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Sokolakis I, Pyrgidis N, Koneval L, Krebs M, Thurner A, Kübler H, Hatzichristodoulou G. Usability and diagnostic accuracy of different MRI/ultrasound-guided fusion biopsy systems for the detection of clinically significant and insignificant prostate cancer: a prospective cohort study. World J Urol 2021; 39:4101-4108. [PMID: 34142231 DOI: 10.1007/s00345-021-03761-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/10/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To explore the usability and diagnostic accuracy for prostate cancer of three multiparametric magnetic resonance imaging (mpMRI)/transrectal ultrasound (TRUS)-guided fusion biopsy systems operated by the same urologists. METHODS We performed a prospective, observational study including patients that underwent prostate biopsy due to a visible lesion in mpMRI (PI-RADS ≥ 3). We consecutively assessed two platforms with a rigid image registration (BioJet, D&K Technologies and UroNav, Invivo Corporation) and one with an elastic registration (Trinity, KOELIS). Four urologists evaluated each fusion system in terms of usability based on the System Usability Scale and diagnostic accuracy based on the detection of prostate cancer. RESULTS We enrolled 60 consecutive patients that received mpMRI/TRUS-guided prostate biopsy with the BioJet (n = 20), UroNav (n = 20) or Trinity (n = 20) fusion system. Comparing the rigid with the elastic registration systems, the rigid registration systems were more user-friendly compared to the elastic registration systems (p = 0.012). Similarly, the prostate biopsy with the rigid registration systems had a shorter duration compared to the elastic registration system (p < 0.001). Overall, 40 cases of prostate cancer were detected. Of them, both the BioJet and UroNav fusion systems detected 13 prostate cancer cases, while the Trinity detected 14. No significant differences were demonstrated among the three fusion biopsy systems in terms of highest ISUP Grade Group (p > 0.99). CONCLUSIONS Rigid fusion biopsy systems are easier to use and provide shorter operative time compared to elastic systems, while both types of platforms display similar detection rates for prostate cancer. Still, further high-quality, long-term results are mandatory.
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Affiliation(s)
- Ioannis Sokolakis
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany. .,Department of Urology, Martha-Maria Hospital Nuremberg, Stadenstraße 58, 90491, Nuremberg, Germany.
| | - Nikolaos Pyrgidis
- Department of Urology, Martha-Maria Hospital Nuremberg, Stadenstraße 58, 90491, Nuremberg, Germany
| | - Lukas Koneval
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Markus Krebs
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Annette Thurner
- Department of Diagnostic and Interventional Radiology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Hubert Kübler
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Georgios Hatzichristodoulou
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany.,Department of Urology, Martha-Maria Hospital Nuremberg, Stadenstraße 58, 90491, Nuremberg, Germany
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von Landenberg N, Hanske J, Noldus J, Roghmann F, Tully KH, Wald J, Berg S, Brock M. Probability of Prostate Cancer Diagnosis following Negative Systematic and Targeted MRI: Transrectal Ultrasound Fusion Biopsy: A Real-Life Observational Study. Urol Int 2021; 105:446-452. [PMID: 33498059 DOI: 10.1159/000513075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The risk of occult prostate carcinoma (PCa) after negative multiparametric MRI (mpMRI)-transrectal fusion biopsy (F-Bx) is unknown. To determine the false-negative predictive value, we examined PCa detection after prior negative F-Bx. METHODS Between December 2012 and November 2016, 491 patients with suspected PCa and suspicious mpMRI findings underwent transrectal F-Bx. Patients with benign pathology (n = 191) were eligible for our follow-up (FU) survey. Patient characteristics and clinical parameters were correlated to subsequent findings of newly detected PCa. RESULTS Complete FU with a median of 31 (interquartile range: 17-39) months was available for 176/191 (92.2%) patients. Of those, 54 men had either surgical interventions on the prostate or re-Bxs. Newly detected PCa was evident in 14/176 (7.95%) patients stratified to ISUP ≤2 in 10 and ≥3 in 4 cases. The comparison of patients with newly detected PCa to those without cancerous findings in FU showed significant differences in prostate-specific antigen (PSA) density (0.16 vs. 0.13 ng/mL2) and prostate volume (45 vs. 67 mL, both p < 0.05). Both factors are significant predictors for newly detected cancer after initial negative F-Bx. CONCLUSION Only PSA density (>0.13 ng/mL2) and small prostate volume are significant predictors for newly detected PCa after initial negative F-Bx. Despite negative mpMRI/TRUS F-Bx results, patients should be further monitored due to a risk of developing PCa over time. Notwithstanding the limitation of our study that not all patients underwent another Bx, we assume that the false-negative rate is low but existing. Our data represent a real-world scenario.
