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Lenfant L, Beitone C, Troccaz J, Rouprêt M, Seisen T, Voros S, Mozer PC. Learning curve for fusion magnetic resonance imaging targeted prostate biopsy and three-dimensional transrectal ultrasonography segmentation. BJU Int 2024; 133:709-716. [PMID: 38294145 DOI: 10.1111/bju.16287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE To report the learning curve of multiple operators for fusion magnetic resonance imaging (MRI) targeted biopsy and to determine the number of cases needed to achieve proficiency. MATERIALS AND METHODS All adult males who underwent fusion MRI targeted biopsy between February 2012 and July 2021 for clinically suspected prostate cancer (PCa) in a single centre were included. Fusion transrectal MRI targeted biopsy was performed under local anaesthesia using the Koelis platform. Learning curves for segmentation of transrectal ultrasonography (TRUS) images and the overall MRI targeted biopsy procedure were estimated with locally weighted scatterplot smoothing by computing each operator's timestamps for consecutive procedures. Non-risk-adjusted cumulative sum (CUSUM) methods were used to create learning curves for clinically significant (i.e., International Society of Urological Pathology grade ≥ 2) PCa detection. RESULTS Overall, 1721 patients underwent MRI targeted biopsy in our centre during the study period. The median (interquartile range) times for TRUS segmentation and for the MRI targeted biopsy procedure were 4.5 (3.5, 6.0) min and 13.2 (10.6, 16.9) min, respectively. Among the 14 operators with experience of more than 50 cases, a plateau was reached after 40 cases for TRUS segmentation time and 50 cases for overall MRI targeted biopsy procedure time. CUSUM analysis showed that the learning curve for clinically significant PCa detection required 25 to 45 procedures to achieve clinical proficiency. Pain scores ranged between 0 and 1 for 84% of patients, and a plateau phase was reached after 20 to 100 cases. CONCLUSIONS A minimum of 50 cases of MRI targeted biopsy are necessary to achieve clinical and technical proficiency and to reach reproducibility in terms of timing, clinically significant PCa detection, and pain.
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Affiliation(s)
- Louis Lenfant
- GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Urology, Sorbonne Université, Paris, France
- CNRS UMR 7222, INSERM U1150, Institut des Systèmes Intelligents et Robotique (ISIR), Sorbonne Université, Paris, France
- CNRS, INSERM, Grenoble INP, TIMC, Univ. Grenoble Alpes, Grenoble, France
| | - Clément Beitone
- CNRS, INSERM, Grenoble INP, TIMC, Univ. Grenoble Alpes, Grenoble, France
| | - Jocelyne Troccaz
- CNRS, INSERM, Grenoble INP, TIMC, Univ. Grenoble Alpes, Grenoble, France
| | - Morgan Rouprêt
- GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Urology, Sorbonne Université, Paris, France
| | - Thomas Seisen
- GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Urology, Sorbonne Université, Paris, France
| | - Sandrine Voros
- CNRS UMR 7222, INSERM U1150, Institut des Systèmes Intelligents et Robotique (ISIR), Sorbonne Université, Paris, France
| | - Pierre C Mozer
- GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Urology, Sorbonne Université, Paris, France
- CNRS UMR 7222, INSERM U1150, Institut des Systèmes Intelligents et Robotique (ISIR), Sorbonne Université, Paris, France
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Lenfant L, Beitone C, Troccaz J, Beaugerie A, Rouprêt M, Seisen T, Renard-Penna R, Voros S, Mozer PC. Impact of Relative Volume Difference Between Magnetic Resonance Imaging and Three-dimensional Transrectal Ultrasound Segmentation on Clinically Significant Prostate Cancer Detection in Fusion Magnetic Resonance Imaging-targeted Biopsy. Eur Urol Oncol 2024; 7:430-437. [PMID: 37599199 DOI: 10.1016/j.euo.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/10/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Segmentation of three-dimensional (3D) transrectal ultrasound (TRUS) images is known to be challenging, and the clinician often lacks a reliable and easy-to-use indicator to assess its accuracy during the fusion magnetic resonance imaging (MRI)-targeted prostate biopsy procedure. OBJECTIVE To assess the effect of the relative volume difference between 3D-TRUS and MRI segmentation on the outcome of a targeted biopsy. DESIGN, SETTING, AND PARTICIPANTS All adult males who underwent an MRI-targeted prostate biopsy for clinically suspected prostate cancer between February 2012 and July 2021 were consecutively included. INTERVENTION All patients underwent a fusion MRI-targeted prostate biopsy with a Koelis device. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Three-dimensional TRUS and MRI prostate volumes were calculated using 3D prostate models issued from the segmentations. The primary outcome was the relative segmentation volume difference (SVD) between transrectal ultrasound and MRI divided by the MRI volume (SVD = MRI volume - TRUS volume/MRI volume) and its correlation with clinically significant prostate cancer (eg, International Society of Urological Pathology [ISUP] ≥2) positiveness on targeted biopsy cores. RESULTS AND LIMITATIONS Overall, 1721 patients underwent a targeted biopsy resulting in a total of 5593 targeted cores. The median relative SVD was significantly lower in patients diagnosed with clinically significant prostate cancer than in those with ISUP 0-1: (6.7% [interquartile range {IQR} -2.7, 13.6] vs 8.0% [IQR 3.3, 16.4], p < 0.01). A multivariate regression analysis showed that a relative SVD of >10% of the MRI volume was associated with a lower detection rate of clinically significant prostate cancer (odds ratio = 0.74 [95% confidence interval: 0.55-0.98]; p = 0.038). CONCLUSIONS A relative SVD of >10% of the MRI segmented volume was associated with a lower detection rate of clinically significant prostate cancer on targeted biopsy cores. The relative SVD can be used as a per-procedure quality indicator of 3D-TRUS segmentation. PATIENT SUMMARY A discrepancy of ≥10% between segmented magnetic resonance imaging and transrectal ultrasound volume is associated with a reduced ability to detect significant prostate cancer on targeted biopsy cores.
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Affiliation(s)
- Louis Lenfant
- Urologie, GRC n 5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France; CNRS, INSERM, Grenoble INP, TIMC, Univ. Grenoble Alpes, Grenoble, France; CNRS UMR 7222, INSERM U1150, Institut des Systèmes Intelligents et Robotique (ISIR), Sorbonne Université, Paris, France.
| | - Clément Beitone
- CNRS, INSERM, Grenoble INP, TIMC, Univ. Grenoble Alpes, Grenoble, France
| | - Jocelyne Troccaz
- CNRS, INSERM, Grenoble INP, TIMC, Univ. Grenoble Alpes, Grenoble, France
| | - Aurélien Beaugerie
- Urologie, GRC n 5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Morgan Rouprêt
- Urologie, GRC n 5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Thomas Seisen
- Urologie, GRC n 5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Raphaele Renard-Penna
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Sandrine Voros
- CNRS, INSERM, Grenoble INP, TIMC, Univ. Grenoble Alpes, Grenoble, France
| | - Pierre C Mozer
- Urologie, GRC n 5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France; CNRS UMR 7222, INSERM U1150, Institut des Systèmes Intelligents et Robotique (ISIR), Sorbonne Université, Paris, France
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Quentin M, Boschheidgen M, Radtke JP, Spohn F, Ullrich T, Drewes L, Valentin B, Lakes J, Al-Monajjed, Arsov C, Esposito I, Albers P, Antoch G, Schimmöller L. MRI in-bore biopsy following MRI/US fusion-guided biopsy in patients with persistent suspicion of clinically significant prostate cancer. Eur J Radiol 2024; 175:111436. [PMID: 38522396 DOI: 10.1016/j.ejrad.2024.111436] [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: 12/17/2023] [Revised: 02/23/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Patients with suspicion of clinically significant prostate cancer (csPC) on multiparametric prostate MRI (mpMRI) but negative or inconclusive MRI/US fusion-guided biopsy (FB) can be challenging in clinical practice. To assess the utility of MRI in-bore biopsy (IB) in patients with discordant imaging and histopathological findings after FB. METHODS Consecutive patients with Prostate Imaging Reporting and Data System (PI-RADS) category 4 or 5 on mpMRI at 3T after FB without histologically confirmed csPC who underwent IB between 01/2014 and 05/2022, were retrospectively included. The primary objective was to assess the detection rate of csPC. Secondary objectives were to analyze clinical parameters, MRI parameters, and lesion localization. RESULTS In the final cohort of 51 patients, the IB resulted in an overall detection rate of 71% for PC and 47% for csPC. Furthermore, in 55% of cases with initial low-grade PC, the Gleason score was upgraded after IB. CsPC was often detected apical and/or anterior. The detection rate for PC was 58% in PI-RADS category 4 and 94% in PI-RADS category 5 (csPC 39% and 61%, respectively). Patients with csPC had statistically significant smaller prostate volumes, a higher PI-RADS category, a higher prostate-specific antigen density (PSAD), and were older. CONCLUSIONS For a relevant proportion of patients with PI-RADS category 4 or 5 and negative or inconclusive findings on previous FB, but with persistent suspicion of csPC, a subsequent IB verified the presence of csPC. Therefore, IB can be a backup in cases of uncertainty.
