To determine whether the difference between MRI-based and ultrasound (US)-based volume measurements are associated with MRI/US-targeted fusion-guided biopsy outcomes.
This retrospective, single-center study involved 4177 consecutive patients biopsied between 2010 and 2023 using both MRI/US-targeted fusion and systematic biopsy. Biopsies were indicated because of elevated prostate-specific antigen levels or abnormal multiparametric MRI results. US volume measurements were calculated using the triplane ellipsoid formula and MRI volumes were obtained by semi-automatic planimetric segmentation. Performance of fusion biopsy compared to systematic biopsy was analyzed with respect to the discordance between MRI and US volume measurements.
In 2736 (66%) patients, biopsy detected prostate cancer. In patients where both techniques yielded prostate cancers (1695/2736 [62%]), a statistically higher proportion of patients had higher Gleason scores on MRI/US-targeted fusion biopsy compared to systematic biopsy (343 patients [20.2%] vs. 137 patients [8.1%], p<0.001). MRI volume measurements were significantly smaller compared to US volume measurements (median [IQR] 54ml [39-77], 56ml [40-80], respectively, p<0.001). Beyond 5ml volume discordance, MRI/US-targeted fusion biopsy gradually showed less added diagnostic benefit compared to systematic biopsy. In the ≤5ml cohort, MRI/US-targeted fusion biopsy detected more aggressive tumors in four times as many patients than systematic biopsy (136 vs 32 patients, p<0.001).
Although MRI/US-targeted fusion biopsy detected more prostate cancers than systematic biopsy, the performance of MRI/US-targeted fusion biopsy declined with more discordance between volumes measured in MRI vs. US. Awareness of volume discordance in MRI and US-based volume measurements should alert the operator about the possibility of reduced performance of MRI/US-targeted fusion biopsy.
The Journal of urology. 2024 Dec 10 [Epub ahead of print]
Tabea Borde, Nicole A Varble, Lindsey A Hazen, Laetitia Saccenti, Charisse Garcia, Meredith Digennaro, Sandeep Gurram, Peter A Pinto, Baris Turkbey, Bradford J Wood
Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA., Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA., Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.