidence: 99%

The Potential and Emerging Role of Quantitative Imaging Biomarkers for Cancer Characterization

Tharmaseelan

Hertel

Rennebaum

et al. 2022

Cancers

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Similar to the transformation towards personalized oncology treatment, emerging techniques for evaluating oncologic imaging are fostering a transition from traditional response assessment towards more comprehensive cancer characterization via imaging. This development can be seen as key to the achievement of truly personalized and optimized cancer diagnosis and treatment. This review gives a methodological introduction for clinicians interested in the potential of quantitative imaging biomarkers, treating of radiomics models, texture visualization, convolutional neural networks and automated segmentation, in particular. Based on an introduction to these methods, clinical evidence for the corresponding imaging biomarkers—(i) dignity and etiology assessment; (ii) tumoral heterogeneity; (iii) aggressiveness and response; and (iv) targeting for biopsy and therapy—is summarized. Further requirements for the clinical implementation of these imaging biomarkers and the synergistic potential of personalized molecular cancer diagnostics and liquid profiling are discussed.

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Why Does Magnetic Resonance Imaging-Targeted Biopsy Miss Clinically Significant Cancer?

Cited by 42 publications

References 31 publications

Current role of systematic biopsy in diagnosis of clinically significant prostate cancer in primary combined MRI-targeted biopsy: a high-volume single-center study

Current role of systematic biopsy in diagnosis of clinically significant prostate cancer in primary combined MRI-targeted biopsy: a high-volume single-center study

Assessing the Role of High-resolution Microultrasound Among Naïve Patients with Negative Multiparametric Magnetic Resonance Imaging and a Persistently High Suspicion of Prostate Cancer

The Potential and Emerging Role of Quantitative Imaging Biomarkers for Cancer Characterization

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