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Fang JH, Zhang L, Xie X, Zhao P, Bao L, Kong F. Comparative diagnostic accuracy of multiparametric magnetic resonance imaging-ultrasound fusion-guided biopsy versus systematic biopsy for clinically significant prostate cancer. PeerJ 2023; 11:e16614. [PMID: 38107582 PMCID: PMC10725670 DOI: 10.7717/peerj.16614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose To examine the accuracy of transperineal magnetic resonance imaging (MRI)-ultrasound (US) fusion biopsy (FB) in identifying men with prostate cancer (PCa) that has reached a clinically relevant stage. Methods This investigation enrolled 459 males. In 210 of these patients (FB group), transperineal MRI/US fusion-guided biopsies were performed on the suspicious region, and in 249 others, a systematic biopsy (SB) was performed (SB group). We compared these groups using Gleason scores and rates of cancer detection. Results PCa cases counted 198/459 (43.1%), including 94/249 (37.8%) in the SB group and 104/210 (49.5%) in the FB group. FB was associated with higher overall diagnostic accuracy relative to SB (88.5% and 72.3%, P = 0.024). FB exhibited greater sensitivity than SB (88.9% and 71.2%, P = 0.025). The area under the curve for FB and SB approaches was 0.837 and 0.737, respectively, such that FB was associated with an 11.9% increase in accuracy as determined based upon these AUC values. Relative to SB, FB was better able to detect high-grade tumors (GS ≥ 7) (78.85% vs. 60.64%, P = 0.025). Conclusion Transperineal MRI-US fusion targeted biopsy is superior to the systematic one as an approach to diagnosing clinically significant PCa, as it is a viable technical approach to prostate biopsy.
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Affiliation(s)
- Jian-hua Fang
- Department of Medical Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
| | - Liqing Zhang
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
| | - Xi Xie
- Department of Urology Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
| | - Pan Zhao
- Department of Pathology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
| | - Lingyun Bao
- Department of Medical Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
| | - Fanlei Kong
- Department of Medical Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
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Grajales D, Kadoury S, Shams R, Barkati M, Delouya G, Béliveau-Nadeau D, Nicolas B, Le WT, Benhacene-Boudam MK, Juneau D, DaSilva JN, Carrier JF, Hautvast G, Ménard C. Performance of an integrated multimodality image guidance and dose-planning system supporting tumor-targeted HDR brachytherapy for prostate cancer. Radiother Oncol 2021; 166:154-161. [PMID: 34861267 DOI: 10.1016/j.radonc.2021.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Advances in high-dose-rate brachytherapy to treat prostate cancer hinge on improved accuracy in navigation and targeting while optimizing a streamlined workflow. Multimodal image registration and electromagnetic (EM) tracking are two technologies integrated into a prototype system in the early phase of clinical evaluation. We aim to report on the system's accuracy and workflow performance in support of tumor-targeted procedures. MATERIALS AND METHODS In a prospective study, we evaluated the system in 43 consecutive procedures after clinical deployment. We measured workflow efficiency and EM catheter reconstruction accuracy. We also evaluated the system's MRI-TRUS registration accuracy with/without deformation, and with/without y-axis rotation for urethral alignment at initialization. RESULTS The cohort included 32 focal brachytherapy and 11 integrated boost whole-gland implants. Mean procedure time excluding dose delivery was 38 min (range: 21-83) for focal, and 56 min (range: 38-89) for whole-gland implants; stable over time. EM catheter reconstructions achieved a mean difference between computed and measured free-length of 0.8 mm (SD 0.8, no corrections performed), and mean axial manual corrections 1.3 mm (SD 0.7). EM also enabled the clinical use of a non or partially visible catheter in 21% of procedures. Registration accuracy improved with y-axis rotation for urethral alignment at initialization and with the elastic registration (mTRE 3.42 mm, SD 1.49). CONCLUSION The system supported tumor-targeting and was implemented with no demonstrable learning curve. EM reconstruction errors were small, correctable, and improved with calibration and control of external distortion sources; increasing confidence in the use of partially visible catheters. Image registration errors remained despite rotational alignment and deformation, and should be carefully considered.
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Affiliation(s)
- David Grajales
- Polytechnique Montréal, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Samuel Kadoury
- Polytechnique Montréal, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | | | - Maroie Barkati
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | - Guila Delouya
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | | | - Benedicte Nicolas
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | | | | | - Daniel Juneau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | - Jean N DaSilva
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | - Jean-Francois Carrier
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | | | - Cynthia Ménard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada.