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Affiliation(s)
| | - Julian Hanske
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Joachim Noldus
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Florian Roghmann
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Karl H Tully
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Jan Wald
- Department of Radiology and Nuclear Medicine, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Sebastian Berg
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Marko Brock
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
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Schoeb DS, Rassweiler J, Sigle A, Miernik A, Engels C, Goezen AS, Teber D. [Robotics and intraoperative navigation]. Urologe A 2020; 60:27-38. [PMID: 33320305 DOI: 10.1007/s00120-020-01405-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
Urology has always been closely linked to technological progress. In the last few decades, we have witnessed increasing implementation of various technologies and innovations in subdisciplines of urology. While conventional laparoscopy is increasingly being replaced by robot-assisted procedures and the introduction of new robotic systems from various manufactures will continue for years, the field of endourolgy is still not dominated by robotic systems. However, new systems (e.g., autonomous, robot-controlled aquablation of the prostate) are becoming increasingly popular and numerous development projects will also probably change clinical care in coming years. In addition, further advancements in the combination of robotics with intraoperative navigation through the integration of imaging and augmented-reality (AR) and virtual reality (VR) technology can be expected. This combination of navigation and robotic technology is already being used successfully in prostate biopsy.
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Affiliation(s)
- D S Schoeb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - J Rassweiler
- Klinik für Urologie, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland
| | - A Sigle
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - C Engels
- Urologische Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland
| | - A S Goezen
- Klinik für Urologie, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland
| | - D Teber
- Urologische Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland.
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Hellms S, Gutberlet M, Peperhove MJ, Pertschy S, Henkenberens C, Peters I, Wacker F, Derlin K. Applicability of readout-segmented echoplanar diffusion weighted imaging for prostate MRI. Medicine (Baltimore) 2019; 98:e16447. [PMID: 31335699 PMCID: PMC6709253 DOI: 10.1097/md.0000000000016447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To evaluate readout-segmented echoplanar (rsEPI) diffusion weighted imaging (DWI) for multiparametric (mp) magnetic resonance imaging (MRI) of the prostate compared to the established single-shot echoplanar imaging (ssEPI) sequence.One hundred ten consecutive patients with clinical suspicion of prostate cancer underwent mp prostate MRI using both, the ssEPI and the rsEPI DWI sequence. For an objective assessment, delineation of the prostate shape on both DWI sequences was compared to T2-weighted images by measuring organ diameters. Apparent diffusion coefficient (ADC) values, image contrast and contrast-to-noise ratio (CNR) were compared between the 2 sequences on a region-of-interest-based analysis. Diagnostic accuracy for quantitative ADC-values was calculated. Histopathology from MRI/ultrasound fusion-guided biopsy was used as reference standard. For a subjective assessment, 2 independent readers visually assessed image quality of both sequences using Likert-scales.Delineation of the prostate shape was more accurate with rsEPI compared to ssEPI. ADC values in target lesions were not significantly different but significantly higher in the surrounding normal prostatic tissue of the transition zone. CNR was comparable between ssEPI and rsEPI. Sensitivity and specificity were good for both sequences with 84/84% and 82/73% with a Youden selected cut-off of ADC = 0.971*10 mm/s for rsEPI and 1.017*10 mm/s for ssEPI. Anatomic artifacts were significantly less and SNR was lower on rsEPI compared to ssEPI in the subjective analysis.Delineation of the prostate shape was more accurate with rsEPI DWI than with ssEPI DWI with less anatomic artifacts and higher subjective SNR and image quality on rsEPI DW images. Diagnostic ability of quantitative ADC-values was not significantly different between the 2 sequences. Thus, rsEPI DWI might be more suitable for prostate MRI with regard to MRI-guided targeted biopsy and therapy planning.
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Affiliation(s)
| | | | | | | | | | - Inga Peters
- Clinic for Urology and urologic Oncology, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology
| | - Katja Derlin
- Institute for Diagnostic and Interventional Radiology
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Püllen L, Hadaschik B, Eberli D, Kuru TH. [Fusion biopsies for primary diagnosis of prostate cancer : Implementation, benefits, and clinical aspects]. Urologe A 2019; 58:504-510. [PMID: 30838429 DOI: 10.1007/s00120-019-0889-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Prostate carcinoma is one of the most common tumors worldwide. Histological confirmation by biopsy is an obligatory part of the diagnostic approach. The main problem of the 10-12-fold transrectal ultrasound-guided (TRUS) biopsy, which has so far been regarded as the gold standard, is the underdiagnosis of clinically significant cancer. MRI-based procedures, so-called fusion biopsies, have shown superior results when compared to conventional biopsies. There are three different approaches (cognitive and software-based MRI/TRUS fusion and in-bore biopsy) with comparable detection rates but differences in the technical aspects and time involvement. In order to reduce fusion errors, targeted biopsies should consist of multiple cores. There is currently no clear preference for the access pathway (transrectal or transperineal), but clinical parameters such as infection risk or location of the tumor can influence the decision. While the German S3 guideline considers MRI prior to primary biopsy to be optional, the 2019 European Association of Urology guidelines already recommend MRI prior to biopsy for all patients. The combination of MRI-targeted and systematic biopsy offers the highest detection rates with the disadvantage that more low-risk tumors are diagnosed. Both the patient and the urologist benefit from an improved informative value of the biopsy when deciding on active surveillance as well as when planning invasive therapies.