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Affiliation(s)
- M Quentin
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - M Boschheidgen
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - J P Radtke
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - F Spohn
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - T Ullrich
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - L Drewes
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - B Valentin
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - J Lakes
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - Al-Monajjed
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - C Arsov
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany; Elisabeth-Krankenhaus Rheydt, Departement of Urology and Paediatric Urology, Staedtische Kliniken Moenchengladbach GmbH, Moenchengladbach, Germany.
| | - I Esposito
- University Dusseldorf, Medical Faculty, Institute of Pathology, D-40225 Dusseldorf, Germany.
| | - P Albers
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - G Antoch
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - L Schimmöller
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany; Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
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Alargkof V, Engesser C, Breit HC, Winkel DJ, Seifert H, Trotsenko P, Wetterauer C. The learning curve for robotic-assisted transperineal MRI/US fusion-guided prostate biopsy. Sci Rep 2024; 14:5638. [PMID: 38454051 PMCID: PMC10920700 DOI: 10.1038/s41598-024-55492-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/23/2024] [Indexed: 03/09/2024] Open
Abstract
Transperineal fusion prostate biopsy has a considerable learning curve (LC). Robotic-assisted transperineal MRI/Ultrasound fusion-guided biopsy (RA-TP-FBx) may have an easier LC due to automatization. We aimed to assess the LC of RA-TP-FBx and analyze its most difficult steps. We prospectively analyzed cases randomized to a biopsy-naïve urology resident, the chief resident, and an expert urologist in RA-TP-FBx (controls). We also analyzed consecutive cases in the LC of the expert. The LC was defined by procedure time, PCa detection rate (including stratification by PI-RADS), entrustable professional activities (EPA) assessment scores, and the NASA task load index. We collectively performed 246 RA-TP-FBx with the Mona Lisa device. Procedure time for residents decreased steeply from maximum 53 min to minimum 10 min, while the mean procedure time for the expert was 9 min (range 17-5 min). PCa detection for PI-RADS-4 lesions was 57% for the naïve resident, 61% for the chief resident and 62% for the expert. There was also no difference in Pca detection for PI-RADS-4 lesions when comparing the first and second half of the experts' biopsies (p = 0.8). Maximum EPA score was registered after 22 cases. Workload steeply declined. Proficient RA-TP-FBx performance appears feasible after 22 cases regardless of previous experience.
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Affiliation(s)
- Viktor Alargkof
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland
| | - Christian Engesser
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland
| | | | - David Jean Winkel
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Helge Seifert
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland
| | - Pawel Trotsenko
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland
- Department of Urology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Christian Wetterauer
- Department of Urology, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
- Department of Medicine, Faculty of Medicine and Dentistry, Danube Private University, Krems, Austria.
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Xu L, Ye NY, Lee A, Chopra J, Naslund M, Wong-You-Cheong J, Wnorowski A, Siddiqui MM. Learning curve for magnetic resonance imaging/ultrasound fusion prostate biopsy in detecting prostate cancer using cumulative sum analysis. Curr Urol 2023; 17:159-164. [PMID: 37448610 PMCID: PMC10337819 DOI: 10.1097/cu9.0000000000000116] [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: 07/06/2020] [Accepted: 09/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background Targeted magnetic resonance (MR) with ultrasound (US) fusion-guided biopsy has been shown to improve detection of prostate cancer. The implementation of this approach requires integration of skills from radiologists and urologists. Objective methods for assessment of learning curves, such as cumulative sum (CUSUM) analysis, may be helpful in identifying the presence and duration of a learning curve. The aim of this study is to determine the learning curve for MR/US fusion-guided biopsy in detecting clinically significant prostate cancer using CUSUM analysis. Materials and methods Retrospective analysis was performed in this institutional review board-approved study. Two urologists implemented an MR/US fusion-guided prostate biopsy program between March 2015 and September 2017. The primary outcome measure was cancer detection rate (CDR) stratified by Prostate Imaging Reporting and Data System (PI-RADS) scores assigned on the MR imaging. Cumulative sum analysis quantified actual cancer detection versus a predetermined target satisfactory CDR of MR/US fusion biopsies in a sequential case-by-case basis. For this analysis, satisfactory performance was defined as >80% CDR in patients with PI-RADS 5, >50% in PI-RADS 4, and <20% in PI-RADS 1-3. Results Complete data were available for MR/US fusion-guided biopsies performed on 107 patients. The CUSUM learning curve analysis demonstrated intermittent underperformance until approximately 50 cases. After this inflection point, there was consistently good performance, evidence that no further learning curve was being encountered. Conclusions At a new center implementing MR/US fusion-guided prostate biopsy, the learning curve was approximately 50 cases before a consistently high performance for prostate cancer detection.
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Affiliation(s)
- Linhan Xu
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nancy Yating Ye
- Division of Urology, Department of General Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Adrianna Lee
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jasleen Chopra
- Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael Naslund
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Jade Wong-You-Cheong
- Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amelia Wnorowski
- Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohummad Minhaj Siddiqui
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
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Dhir A, Ellimoottil CS, Qi J, Zhu A, Wang RS, Montgomery JS, Salami SS, Wei JT, Shankar PR, Davenport MS, Curci NE, Millet JD, Wu CY, Johnson A, Miller DC, George AK. Intra-practice Urologist-level Variation in Targeted Fusion Biopsy Outcomes. Urology 2023; 177:122-127. [PMID: 37121355 DOI: 10.1016/j.urology.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To examine the extent to which the urologist performing biopsy contributes to variation in prostate cancer detection during fusion-guided prostate biopsy. METHODS All men in the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry who underwent fusion biopsy at Michigan Medicine from August 2017 to March 2019 were included. The primary outcomes were clinically significant cancer detection rate (defined as Gleason Grade ≥2) in targeted cores and clinically significant cancer detection on targeted cores stratified by PI-RADS score. Bivariate and multivariable logistic regression analyses were performed. RESULTS A total of 1133 fusion biopsies performed by 5 providers were included. When adjusting for patient age, PSA, race, family history, prostate volume, clinical stage, and PI-RADS score, there was no significant difference in targeted clinically significant cancer detection rates across providers (range = 38.5%-46.9%, adjusted P-value = .575). Clinically significant cancer detection rates ranged from 11.1% to 16.7% in PI-RADS 3 (unadjusted P = .838), from 24.6% to 43.4% in PI-RADS 4 (adjusted P = .003), and from 69.4% to 78.8% in PI-RADS 5 (adjusted P = .766) lesions. CONCLUSION There was a statistically significant difference in clinically significant prostate cancer detection in PI-RADS 4 lesions across providers. These findings suggest that even among experienced providers, variation at the urologist level may contribute to differences in clinically significant cancer detection rates within PI-RADS 4 lesions. However, the relative impact of biopsy technique, radiologist interpretation, and MR acquisition protocol requires further study.