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Cornud F, Lefevre A, Flam T, Dumonceau O, Galiano M, Soyer P, Camparo P, Barral M. MRI-directed high-frequency (29MhZ) TRUS-guided biopsies: initial results of a single-center study. Eur Radiol 2020; 30:4838-4846. [PMID: 32350662 DOI: 10.1007/s00330-020-06882-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/25/2020] [Accepted: 04/09/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate the ability of high-frequency (29 MHz) transrectal micro-ultrasound (microUS) as a second-look examination after biparametric MRI (bp-MRI) and to reidentify focal lesions seen on diagnostic MRI and to detect new ones METHODS: A total of 118 consecutive men (mean age, 66 ± 13 [SD] years; range, 49-93 years) with a mean prostate-specific antigen level of 11 ± 19 (SD) ng/mL (range, 2-200 ng/mL) and at least one focal lesion (MRI+) with a score > 2 on bp-MRI were included. Of these, 79/118 (66.9%) were biopsy-naïve and 102/118 (86.5%) had non-suspicious rectal examination. All patients had MRI-directed microUS-guided biopsy using a 29-MHz transducer. All lesions visible on micro-ultrasound (microUS+) were targeted without image fusion, which was only used for MRI+/microUS- lesions. Significant prostate cancer (sPCa) was defined by a Gleason score ≥ 7 or a maximum cancer core length > 3 mm. RESULTS A total of 144 focal prostatic lesions were analyzed, including 114 (114/144, 79.2%) MRI+/microUS+ lesions, 13 MRI+/microUS- lesions (13/144, 9%), and 17 MRI-/microUS+ lesions (17/144, 11.8%). Significant PCa was detected in 70 MRI+/microUS+ lesions (70/114, 61.4%), in no MRI+/microUS- lesion (0/13, 0%), and in 4 MRI-/microUS+ lesions (4/17, 23.5%). The sensitivity and specificity of microUS on a per-patient and a per-lesion basis were 100% (95% CI, 84.9-100%) and 22.8% (95% CI, 12.5-35.8%) and 100% (95% CI, 85.1-100%) and 22.6% (95% CI, 12.3-36.2%), respectively. CONCLUSION MicroUS, as a second-look examination, may show promise to localize targets detected on bp-MRI. KEY POINTS • Used as a second-look examination, microUS-guided biopsies have a 100% detection rate of sCa originating in the PZ or lower third of the TZ, without microUS-MRI image fusion. • MicroUS results may provide additional information about lesions visible on MRI. • MicroUS may provide the ability to detect small PZ lesions undetected by bp-MRI.
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Affiliation(s)
- François Cornud
- Department of Radiology, Clinique de l'Alma, Paris, France. .,Department of Radiology, Hôpital Cochin, Assistance Publique Hôpitaux Paris, AP-HP, Paris, France.
| | - Arnaud Lefevre
- Department of Radiology, Clinique de l'Alma, Paris, France
| | - Thierry Flam
- Department of Urology, Clinique St Jean de Dieu, Paris, France
| | | | - Marc Galiano
- Department of Urology, Clinique de l'Alma, Paris, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique Hôpitaux Paris, AP-HP, Paris, France.,Université de Paris Descartes Paris V, Paris, France
| | | | - Matthias Barral
- Department of Radiology, Hôpital Cochin, Assistance Publique Hôpitaux Paris, AP-HP, Paris, France
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Venderink W, Bomers JG, Overduin CG, Padhani AR, de Lauw GR, Sedelaar MJ, Barentsz JO. Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know. Part 3: Targeted Biopsy. Eur Urol 2020; 77:481-490. [DOI: 10.1016/j.eururo.2019.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/18/2019] [Indexed: 02/02/2023]
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Mai Z, Zhou Z, Yan W, Xiao Y, Zhou Y, Liang Z, Ji Z, Li H. The transverse and vertical distribution of prostate cancer in biopsy and radical prostatectomy specimens. BMC Cancer 2018; 18:1205. [PMID: 30514243 PMCID: PMC6278093 DOI: 10.1186/s12885-018-5124-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/22/2018] [Indexed: 01/29/2023] Open
Abstract
Background Prostate biopsy is the most common method for the diagnosis of prostate cancer and the basis for further treatment. Confirmation using radical prostatectomy specimens is the most reliable method for verifying the accuracy of template-guided transperineal prostate biopsy. The study aimed to reveal the spatial distribution of prostate cancer in template-guided transperineal saturation biopsy and radical prostatectomy specimens. Methods Between December 2012 to December 2016, 171 patients were diagnosed with prostate cancer via template-guided transperineal prostate biopsy and subsequently underwent laparoscopic radical prostatectomy. The spatial distributions of prostate cancer were analyzed and the consistency of the tumor distribution between biopsy and radical prostatectomy specimens were compared. Results The positive rate of biopsy in the apex region was significantly higher than that of the other biopsy regions (43% vs 28%, P < 0.01). In radical prostatectomy specimens, the positive rate was highest at the region 0.9–1.3 cm above the apex, and it had a tendency to decrease towards the base. There was a significant difference in the positive rate between the cephalic and caudal half of the prostate (68% vs 99%, P < 0.01). There were no significant differences between the anterior and posterior zones for either biopsy or radical prostatectomy specimens. Conclusion The tumor spatial distribution generated by template-guided transperineal prostate biopsy was consistent with that of radical prostatectomy specimens in general. The positive rate was consistent between anterior and posterior zones. The caudal half of the prostate, especially the vicinity of the apex, was the frequently occurred site of the tumor.
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Affiliation(s)
- Zhipeng Mai
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 WangfujingShuaifuyuan, Beijing, 100730, China
| | - Zhien Zhou
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 WangfujingShuaifuyuan, Beijing, 100730, China
| | - Weigang Yan
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 WangfujingShuaifuyuan, Beijing, 100730, China.
| | - Yu Xiao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 WangfujingShuaifuyuan, Beijing, 100730, China
| | - Yi Zhou
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 WangfujingShuaifuyuan, Beijing, 100730, China
| | - Zhiyong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 WangfujingShuaifuyuan, Beijing, 100730, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 WangfujingShuaifuyuan, Beijing, 100730, China
| | - Hanzhong Li
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 WangfujingShuaifuyuan, Beijing, 100730, China
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Cornud F, Bomers J, Futterer J, Ghai S, Reijnen J, Tempany C. MR imaging-guided prostate interventional imaging: Ready for a clinical use? Diagn Interv Imaging 2018; 99:743-753. [DOI: 10.1016/j.diii.2018.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/08/2018] [Indexed: 01/22/2023]
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