Direct comparison of multiparametric MRI and final histopathology in patients with proven prostate cancer in MRI/Ultrasound-fusion biopsy.

To compare multiparametric magnetic resonance imaging of the prostate (mpMRI) and histological findings of targeted MRI/ultrasound-fusion biopsy (fusPBx) and systematic biopsy (sysPBx) to final histology of prostatectomy specimen (PrS).

105 patients with histopathologically proven prostate cancer (PCa) by combination of fusPbx and sysPBx and undergoing radical prostatectomy were investigated. All patients had been examined by mpMRI, applying the European Society of Urogenital Radiology criteria. Histological findings of PrS were compared to those of the biopsy. Whole mount PrS and MR-images were compared directly by a uro-pathologist and a uro-radiologist in step-section analysis.

105 patients with histopathologically proven PCa by combination of fusPBx and sysPBx (combPBx) were investigated. The detection rate of PCa was 90% (94/105) in fusPBx alone and 68% (72/105) in sysPBx alone (p=0.001). CombPBx detected 23 (22%) Gleason Score (GS) 6, 69 (66%) GS 7 and 13 (12%) GS ≥8 tumours. FusPBx alone detected 25 (26%) GS 6, 57 (61%) GS 7 and 12 (13%) GS ≥8 tumours. SysPBx alone detected 17 (24%) GS 6, 49 (68%) GS 7 and 6 (8%) GS ≥8 tumours. FusPBx alone would have missed 11 tumours (4% (4/105) (GS) 6; 6% (6/105) GS 7; 1% (1/105) GS ≥8), sysPBx alone would have missed 33 tumours (10% (10/105) GS 6; 20% (21/105) GS 7; 2% (2/105) GS ≥8). Concordance on GS between biopsy and PrS was 63% (n=65), 54% (n=56) and 75% (n=78) in fusPBx, in sysPBx and in the combination of both biopsy modalities (combPBx), respectively. Upgrading on GS between biopsy and PrS occurred in 33% (n=34), 44% (n=46) and 18% (n=19) in fusPBx, sysPBx and combPBx, respectively. Gamma correlation for detection of any cancer was 0.76 for combPBx, 0.68 for fusPBx alone and 0.23 for sysPBx alone. 84% (n=88) of index tumours could be identified by mpMRI; 86% (n=91) of index lesions in the mpMRI could be proven in PrS.

FusPBx of tumour suspicious lesions in mpMRI was associated with a higher detection rate of more aggressive PCa and a better tumour prediction in final histopathology than sysPBx alone. But combPBx has been shown the best concordance for the prediction of GS. Furthermore, the additional findings of sysPBx reflect the multifocality of PCa. Hence, the combination of both biopsy modalities would still present the best approach for the prediction of the final tumour grading in PCa. This article is protected by copyright. All rights reserved.

BJU international. 2016 Mar 02 [Epub ahead of print]

Angelika Borkowetz, Ivan Platzek, Marieta Toma, Theresa Renner, Roman Herout, Martin Baunacke, Michael Laniado, Gustavo Baretton, Michael Froehner, Stefan Zastrow, Manfred Wirth

Department of Urology, Technische Universität Dresden, Dresden, Germany., Department of Radiology and Interventional Radiology, Technische Universität Dresden, Dresden, Germany., Department of Pathology, Technische Universität Dresden, Dresden, Germany., Department of Urology, Technische Universität Dresden, Dresden, Germany., Department of Urology, Technische Universität Dresden, Dresden, Germany., Department of Urology, Technische Universität Dresden, Dresden, Germany., Department of Radiology and Interventional Radiology, Technische Universität Dresden, Dresden, Germany., Department of Pathology, Technische Universität Dresden, Dresden, Germany., Department of Urology, Technische Universität Dresden, Dresden, Germany., Department of Urology, Technische Universität Dresden, Dresden, Germany., Department of Urology, Technische Universität Dresden, Dresden, Germany.

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