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Affiliation(s)
- L Püllen
- Klinik für Urologie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
| | - B Hadaschik
- Klinik für Urologie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - D Eberli
- Klinik für Urologie, Universitätsspital Zürich, Zürich, Schweiz
| | - T H Kuru
- Klinik für Urologie, Universitätsklinikum Köln, Köln, Deutschland.,Urologie am Ebertplatz, Köln, Deutschland
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Cognitive versus Software-Assisted Registration: Development of a New Nomogram Predicting Prostate Cancer at MRI-Targeted Biopsies. Clin Genitourin Cancer 2018; 16:e953-e960. [DOI: 10.1016/j.clgc.2018.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/24/2018] [Accepted: 03/24/2018] [Indexed: 11/18/2022]
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Bründl J, Breyer J, Burger M. [Imaging in individualized uro-oncology]. Urologe A 2018; 57:1048-1057. [PMID: 30054677 DOI: 10.1007/s00120-018-0729-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The recent introduction of new diagnostic techniques has revolutionized uro-oncolgy. In addition to multiparametric magnetic resonance imaging (mpMRI), prostate-specific membrane antigen positron-emission tomography (PSMA-PET) plays an increasingly import role in daily practice. The introduction of three-dimensional (3D) printing technologies in the context of robot-assisted uro-oncological surgery represents a first step towards individualized 3D imaging. In the era of immunotherapy, imaging is challenged by new diagnostic criteria (iRECIST) and immune-related adverse effects.
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Affiliation(s)
- J Bründl
- Klinik für Urologie der Universität Regensburg, Caritas-Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Deutschland.
| | - J Breyer
- Klinik für Urologie der Universität Regensburg, Caritas-Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Deutschland
| | - M Burger
- Klinik für Urologie der Universität Regensburg, Caritas-Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Deutschland
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von Hardenberg J, Büsing KA, Nuhn P, Ritter M. Die Rolle des PSMA-PET/CT bei Patienten mit metastasiertem Prostatakarzinom. Urologe A 2017; 56:1410-1416. [DOI: 10.1007/s00120-017-0513-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Evaluation of MRI/Ultrasound Fusion-Guided Prostate Biopsy Using Transrectal and Transperineal Approaches. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2176471. [PMID: 29094042 PMCID: PMC5637860 DOI: 10.1155/2017/2176471] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/12/2017] [Accepted: 08/20/2017] [Indexed: 12/22/2022]
Abstract
Purpose To evaluate transrectal (TR) and transperineal (TP) approaches for MRI/ultrasound (MRI/US) fusion-guided biopsy to detect prostate cancer (PCa). Materials and Methods 154 men underwent multiparametric MRI and MRI/US fusion-guided biopsy between July 2012 and October 2016. 79/154 patients were biopsied with a TR approach and 75/154 with a TP approach. MRI was retrospectively analyzed according to PI-RADS version 2. PI-RADS scores were compared with histopathological results. Descriptive statistics, accuracy, and negative and positive predictive values were calculated. Histopathological results of first, second, and third MRI targeted biopsy cores were compared to evaluate the impact of one verus multiple targeted cores. Results Detection rates of PCa were 39% for TR biopsy and 75% for TP biopsy. Sensitivity/specificity for tumor detection with PI-RADS ≥ 4 were 81/69% for TR biopsy and 86/84% for TP biopsy. In 31% for TR biopsy and 19% for TP biopsy, PCa was found in the second or third MRI targeted biopsy core only. Conclusion MRI/US fusion-guided biopsy may be conducted with the TR as well as the TP approach with high accuracy, giving more flexibility for diagnosis and the option for focal treatment of PCa.
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[Prostate gland - what would urologists like to know from radiologists?]. Radiologe 2017; 57:608-614. [PMID: 28660295 DOI: 10.1007/s00117-017-0273-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A more than 100-year period, where the prostate was only seen and treated as a whole is coming to an end right now. Finally, high resolution imaging is providing deep insights and detailed information so that new therapeutic procedures can aim for the smallest targets within the gland. The long-standing wish of patients for individual noninvasive diagnostics and treatment of prostate diseases can now be fulfilled by providing new tailored concepts; however, in order to transfer the enormous amount of new information into the specific clinical patient situation, a closely knit interdisciplinary approach is required. In this setting, the traditional outpatient consultation service is overstretched in every aspect. It is now the time for new innovative constructs. The current one-sided service concept for urologists, radiologists and radiation therapists is therefore behind the times and the development of a "prostate management team" with equally cooperating partners from each specialty is the task for the future.
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