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Affiliation(s)
- Apoorv Dhir
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Chad S Ellimoottil
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Ji Qi
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Alex Zhu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Robert S Wang
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Jeffrey S Montgomery
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Simpa S Salami
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - John T Wei
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Prasad R Shankar
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Matthew S Davenport
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Nicole E Curci
- Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - John D Millet
- Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Chen-Yu Wu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Anna Johnson
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - David C Miller
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Arvin K George
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
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Paesano N, Catalá V, Tcholakian L, Trilla E, Morote J. A Systematic Review of the Current Status of Magnetic Resonance-Ultrasound Images Fusion Software Platforms for Transperineal Prostate Biopsies. Cancers (Basel) 2023; 15:3329. [PMID: 37444439 DOI: 10.3390/cancers15133329] [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: 05/14/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Given this new context, our objective is to recognize the suitability of the currently available software for image fusion and the reported series using the transperineal route, as well as to generate new evidence on the complementarity of the directed and systematic biopsies, which has been established through the transrectal approach. EVIDENCE ACQUISITION This systematic review, registered in Prospero (CRD42022375619), began with a bibliographic search that was carried out in PubMed, Cochrane, and Google Scholar databases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria and the studied eligibility based on the Participants, Intervention, Comparator, and Outcomes (PICO) strategy were followed. Warp analysis of selected studies was performed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. In addition, a Google search of all currently available fusion platforms was performed. Our Google search found 11 different commercially available robots to perform transperineal image fusion biopsies, of which 10 devices have published articles supporting their diagnostic effectiveness in transperineal prostate biopsies. RESULTS A total of 30 articles were selected and the characteristics and results of the biopsies of 11,313 patients were analyzed. The pooled mean age was 66.5 years (63-69). The mean pooled PSA level was 7.8 ng/mL (5.7-10.8). The mean pooled prostate volume was 45.4 cc. (34-56). The mean pooled PSA density was 0.17 (0.12-0.27). The overall cancer detection rate for all prostate cancers was 61.4%, while for csPCa it was 47.8%. PCa detection rate was more effective than that demonstrated in the systematic transrectal biopsy. However, the detection of csPCa in the systematic biopsy was only 9.5% in the reported series. To standardize our review, we grouped prostate cancer screening results according to the population studied and the software used. When the same populations were compared between elastic and rigid software, we found that rigid biopsies had a higher csPCa detection rate than biopsies with elastic fusion systems. CONCLUSION Platforms performing prostate biopsy using transperineal image fusion have better detection rates of csPCa than systematic transrectal biopsies. Rigid fusion systems have a better csPCa detection rate than elastic ones. We found no diagnostic differences between the different types of robotic systems currently available. The complementarity of systematic biopsy has also been demonstrated in transperineal imaging fusion biopsies.
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Affiliation(s)
| | | | | | - Enric Trilla
- Department of Urology, Vall d'Hebron Hospital, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Juan Morote
- Department of Urology, Vall d'Hebron Hospital, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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8
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Hsieh PF, Li PI, Lin WC, Chang H, Chang CH, Wu HC, Chang YH, Wang YD, Huang WC, Huang CP. Learning Curve of Transperineal MRI/US Fusion Prostate Biopsy: 4-Year Experience. Life (Basel) 2023; 13:life13030638. [PMID: 36983794 PMCID: PMC10059778 DOI: 10.3390/life13030638] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
This study aimed to evaluate the learning curve of transperineal magnetic resonance imaging (MRI)/ultrasound (US) fusion biopsy in a team composed of a single surgeon, a single radiologist, and a single pathologist. We prospectively enrolled 206 patients undergoing MRI/US fusion prostate biopsy and divided them into four cohorts by the year of biopsy. We analyzed temporal changes in clinically significant prostate cancer (csPC) detection rate, percentage of positive cores on biopsy, and Gleason upgrading rate after radical prostatectomy. The csPC detection rate by MRI/US fusion targeted biopsy (TB) increased significantly (from 35.3% to 60.0%, p = 0.01). With increased experience, the csPC detection rates for small (≤1 cm) and anterior target lesions gradually increased (from 41.2% to 51.6%, p = 0.5; from 54.5% to 88.2%, p = 0.8, respectively). The percentage of positive cores on TB increased significantly (from 18.4% to 44.2%, p = 0.001). The Gleason upgrading rate gradually decreased (from 22.2% to 11.1%, p = 0.4). In conclusion, with accumulated experience and teamwork, the csPC detection rate by TB significantly increased. Multidisciplinary team meetings and a free-hand biopsy technique were the key factors for overcoming the learning curve.
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Affiliation(s)
- Po-Fan Hsieh
- Department of Urology, China Medical University Hospital, Taichung 404, Taiwan
- School of Medicine, China Medical University, Taichung 404, Taiwan
| | - Po-I Li
- Department of Urology, China Medical University Hospital, Taichung 404, Taiwan
| | - Wei-Ching Lin
- School of Medicine, China Medical University, Taichung 404, Taiwan
- Department of Radiology, China Medical University Hospital, Taichung 404, Taiwan
| | - Han Chang
- School of Medicine, China Medical University, Taichung 404, Taiwan
- Department of Pathology, China Medical University Hospital, Taichung 404, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University Hospital, Taichung 404, Taiwan
| | - Hsi-Chin Wu
- Department of Urology, China Medical University Hospital, Taichung 404, Taiwan
- Department of Urology, China Medical University Beigang Hospital, Yunlin 651, Taiwan
| | - Yi-Huei Chang
- Department of Urology, China Medical University Hospital, Taichung 404, Taiwan
| | - Yu-De Wang
- Department of Urology, China Medical University Hospital, Taichung 404, Taiwan
| | - Wen-Chin Huang
- Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung 404, Taiwan
- International Master’s Program of Biomedical Sciences, School of Medicine, China Medical University, Taichung 404, Taiwan
- Correspondence: (W.-C.H.); (C.-P.H.); Tel.: +886-4-2205-2121 (ext. 2955) (C.-P.H.)
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, Taichung 404, Taiwan
- School of Medicine, China Medical University, Taichung 404, Taiwan
- Correspondence: (W.-C.H.); (C.-P.H.); Tel.: +886-4-2205-2121 (ext. 2955) (C.-P.H.)
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9
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Saner YM, Wiesenfarth M, Weru V, Ladyzhensky B, Tschirdewahn S, Püllen L, Bonekamp D, Reis H, Krafft U, Heß J, Kesch C, Darr C, Forsting M, Wetter A, Umutlu L, Haubold J, Hadaschik B, Radtke JP. Detection of Clinically Significant Prostate Cancer Using Targeted Biopsy with Four Cores Versus Target Saturation Biopsy with Nine Cores in Transperineal Prostate Fusion Biopsy: A Prospective Randomized Trial. Eur Urol Oncol 2023; 6:49-55. [PMID: 36175281 DOI: 10.1016/j.euo.2022.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy (TB) facilitate accurate detection of clinically significant prostate cancer (csPC). However, it remains unclear how targeted cores should be applied for accurate diagnosis of csPC. OBJECTIVE To assess csPC detection rates for two target-directed MRI/transrectal ultrasonography (TRUS) fusion biopsy approaches, conventional TB and target saturation biopsy (TS). DESIGN, SETTING, AND PARTICIPANTS This was a prospective single-center study of outcomes for transperineal MRI/TRUS fusion biopsies for 170 men. Half of the men (n = 85) were randomized to conventional TB with four cores per lesion and half (n = 85) to TS with nine cores. Biopsies were performed by three experienced board-certified urologists. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS PC and csPC (International Society of Urological Pathology grade group ≥2) detection rates for systematic biopsy (SB), TB, and TS were analyzed using McNemar's test for intrapatient comparisons and Fisher's exact test for TS versus TB. A combination of targeted biopsy (TS or TB) and SB served as the reference. RESULTS AND LIMITATIONS According to the reference, csPC was diagnosed for 57 men in the TS group and 36 men in the TB group. Of these, TS detected 57/57 csPC cases and TB detected 33/36 csPC cases (p = 0.058). Detection of Gleason grade group 1 disease was 10/12 cases with TS and 8/17 cases with TB (p = 0.055). In addition, TS detected 97% of 63 csPC lesions, compared to 86% with TB (p = 0.1). Limitations include the single-center design, the limited generalizability owing to the transperineal biopsy route, the lack of central review of pathology and radical prostatectomy correlation, and uneven distributions of csPC prevalence, Prostate Imaging-Reporting and Data System (PI-RADS) 5 lesions, men with two or more PI-RADS ≥3 lesions, and prostate-specific antigen density between the groups, which may have affected the results. CONCLUSIONS In our study, rates of csPC detection did not significantly differ between TS and TB. PATIENT SUMMARY In this study, we investigated two targeted approaches for taking prostate biopsy samples after observation of suspicious lesions on prostate scans. We found that the rates of detection of prostate cancer did not significantly differ between the two approaches.
