A prospective study on inter-operator variability in semi-robotic software-based MRI/TRUS-fusion targeted prostate biopsies.

Magnetic resonance imaging (MRI)/ultrasound-fusion prostate biopsy (FB) comprises multiple steps each of which can cause alterations in targeted biopsy (TB) accuracy leading to false-negative results. The aim was to assess the inter-operator variability of software-based fusion TB by targeting the same MRI-lesions by different urologists.

In this prospective study, 142 patients eligible for analysis underwent software-based FB. TB of all lesions (n = 172) were carried out by two different urologists per patient (n = 31 urologists). We analyzed the number of mismatches [overall prostate cancer (PCa), clinically significant PCa (csPCa) and non-significant PCa (nsPCa)] between both performed TB per patient. In addition we evaluated factors contributing to inter-operator variability by uni- and multivariable analyses.

In 11.6% of all MRI-lesions (10.6% of all patients) there was a mismatch between TB1 and TB2 in terms of overall prostate cancer (PCa detection. Regarding csPCa, patient-based mismatch occurred in 14.8% (n = 21). Overall PCa and csPCa detection rate of TB1 and TB2 did not differ significantly on a per-patient and per-lesion level. Analyses revealed a smaller lesion size as predictive for mismatches (OR 9.19, 95% CI 2.02-41.83, p < 0.001).

Reproducibility and precision of targeting particularly small lesions is still limited although using software-based FB. Further improvements in image-fusion, segmentation, needle-guidance, and automatization are necessary.

World journal of urology. 2021 Nov 26 [Epub ahead of print]

Fabian Derigs, Samuel Doryumu, Fabian Tollens, Dominik Nörenberg, Manuel Neuberger, Jost von Hardenberg, Maurice Stephan Michel, Manuel Ritter, Niklas Westhoff

Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. ., Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany., Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany., Department of Urology and Pediatric Urology, University Hospital of Bonn, Bonn, Germany.

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