Prostate cancer diagnosis: Multiparametric MR-targeted biopsy with cognitive and transrectal US-MR fusion guidance versus systematic biopsy--Prospective multicenter study - Abstract

Purpose: To compare biopsy performance of two approaches for multiparametric magnetic resonance (MR)-targeted biopsy (TB) with that of extended systematic biopsy (SB) in prostate cancer (PCa) detection.

Materials and Methods: This institutional review board-approved multicenter prospective study (May 2009 to January 2011) included 95 patients with informed consent who were suspected of having PCa, with a suspicious abnormality (target) at prebiopsy MR. Patients underwent 12-core SB and four-core TB with transrectal ultrasonographic (US) guidance, with two cores aimed visually (cognitive TB [TB-COG]) and two cores aimed using transrectal US-MR fusion software (fusion-guided TB [TB-FUS]). SB and TB positivity for cancer and sampling quality (mean longest core cancer length, Gleason score) were compared. Clinically significant PCa was any 3 mm or greater core cancer length or any greater than 3 Gleason pattern for SB or any cancer length for TB. Statistical analysis included t test, paired χ2 test, and κ statistic. Primary end point (core cancer length) was calculated (paired t test).

Results: Among 95 patients (median age, 65 years; mean prostate-specific antigen level, 10.05 ng/mL [10.05 μg/L]), positivity rate for PCa was 59% (n = 56) for SB and 69% (n = 66) for TB (P = .033); rate for clinically significant PCa was 52% (n = 49) for SB and 67% (n = 64) for TB (P = .0011). Cancer was diagnosed through TB in 16 patients (17%) with negative SB results. Mean longest core cancer lengths were 4.6 mm for SB and 7.3 mm for TB (P < .0001). In 12 of 51 (24%) MR imaging targets with positive SB and TB results, TB led to Gleason score upgrading. In 79 MR imaging targets, positivity for cancer was 47% (n = 37) with TB-COG and 53% (n = 42) with TB-FUS (P = .16). Neither technique was superior for Gleason score assessment.

Conclusion: Prebiopsy MR imaging combined with transrectal US-guided TB increases biopsy performance in detecting PCa, especially clinically significant PCa. No significant difference was observed between TB-FUS and TB-COG for TB guidance.

Written by:
Puech P, Rouvière O, Renard-Penna R, Villers A, Devos P, Colombel M, Bitker MO, Leroy X, Mège-Lechevallier F, Comperat E, Ouzzane A, Lemaitre L.   Are you the author?
Departments of Radiology, Urology, Pathology, and Biostatistics, CHRU Lille, Université Lille Nord de France, Lille, France; INSERM U703, CHRU Lille, Université Lille Nord de France, Loos, France; Hospices Civils de Lyon, Departments of Urinary and Vascular Radiology, Urology, and Pathology, Hôpital Edouard Herriot, Lyon, France; Faculté de Médicine, Université Lyon 1, Lyon, France; Departments of Radiology, Urology, and Pathology, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médicine Pierre and Marie Curie, University Paris VI, Paris, France.

Reference: Radiology. 2013 Apr 11. Epub ahead of print.
doi: 10.1148/radiol.13121501


PubMed Abstract
PMID: 23579051

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