Association of Patient and Imaging-Related Factors with False Negative MRI-Targeted Prostate Biopsies of Suspicious PI-RADS 4 and 5 Lesions.

To investigate specific imaging and patient-related factors associated with a false negative (FN) MRI-targeted prostate fusion biopsies (TBx) of suspicious MRI lesions.

Retrospective study of men with PI-RADS 4 or 5 lesions (11/2015-12/2020) and with TBx and SBx performed.

Only FN and true positive (TP) targeted lesions were included. FN biopsy was defined as a negative TBx with a positive systematic core in the ROI or perilesional sextant. Logistic regression was used to determine the association of patient and imaging-specific factors with the probability of a FN TBx.

361 PI-RADS 4 or 5 lesions in 304 patients, including 67 FN (19%) and 294 TP (81%) were included. There was a significant inverse association between lesion size (OR: 0.94, p-value: 0.02), presence of a suspicious DRE (OR: 0.36, p-value: 0.02) and PSA density (OR: 0.01, p-value: 0.004) on the probability of obtaining a FN TBx. There was no association between age, biopsy indication, use of an enema before MRI, prostate size, or discrepant US and MRI segmentation volumes on the probability of a FN TBx.

In this cohort, SBx detected 19% of csPCa missed on TBx. Smaller PI-RADS 4/5 lesions, lower PSAD values, and a normal DRE were all associated with an increased probability of a FN TBx.

Urology. 2022 May 06 [Epub ahead of print]

M Movassaghi, F Ahmed, H Patel, L Luk, E Hyams, S Wenske, H Shaish

Department of Urology, Columbia University Irving Medical Center, New York, NY. Electronic address: ., Department of Radiology, Columbia University Irving Medical Center, New York, NY., Department of Surgery, Division of Urology, Brown University., Department of Urology, Columbia University Irving Medical Center, New York, NY.

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