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Affiliation(s)
| | - Manuel Wiesenfarth
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Vivienn Weru
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Boris Ladyzhensky
- Department of Anesthesia and Perioperative Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Lukas Püllen
- Department of Urology, University Hospital Essen, Essen, Germany
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Henning Reis
- Institute of Pathology, University Duisburg-Essen, Essen, Germany
| | - Ulrich Krafft
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Jochen Heß
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Christopher Darr
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Axel Wetter
- Institute of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Essen, Germany; Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
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10
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Dias AB, O’Brien C, Correas JM, Ghai S. Multiparametric ultrasound and micro-ultrasound in prostate cancer: a comprehensive review. Br J Radiol 2022; 95:20210633. [PMID: 34752132 PMCID: PMC8978255 DOI: 10.1259/bjr.20210633] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer (PCa) is the most common non-cutaneous cancer diagnosed in males. Traditional tools for screening and diagnosis, such as prostate-specific antigen, digital rectal examination and conventional transrectal ultrasound (TRUS), present low accuracy for PCa detection. Multiparametric MRI has become a game changer in the PCa diagnosis pathway and MRI-targeted biopsies are currently recommended for males at risk of clinically significant PCa, even in biopsy-naïve patients. Recent advances in ultrasound have also emerged with the goal to provide a readily accessible and cost-effective tool for detection of PCa. These newer techniques include elastography and contrast-enhanced ultrasound, as well as improved B-mode and Doppler techniques. These modalities can be combined to define a novel ultrasound approach, multiparametric ultrasound. High frequency Micro-ultrasound has emerged as a promising imaging technology for PCa diagnosis. Initial results have shown high sensitivity of Micro-ultrasound in detecting PCa in addition to its potential in improving the accuracy of targeted biopsies, based on targeting under real-time visualization, rather than relying on cognitive/fusion software MRI-transrectal ultrasound-guided biopsy.
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Affiliation(s)
- Adriano Basso Dias
- Joint Department of Medical Imaging, University Health Network–Mount Sinai Hospital–Women’s College Hospital, University of Toronto, Toronto, Canada
| | - Ciara O’Brien
- Joint Department of Medical Imaging, University Health Network–Mount Sinai Hospital–Women’s College Hospital, University of Toronto, Toronto, Canada
| | - Jean-Michel Correas
- Department of Adult Radiology, Paris University and Necker University Hospital, Paris, France
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network–Mount Sinai Hospital–Women’s College Hospital, University of Toronto, Toronto, Canada
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11
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Derigs F, Doryumu S, Tollens F, Nörenberg D, Neuberger M, von Hardenberg J, Michel MS, Ritter M, Westhoff N. A prospective study on inter-operator variability in semi-robotic software-based MRI/TRUS-fusion targeted prostate biopsies. World J Urol 2021; 40:427-433. [PMID: 34825944 PMCID: PMC8921147 DOI: 10.1007/s00345-021-03891-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/14/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose Magnetic resonance imaging (MRI)/ultrasound-fusion prostate biopsy (FB) comprises multiple steps each of which can cause alterations in targeted biopsy (TB) accuracy leading to false-negative results. The aim was to assess the inter-operator variability of software-based fusion TB by targeting the same MRI-lesions by different urologists. Methods In this prospective study, 142 patients eligible for analysis underwent software-based FB. TB of all lesions (n = 172) were carried out by two different urologists per patient (n = 31 urologists). We analyzed the number of mismatches [overall prostate cancer (PCa), clinically significant PCa (csPCa) and non-significant PCa (nsPCa)] between both performed TB per patient. In addition we evaluated factors contributing to inter-operator variability by uni- and multivariable analyses. Results In 11.6% of all MRI-lesions (10.6% of all patients) there was a mismatch between TB1 and TB2 in terms of overall prostate cancer (PCa detection. Regarding csPCa, patient-based mismatch occurred in 14.8% (n = 21). Overall PCa and csPCa detection rate of TB1 and TB2 did not differ significantly on a per-patient and per-lesion level. Analyses revealed a smaller lesion size as predictive for mismatches (OR 9.19, 95% CI 2.02–41.83, p < 0.001). Conclusion Reproducibility and precision of targeting particularly small lesions is still limited although using software-based FB. Further improvements in image-fusion, segmentation, needle-guidance, and automatization are necessary. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03891-3.
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Affiliation(s)
- Fabian Derigs
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Department of Urology and Urosurgery, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Samuel Doryumu
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Fabian Tollens
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dominik Nörenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Manuel Neuberger
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jost von Hardenberg
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Maurice Stephan Michel
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Manuel Ritter
- Department of Urology and Pediatric Urology, University Hospital of Bonn, Bonn, Germany
| | - Niklas Westhoff
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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12
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Checcucci E, Piramide F, Amparore D, De Cillis S, Granato S, Sica M, Verri P, Volpi G, Piana A, Garrou D, Manfredi M, Fiori C, Porpiglia F. Beyond the Learning Curve of Prostate MRI/TRUS Target Fusion Biopsy after More than 1000 Procedures. Urology 2021; 155:39-45. [PMID: 34224778 DOI: 10.1016/j.urology.2021.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/20/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the learning curve (LC) of two urology residents in the execution of fusion biopsy (FB) in terms of overall prostate cancer (PCa) and clinically significant (cs) PCa detection rate (DR) and according to different characteristics of the lesions on MRI MATERIAL AND METHODS: We analyzed data from our prospective maintained FB database between January 2015 and December 2019. FB was performed using the BioJet fusion system (D&K Technologies, Barum, Germany) with a transrectal or transperineal approach. An ANOVA test was used to evaluate the homogeneity of our cohort. Multivariable linear and logistic regression analysis were used to evaluate the relationship between operator experience and DR for PCa and csPCa. Then, the postprocedural complication rate trend was evaluated. RESULTS 1005 patients were included. The overall DR of PCa was 61.2% (615/1005) [IC 0.58 - 0.64]; whilst DR for csPCA was 54.6% (549/1005) [IC 0.51 - 0.57]. Operator experience does not seem to influence the DR of overall PCa and csPCa; whilst for lesions <8 mm in diameter, PCa and csPCa DR increased significantly with operator experience (P = 0.048 and P = 0.038, respectively). Postprocedural complications remained stable during the whole study period (P = 0.75). CONCLUSION A standardized FB approach turned out to be feasible, safe, and effective since the beginning of the residents' LC. PCa and csPCa DR remained stable, at 60% and 55% respectively, after more than 1,000 biopsies. However, for lesions smaller than 8 mm, at least 100 FB of experience is needed to correctly sample the area.
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Affiliation(s)
- Enrico Checcucci
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043; Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, 10043.
| | - Federico Piramide
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Daniele Amparore
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Sabrina De Cillis
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Stefano Granato
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Michele Sica
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Paolo Verri
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Gabriele Volpi
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Alberto Piana
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Diletta Garrou
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043; Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, 10043
| | - Matteo Manfredi
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Cristian Fiori
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, 10043
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13
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Number of cores needed to diagnose prostate cancer during MRI targeted biopsy decreases after the learning curve. Urol Oncol 2021; 40:7.e19-7.e24. [PMID: 34187748 DOI: 10.1016/j.urolonc.2021.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/29/2021] [Accepted: 05/23/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION We hypothesized that the number of cores needed to detect prostate cancer would decrease with increasing MRI-targeted biopsy (TBx) experience. METHODS All patients undergoing TBx at our institution from May 2017 to August 2019 were enrolled in a prospectively maintained database. Five biopsy cores were obtained from each lesion ≥3 on PI-RADS v2.0 followed by a systematic 12-core biopsy. To assess learning curve, the study population was divided into quartiles by sequential biopsies. Clinically significant prostate cancer (csPC) was defined as Gleason Grade Group 2 or higher. RESULTS 377 patients underwent prostate biopsy (533 lesions); 233 lesions (44%) were positive for prostate cancer and 173 lesions (32%) were csPC. There was a significant decline in the number of cores required for diagnosing any cancer (P < 0.001) and csPC (P < 0.05) after the first quartile. There was no difference when stratifying by PI-RADS score or lesion volume. Within the first quartile, limiting the biopsy to 3 cores would miss 16.2% of csPC, decreasing to 6.6% after approximately 100 patients. CONCLUSION MRI TBx is associated with a learning curve of approximately 100 cases. Four or 5 cores should be considered during the initial experience, but thereafter, 3 cores per lesion is sufficient to detect csPC.
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14
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Pecoraro M, Messina E, Bicchetti M, Carnicelli G, Del Monte M, Iorio B, La Torre G, Catalano C, Panebianco V. The future direction of imaging in prostate cancer: MRI with or without contrast injection. Andrology 2021; 9:1429-1443. [PMID: 33998173 DOI: 10.1111/andr.13041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/23/2021] [Accepted: 05/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Multiparametric MRI (mpMRI) is the "state of the art" management tool for patients with suspicion of prostate cancer (PCa). The role of non-contrast MRI is investigated to move toward a more personalized, less invasive, and highly cost-effective PCa diagnostic workup. OBJECTIVE To perform a non-systematic review of the existing literature to highlight strength and flaws of performing non-contrast MRI, and to provide a critical overview of the international scientific production on the topic. MATERIALS AND METHODS Online databases (Medline, PubMed, and Web of Science) were searched for original articles, systematic review and meta-analysis, and expert opinion papers. RESULTS Several investigations have shown comparable diagnostic accuracy of biparametric (bpMRI) and mpMRI for the detection of PCa. The advantage of abandoning contrast-enhanced sequences improves operational logistics, lowering costs, acquisition time, and side effects. The main limitations of bpMRI are that most studies comparing non-contrast with contrast MRI come from centers with high expertise that might not be reproducible in the general community setting; besides, reduced protocols might be insufficient for estimation of the intra- and extra-prostatic extension and regional disease. The mentioned observations suggest that low-quality mpMRI for the general population might represent the main shortage to overcome. DISCUSSION Non-contrast MRI future trends are likely represented by PCa screening and the application of artificial intelligence (AI) tools. PCa screening is still a controversial topic; bpMRI has become one of the most promising diagnostic applications, as it is a more sensitive test for PCa early detection, compared to serum PSA level test. Also, AI applications and radiomic have been the object of several studies investigating PCa detection using bpMRI, showing encouraging results. CONCLUSION Today, the accessibility to MRI for early detection of PCa is a priority. Results from prospective, multicenter, multireader, and paired validation studies are needed to provide evidence supporting its role in the clinical practice.
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Affiliation(s)
- Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Marco Bicchetti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Giorgia Carnicelli
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Maurizio Del Monte
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Beniamino Iorio
- Department of Surgical Sciences, "Tor Vergata" University of Rome, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Disease, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Rome, Italy
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15
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Urkmez A, Ward JF, Choi H, Troncoso P, Inguillo I, Gregg JR, Altok M, Demirel HC, Qiao W, Kang HC. Temporal learning curve of a multidisciplinary team for magnetic resonance imaging/transrectal ultrasonography fusion prostate biopsy. BJU Int 2021; 127:524-527. [PMID: 33340435 PMCID: PMC10645433 DOI: 10.1111/bju.15325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Ahmet Urkmez
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - John F. Ward
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Haesun Choi
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Patricia Troncoso
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Irene Inguillo
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Justin R. Gregg
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Muammer Altok
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Huseyin C. Demirel
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Wei Qiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Hyunseon C. Kang
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
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16
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Cata ED, Van Praet C, Andras I, Kadula P, Ognean R, Buzoianu M, Leucuta D, Caraiani C, Tamas-Szora A, Decaestecker K, Coman I, Crisan N. Analyzing the learning curves of a novice and an experienced urologist for transrectal magnetic resonance imaging-ultrasound fusion prostate biopsy. Transl Androl Urol 2021; 10:1956-1965. [PMID: 34159076 PMCID: PMC8185669 DOI: 10.21037/tau-21-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The aim of the current study was to evaluate and compare the learning curves of transrectal magnetic resonance imaging-ultrasound fusion biopsy for two urologists with different backgrounds (Operator 1: experienced, self-trained and Operator 2: novice, trained by a mentor/MRI reading courses). Methods A cohort of 400 patients who underwent fusion prostate biopsy in our department was analyzed. The learning curves were assessed in terms of overall and clinically significant prostate cancer (PCa) detection rates, percentage of positive biopsy cores/targeted and the percentage of PCa tissue on positive targeted cores. Results Increasing trends were observed for both urologists in terms of all biopsy outcomes during the study time. For the novice urologist, a significant increase was observed for overall PCa detection rate, but not for clinically significant disease (25.44%, P=0.04/15%, P=0.145). Operator 1 showed an increasing diagnosis yield of clinically significant disease up to 104 cases. Similar cancer detection rates were observed when comparing the first and last biopsies performed by both operators. Multivariate analysis adjusted for age, PSA, prostate volume, lesion diameter and PIRADS score showed an increase of PCa detection with 51% for every 52 biopsies performed (P=0.022). Conclusions When starting with magnetic resonance imaging-ultrasound fusion prostate biopsy, mentoring and prostate magnetic resonance imaging reading training allow a novice urologist to demonstrate a good initial PCa detection rate. After about 52 cases, he reached a stable PCa and clinically significant PCa detection rate, that was similar to that of an experienced urologist.
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Affiliation(s)
- Emanuel Darius Cata
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Municipal Hospital, Cluj-Napoca, Romania
| | | | - Iulia Andras
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Municipal Hospital, Cluj-Napoca, Romania
| | - Pierre Kadula
- Urology Department, Municipal Hospital, Cluj-Napoca, Romania
| | - Razvan Ognean
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maximilian Buzoianu
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniel Leucuta
- Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Cosmin Caraiani
- Medical Imaging Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | | | | | - Ioan Coman
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Municipal Hospital, Cluj-Napoca, Romania
| | - Nicolae Crisan
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Municipal Hospital, Cluj-Napoca, Romania
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17
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Abstract
PURPOSE OF REVIEW The goal of this study is to review recent findings and evaluate the utility of MRI transrectal ultrasound fusion biopsy (FBx) techniques and discuss future directions. RECENT FINDINGS FBx detects significantly higher rates of clinically significant prostate cancer (csPCa) than ultrasound-guided systematic prostate biopsy (SBx), particularly in repeat biopsy settings. FBx has also been shown to detect significantly lower rates of clinically insignificant prostate cancer. In addition, a dedicated prostate MRI can assist in more accurately predicting the Gleason score and provide further information regarding the index cancer location, prostate volume, and clinical stage. The ability to accurately evaluate specific lesions is vital to both focal therapy and active surveillance, for treatment selection, planning, and adequate follow-up. FBx has been demonstrated in multiple high-quality studies to have improved performance in diagnosis of csPCa compared to SBx. The combination of FBx with novel technologies including radiomics, prostate-specific membrane antigen positron emission tomography (PSMA PET), and high-resolution micro-ultrasound may have the potential to further enhance this performance.
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18
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Klingebiel M, Arsov C, Ullrich T, Quentin M, Al-Monajjed R, Mally D, Sawicki LM, Hiester A, Esposito I, Albers P, Antoch G, Schimmöller L. Reasons for missing clinically significant prostate cancer by targeted magnetic resonance imaging/ultrasound fusion-guided biopsy. Eur J Radiol 2021; 137:109587. [PMID: 33592552 DOI: 10.1016/j.ejrad.2021.109587] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 01/31/2021] [Accepted: 02/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study evaluates cases with clinically significant prostate cancer (csPCa) missed by targeted biopsy (TB) and analyzes the diagnostic impact of an additional systematic biopsy (SB) in a large patient collective. METHODS Consecutive patients with a 3 T multiparametric prostate MRI (mpMRI) and a subsequent MRI/US fusion-guided TB plus 12-core US-guided SB from 01/2014 to 04/2019 were included in this study. Primary study endpoint was the analysis of cases with a csPCa missed by TB and detected by SB. Secondary study objectives were the PCa detection and the correlation with clinical and MRI parameters. RESULTS In total 785 patients met the inclusion criteria. 342 patients had a csPCa (median PSAD 0.29 ng/mL/cm3). In 42 patients (13 %), a csPCa was detected only by SB. In 36 of these cases, the localization of the positive SB cores matched with the cancer suspicious region described on mpMRI (mCSR). Cases with a csPCA missed by TB showed either an insufficient MRI segmentation (prostate boundary correlation) (31 %) and/or insufficient lesion registration (lesion transfer, tracking, and/or matching) (48 %), a missed small lesion (14 %), or a failed center of a large lesion (10 %). Median PSAD of patients with non-significant PCa detected by SB was 0.15 ng/mL/cm3. CONCLUSIONS Main reasons for missing a csPCa by TB were insufficient prostate segmentation or imprecise lesion registration within MRI/US fusion-guided biopsy. Consequently, verification of MRI quality, exact mCSR assessment, and advanced biopsy experience may improve accuracy. Altogether, an additional SB adds limited clinical benefit in men with PSAD ≤ 0.15 ng/mL/cm3.
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Affiliation(s)
- M Klingebiel
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - C Arsov
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - T Ullrich
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - M Quentin
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - R Al-Monajjed
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - D Mally
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - L M Sawicki
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - A Hiester
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - I Esposito
- University Dusseldorf, Medical Faculty, Department of Pathology, D-40225 Dusseldorf, Germany.
| | - P Albers
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - G Antoch
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - L Schimmöller
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
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19
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Moore CM, Cole AP, Allen C, Giganti F. Let's Follow the Golden Mean: Using Magnetic Resonance Imaging to Determine the Need for Biopsy in Men on Active Surveillance. Eur Urol Oncol 2020; 4:235-236. [PMID: 33358393 DOI: 10.1016/j.euo.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Caroline M Moore
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK.
| | - Alexander P Cole
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Urological Surgery, Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
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20
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Bhanji Y, Allaway MJ, Gorin MA. Recent Advances and Current Role of Transperineal Prostate Biopsy. Urol Clin North Am 2020; 48:25-33. [PMID: 33218591 DOI: 10.1016/j.ucl.2020.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
"Approximately 1 million prostate biopsies are performed each year in the United States. This procedure has traditionally been performed using a transrectal approach, which is associated with a significant risk of infectious complications including sepsis. In recent years, transperineal prostate biopsy has been increasingly adopted due to its lower associated infectious risk. In this review, we explore the benefits of the transperineal approach for performing prostate biopsy and detail technical advancements that have allowed for this procedure to now be routinely performed in the outpatient settings under local anesthesia."
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Affiliation(s)
- Yasin Bhanji
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Marburg 134, Baltimore, MD 21287, USA
| | - Mathew J Allaway
- Urology Associates and UPMC Western Maryland, 12234 Williams Road, Cumberland, MD 21502, USA
| | - Michael A Gorin
- Urology Associates and UPMC Western Maryland, 12234 Williams Road, Cumberland, MD 21502, USA.
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21
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Jotwani R, Mehta N, Baig E, Gupta A, Gulati A. Neuromodulation and the Epidemiology of Magnetic Resonance Utilization for Lung, Breast, Colon, and Prostate Cancer. Neuromodulation 2020; 23:912-921. [PMID: 32705734 DOI: 10.1111/ner.13224] [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] [Received: 08/25/2019] [Revised: 05/03/2020] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Neuromodulation is a growing therapeutic modality for the treatment of chronic pain. Determining whether a patient is an appropriate candidate for implantation of a neuromodulatory device and whether the device requires an MRI conditional feature necessitates understanding the patient's likelihood of requiring an MRI. Active treatment of cancer represents known high-risk clinical scenarios for MRI. However, the growth of MRI as a tool for diagnosis of cancer also warrants consideration by implanting physicians when assessing high-risk patients. MATERIALS AND METHODS Here, we conduct a systematic review of the literature to determine the epidemiology for MR utilization for breast, lung, prostate, and colon cancer. Out of 126 papers reviewed, 39 were ultimately analyzed to determine the relative likelihood of an MRI in the course of oncologic care. RESULTS We find that there is a low likelihood for MRI to be utilized as part of any screening process and a variable likelihood during the staging and surveillance phases across all cancer subtypes depending on the clinical circumstances. Certain populations present special consideration for MRI screening, such as the high at-risk breast cancer population, and MRI surveillance and staging, such as aging males (>50 years old) at risk for prostate cancer or individuals diagnosed with rectal cancers. CONCLUSION High likelihood of MRI within the oncologic context represents important distinction criteria for neuromodulation as patients may benefit from implantation of an MR conditional system.
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Affiliation(s)
- Rohan Jotwani
- Department of Anesthesiology, New York-Presbyterian Hospital - Weill Cornell College of Medicine, New York, NY, USA
| | - Neel Mehta
- Department of Anesthesiology, New York-Presbyterian Hospital - Weill Cornell College of Medicine, New York, NY, USA
| | - Ethesham Baig
- Department of Anesthesiology, University of Toronto Western, Toronto, Ontario, Canada
| | - Ajay Gupta
- Department of Radiology, New York-Presbyterian Hospital - Weill Cornell College of Medicine, New York, NY, USA
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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22
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Tschirdewahn S, Wiesenfarth M, Bonekamp D, Püllen L, Reis H, Panic A, Kesch C, Darr C, Heß J, Giganti F, Moore CM, Guberina N, Forsting M, Wetter A, Hadaschik B, Radtke JP. Detection of Significant Prostate Cancer Using Target Saturation in Transperineal Magnetic Resonance Imaging/Transrectal Ultrasonography-fusion Biopsy. Eur Urol Focus 2020; 7:1300-1307. [PMID: 32660838 DOI: 10.1016/j.euf.2020.06.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/30/2020] [Accepted: 06/22/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) and targeted biopsies (TBs) facilitate accurate detection of significant prostate cancer (sPC). However, it remains unclear how many cores should be applied per target. OBJECTIVE To assess sPC detection rates of two different target-dependent magnetic resonance imaging (MRI)/transrectal ultrasonography (TRUS)-fusion biopsy approaches (TB and target saturation [TS]) compared with extended systematic biopsies (SBs). DESIGN, SETTING, AND PARTICIPANTS Retrospective single-centre outcome of transperineal MRI/TRUS-fusion biopsies of 213 men was evaluated. All men underwent TB with a median of four cores per MRI lesion, followed by a median of 24 SBs, performed by experienced urologists. Cancer and sPC (International Society of Urological Pathology grade group ≥2) detection rates were analysed. TB was compared with SB and TS, with nine cores per target, calculated by the Ginsburg scheme and using individual cores of the lesion and its "penumbra". OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cancer detection rates were calculated for TS, TB, and SB at both lesion and patient level. Combination of SB + TB served as a reference. Statistical differences in prostate cancer (PC) detection between groups were calculated using McNemar's tests with confidence intervals. RESULTS AND LIMITATIONS TS detected 99% of 134 sPC lesions, which was significantly higher than the detection by TB (87%, p = 0.001) and SB (82%, p < 0.001). SB detected significantly more of the 72 low-risk PC lesions than TB (99% vs 68%, p < 0.001) and 10% (p = 0.15) more than that detected by TS. At a per-patient level, 99% of men harbouring sPC were detected by TS. This was significantly higher than that by TB and SB (89%, p = 0.03 and 81%, p = 0.001, respectively). Limitations include limited generalisability, as a transperineal biopsy route was used. CONCLUSIONS TS detected significantly more cases of sPC than TB and extended SB. Given that both 99% of sPC lesions and men harbouring sPC were identified by TS, the results suggest that this approach allows to omit SB cores without compromising sPC detection. PATIENT SUMMARY Target saturation of magnetic resonance imaging-suspicious prostate lesions provides excellent cancer detection and finds fewer low-risk tumours than the current gold standard combination of targeted and systematic biopsies.
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Affiliation(s)
| | - Manuel Wiesenfarth
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lukas Püllen
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Henning Reis
- Institute of Pathology, University Duisburg-Essen, Essen, Germany
| | - Andrej Panic
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Christopher Darr
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Jochen Heß
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Francesco Giganti
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nika Guberina
- Institute of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Axel Wetter
- Institute of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Essen, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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23
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O'Connor LP, Lebastchi AH, Horuz R, Rastinehad AR, Siddiqui MM, Grummet J, Kastner C, Ahmed HU, Pinto PA, Turkbey B. Role of multiparametric prostate MRI in the management of prostate cancer. World J Urol 2020; 39:651-659. [PMID: 32583039 DOI: 10.1007/s00345-020-03310-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Prostate cancer has traditionally been diagnosed by an elevation in PSA or abnormal exam leading to a systematic transrectal ultrasound (TRUS)-guided biopsy. This diagnostic pathway underdiagnoses clinically significant disease while over diagnosing clinically insignificant disease. In this review, we aim to provide an overview of the recent literature regarding the role of multiparametric MRI (mpMRI) in the management of prostate cancer. MATERIALS AND METHODS A thorough literature review was performed using PubMed to identify articles discussing use of mpMRI of the prostate in management of prostate cancer. CONCLUSION The incorporation of mpMRI of the prostate addresses the shortcomings of the prostate biopsy while providing several other advantages. mpMRI allows some men to avoid an immediate biopsy and permits visualization of areas likely to harbor clinically significant cancer prior to biopsy to facilitate use of MR-targeted prostate biopsies. This allows for reduction in diagnosis of clinically insignificant disease as well as improved detection and better characterization of higher risk cancers, as well as the improved selection of patients for active surveillance. In addition, mpMRI can be used for selection and monitoring of patients for active surveillance and treatment planning during surgery and focal therapy.
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Affiliation(s)
- Luke P O'Connor
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Amir H Lebastchi
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Rahim Horuz
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | | | - M Minhaj Siddiqui
- Division of Urology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jeremy Grummet
- Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Christof Kastner
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, NIH, 10 Center Drive Room B3B85, Bethesda, MD, USA. .,, 10 Center Drive Room B3B85, Bethesda, MD, 20814, USA.
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24
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O'Connor L, Wang A, Walker SM, Yerram N, Pinto PA, Turkbey B. Use of multiparametric magnetic resonance imaging (mpMRI) in localized prostate cancer. Expert Rev Med Devices 2020; 17:435-442. [PMID: 32275845 DOI: 10.1080/17434440.2020.1755257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Prostate magnetic resonance imaging (MRI) is commonly used for localized disease mainly to detect intraprostatic lesions and to guide biopsies. Despite its documented success in clinical practice, limitations still exist for prostate MRI. In this review, we discuss common clinical uses of prostate MRI, its limitations, and potential solutions for those limitations.Areas covered: Current uses of prostate MRI and challenges discussed. Literature search in PubMed was completed using the keywords "prostate MRI, prostate cancer."Expert opinion: Prostate MRI is a useful method for localization, biopsy, and treatment guidance of prostate cancer. Certain limitations of prostate MRI such as false negatives due to spatial resolution and relatively low repeatability between different radiologists can potentially be solved by investing more on education training and artificial intelligence technology.
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Affiliation(s)
- Luke O'Connor
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA
| | - Alex Wang
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA
| | | | - Nitin Yerram
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, NCI, NIH, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, NCI, NIH, Bethesda, MD, USA
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25
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Manceau C, Roumiguié M, Lesourd M, Beauval JB, Almeras C, Aziza R, Gautier JR, Loison G, Meyrignac O, Salin A, Tollon C, Soulié M, Malavaud B, Ploussard G. Intercenter reproducibility of software-based fusion biopsies for grade group prediction when targeting suspicious MRI lesions. Urol Oncol 2020; 38:734.e11-734.e17. [PMID: 32312641 DOI: 10.1016/j.urolonc.2020.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/24/2020] [Accepted: 03/23/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE To assess the intercenter reproducibility of software-based fusion targeted biopsy (TB) for grade-group assessment and pretherapeutic evaluation of highly suspicious MRI lesions. PATIENTS AND METHODS In this study, were included 380 consecutive patients who underwent radical prostatectomy (RP) after prostate cancer diagnosis and a prebiopsy MRI showing Prostate Imaging-Reporting and Data System (PIRADS) score 4 or 5 lesions. All patients underwent systematic biopsies (SB) combined with software-based fusion TB in the 2 centers. Biopsies were only performed by expert urologists or radiologists in a contemporary time frame. The primary endpoint was the center difference of concordance/upgrading rates between biopsy and RP specimens. RESULTS Pathological features on biopsy and RP specimens were significantly different among centers with more unfavourable disease in center 1. The rate of TB upgrading was 33.6% in center 1 vs. 35.4% (P = 0.860) in center 2. Grading concordance was also comparable among centers (50.0% vs. 47.1%) as well as the SB upgrading rate. Regression analysis did not find any baseline characteristics (Age, prostate-specific antigen, MRI lesions, center) predictive for TB upgrading. These findings were achieved by using fewer TB per lesion in center 1 (2.3 vs. 5.0, P < 0.001), at the expense of more SB cores (14.4 vs. 8.5, P < 0.001). The influence of MRI characteristics (lesion size and number, PIRADS score) on upgrading rates was consistent among centers. CONCLUSIONS Software-based fusion TB technique leads to comparable outcomes in terms of grade group prediction accuracy in PIRADS 4 to 5 lesions, insignificant between centers, in spite of different non imaging-based aggressiveness features.
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Affiliation(s)
- Cécile Manceau
- Department of Urology, CHU-IUCT Oncopole, Toulouse, France.
| | | | - Marine Lesourd
- Department of Urology, CHU-IUCT Oncopole, Toulouse, France
| | | | - Christophe Almeras
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Richard Aziza
- Department of Radiology, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | | | - Guillaume Loison
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Olivier Meyrignac
- Department of Radiology, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - Ambroise Salin
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Christophe Tollon
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Michel Soulié
- Department of Urology, CHU-IUCT Oncopole, Toulouse, France
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26
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Hale GR, Pesapane F, Xu S, Bakhutashvili I, Glossop N, Turkbey B, Pinto PA, Wood BJ. Tracked Foley catheter for motion compensation during fusion image-guided prostate procedures: a phantom study. Eur Radiol Exp 2020; 4:24. [PMID: 32300896 PMCID: PMC7163002 DOI: 10.1186/s41747-020-00147-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uncorrected patient or prostate motion may impair targeting prostate areas during fusion image-guided procedures. We evaluated if a prototype "tracked Foley catheter" (TFC) could maintain fusion image alignment after simulated organ motion. METHODS A pelvic phantom model underwent magnetic resonance imaging (MRI), and the prostate was segmented. The TFC was placed in the phantom. MRI/ultrasound (US) fusion was performed. Four trials were performed varying motion and TFC presence/absence: (1) TFC/no-motion, (2) TFC/motion, (3) no-TFC/no-motion, and (4) no-TFC/motion. To quantify image alignment, screen captures generated Dice similarity coefficient (DSC) and offset distances (ODs) (maximal US-to-MRI distance between edges on fusion images). Three anatomical targets were identified for placement of a needle under fusion guidance. A computed tomography scan was used to measure system error (SE), i.e., the distance from needle tip to intended target. RESULTS The TFC presence improved MRI/US alignment by DSC 0.88, 0.88, 0.74, and 0.61 in trials 1, 2, 3, and 4, respectively. Both OD (trial 2 versus trial 4, 4.85 ± 1.60 versus 25.29 ± 6.50 mm, p < 0.001) and SE (trial 2 versus trial 4, 6.35 ± 1.31 versus 32.16 ± 6.50 mm, p < 0.005) were significantly lower when the TFC was present after artificial motion, and significantly smaller OD when static (trial 1 versus trial 3, 4.29 ± 1.24 versus 6.42 ± 2.29 mm, p < 0.001). CONCLUSION TFC provided better image alignment with or without simulated motion. This may overcome system limitations, allowing for more accurate fusion image alignment during fusion-guided biopsy, ablation, or robotic prostatectomy.
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Affiliation(s)
- Graham R Hale
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Filippo Pesapane
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. .,Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy.
| | - Sheng Xu
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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27
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Noureldin M, Eldred-Evans D, Khoo CC, Winkler M, Sokhi H, Tam H, Ahmed HU. Review article: MRI-targeted biopsies for prostate cancer diagnosis and management. World J Urol 2020; 39:57-63. [PMID: 32253585 DOI: 10.1007/s00345-020-03182-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/25/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Transrectal ultrasound (TRUS)-guided biopsy has been the traditional biopsy route in the detection of prostate cancer. However, due to concern regarding overdetection of low-risk cancer and missed clinically significant cancers as well as risk of sepsis, alternative approaches have been explored. Transperineal template biopsy-sampling the gland every 5 m to 10 mm-reduces error by sampling the whole prostate but increases risk of detecting clinically insignificant cancers as well as conferring risks of side effects such as urinary retention and bleeding. METHODS There are various targeted biopsy techniques, each with different cancer detection rates, costs and learning curves. Current research focuses on refining biopsy methodology to maximize detection of significant cancers, whilst minimising invasiveness and complications. In this article, the up-to-date research data about MRI-targeted prostate biopsy were reviewed to show its utilization in prostate cancer management and diagnosis. RESULTS AND CONCLUSION Prostate multiparametric MRI has become an effective tool in the detection of significant cancers and an essential component of the prostate cancer diagnostic pathway incorporating MRI-guided biopsy decisions.
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Affiliation(s)
- M Noureldin
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Campus, Fulham Palace Road, London, W6 8RF, UK. .,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK. .,Urology Department, Ain Shams University Hospitals, Cairo, Egypt.
| | - D Eldred-Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Campus, Fulham Palace Road, London, W6 8RF, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - C C Khoo
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Campus, Fulham Palace Road, London, W6 8RF, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - M Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Campus, Fulham Palace Road, London, W6 8RF, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - H Sokhi
- Department of Radiology, Hillingdon Hospitals NHS Foundation Trust, London, UK.,Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
| | - H Tam
- Department of Radiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - H U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Campus, Fulham Palace Road, London, W6 8RF, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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28
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Stabile A, Giganti F, Kasivisvanathan V, Giannarini G, Moore CM, Padhani AR, Panebianco V, Rosenkrantz AB, Salomon G, Turkbey B, Villeirs G, Barentsz JO. Factors Influencing Variability in the Performance of Multiparametric Magnetic Resonance Imaging in Detecting Clinically Significant Prostate Cancer: A Systematic Literature Review. Eur Urol Oncol 2020; 3:145-167. [DOI: 10.1016/j.euo.2020.02.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/08/2020] [Accepted: 02/20/2020] [Indexed: 01/19/2023]
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29
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Berg S, Hanske J, von Landenberg N, Noldus J, Brock M. Institutional Adoption and Apprenticeship of Fusion Targeted Prostate Biopsy: Does Experience Affect the Cancer Detection Rate? Urol Int 2020; 104:476-482. [PMID: 32036374 DOI: 10.1159/000505654] [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] [Received: 10/23/2019] [Accepted: 12/28/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There are limited data on the learning curve of magnetic resonance imaging/transrectal ultrasound (MRI/TRUS)-fusion targeted prostate biopsies (tBx). OBJECTIVE The aim of this study was to investigate the difference in prostate cancer (PCa) detection rate between an experienced urologist and novice resident performing tBx. METHODS A total of 183 patients underwent tBx from 2012 to 2016 for a total of 518 tBx cores. Biopsies in this study were performed by an experienced urologist (investigator A) or a novice resident (investigator B). The outcome was the detection of PCa on tBx. Using a multivariable logistic regression model, we estimated odds ratios for the detection of PCa. Inverse probability treatment weighting (IPTW) was used to balance patients' baseline characteristics and compare detection rates of PCa. Before performance of tBx, all patients underwent MRI. RESULTS On multivariable logistic regression analysis, investigator experience was associated with a higher odds of detection of PCa (OR = 1.003; 95% confidence interval 1.002-1.006, p = 0.037). After IPTW adjustment, there was no significant difference between the detection rate of investigator A (23%) and investigator B (32%; p = 0.457). CONCLUSIONS Data revealed a positive association between investigator experience and the odds of PCa detection, although there was no difference in the detection rates of the investigators.
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Affiliation(s)
- Sebastian Berg
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany, .,Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA,
| | - Julian Hanske
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Nicolas von Landenberg
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Joachim Noldus
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Marko Brock
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
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Stabile A, Giganti F, Rosenkrantz AB, Taneja SS, Villeirs G, Gill IS, Allen C, Emberton M, Moore CM, Kasivisvanathan V. Multiparametric MRI for prostate cancer diagnosis: current status and future directions. Nat Rev Urol 2020; 17:41-61. [PMID: 31316185 DOI: 10.1038/s41585-019-0212-4] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 12/31/2022]
Abstract
The current diagnostic pathway for prostate cancer has resulted in overdiagnosis and consequent overtreatment as well as underdiagnosis and missed diagnoses in many men. Multiparametric MRI (mpMRI) of the prostate has been identified as a test that could mitigate these diagnostic errors. The performance of mpMRI can vary depending on the population being studied, the execution of the MRI itself, the experience of the radiologist, whether additional biomarkers are considered and whether mpMRI-targeted biopsy is carried out alone or in addition to systematic biopsy. A number of challenges to implementation remain, such as ensuring high-quality execution and reporting of mpMRI and ensuring that this diagnostic pathway is cost-effective. Nevertheless, emerging clinical trial data support the adoption of this technology as part of the standard of care for the diagnosis of prostate cancer.
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Affiliation(s)
- Armando Stabile
- Division of Surgery and Interventional Science, University College London, London, UK.
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Francesco Giganti
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Samir S Taneja
- Department of Radiology, NYU Langone Health, New York, NY, USA
- Department of Urology, NYU Langone Health, New York, NY, USA
| | - Geert Villeirs
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Inderbir S Gill
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Clare Allen
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Trabulsi EJ, Calio BP, Kamel SI, Gomella LG, Forsberg F, McCue P, Halpern EJ. Prostate Contrast Enhanced Transrectal Ultrasound Evaluation of the Prostate With Whole-Mount Prostatectomy Correlation. Urology 2019; 133:187-191. [DOI: 10.1016/j.urology.2019.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/16/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
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Systematic prostate biopsy still matters: A comprehensive analysis of MRI/TRUS-fusion targeted prostate biopsies across different indications. Urol Oncol 2019; 37:678-687. [DOI: 10.1016/j.urolonc.2019.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/09/2019] [Accepted: 07/08/2019] [Indexed: 01/25/2023]
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Kelley RP, Zagoria RJ, Nguyen HG, Shinohara K, Westphalen AC. The use of prostate MR for targeting prostate biopsies. BJR Open 2019; 1:20180044. [PMID: 33178929 PMCID: PMC7592478 DOI: 10.1259/bjro.20180044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 05/21/2019] [Accepted: 06/12/2019] [Indexed: 11/05/2022] Open
Abstract
Management of prostate cancer relies heavily on accurate risk stratification obtained through biopsies, which are conventionally performed under transrectal ultrasound (TRUS) guidance. Yet, multiparametric MRI has grown to become an integral part of the care of males with known or suspected prostate cancer. This article will discuss in detail the different MRI-targeted biopsy techniques, their advantages and disadvantages, and the impact they have on patient management.
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Affiliation(s)
- R. Phelps Kelley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Ronald J. Zagoria
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Hao G. Nguyen
- Department of Urology, University of California, San Francisco, California
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Katsuto Shinohara
- Department of Urology, University of California, San Francisco, California
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Antonio C. Westphalen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
- Department of Urology, University of California, San Francisco, California
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California
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Calio BP, Deshmukh S, Mitchell D, Roth CG, Calvaresi AE, Hookim K, McCue P, Trabulsi EJ, Lallas CD. Spatial distribution of biopsy cores and the detection of intra-lesion pathologic heterogeneity. Ther Adv Urol 2019; 11:1756287219842485. [PMID: 31065294 PMCID: PMC6488778 DOI: 10.1177/1756287219842485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/13/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives: The objective of this study was to determine if spatial distribution of
multiparametric magnetic resonance imaging–transrectal ultrasound
(mpMRI-TRUS) fusion biopsy cores to the index lesion reveals trends in the
detection of intra-lesion Gleason heterogeneity and a more optimal prostate
biopsy strategy. Methods: Index lesion was the lesion with longest diameter on T2-weighted (T2W)-MRI.
In cohort 1, fusion biopsy cores biopsies were taken in areas in the center
of the target as well as 1 cm laterally on each side. For cohort 2, targeted
biopsies were taken from the center of the lesion only. Heterogeneity was
defined as difference in maximum Gleason score obtained from fusion cores in
the center of the index lesion versus cores obtained from
the periphery (cohort 1), or any difference in maximum Gleason score
obtained from fusion cores targeted to the index lesion (cohort 2) compared
with systematic 12 cores TRUS biopsy. Results: Ninety-nine consecutive patients (35 and 64 in cohorts 1 and 2, respectively)
with median age (SD) and prostate-specific antigen (PSA) of 66.9 (±5.9) and
9.7 (±8.2) respectively, were included. Age, PSA, Prostate Imaging Reporting
and Data System (PI-RADS) score, and preoperative MRI lesion size were not
significantly different between cohorts. Gleason heterogeneity was observed
at a significantly higher rate in cohort 1 versus cohort 2
(58% versus 24%; p = 0.041). In cohort 1,
cores obtained from the center of the lesion had higher Gleason score than
cores obtained from the periphery of the targeted lesion in 57% of
cases. Conclusions: We demonstrate that there is observable tumor heterogeneity in biopsy
specimens, and that increased number of cores, as well as cores focused on
the center and periphery of the largest lesion in the prostate, provide more
comprehensive diagnostic information about the patient’s clinical risk
category than taking nonspecific cores targeted within the tumor.
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Affiliation(s)
- Brian P Calio
- Department of Urology, Thomas Jefferson University Hospitals, USA
| | - Sandeep Deshmukh
- Department of Radiology, Thomas Jefferson University Hospitals, USA
| | - Donald Mitchell
- Department of Radiology, Thomas Jefferson University Hospitals, USA
| | | | - Anne E Calvaresi
- Department of Urology, Thomas Jefferson University Hospitals, USA
| | - Kim Hookim
- Department of Pathology, Thomas Jefferson University Hospitals, USA
| | - Peter McCue
- Department of Pathology, Thomas Jefferson University Hospitals, USA
| | | | - Costas D Lallas
- Professor of Urology, Vice Chair of Academic Affairs, Sidney Kimmel Cancer Center, Thomas Jefferson University, 1025 Walnut Street, Suite 1100, Philadelphia, PA 19107, USA
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Lebastchi AH, Pinto PA. The role of multiparametric MRI in biopsy-naive prostate cancer. Nat Rev Urol 2019; 16:276-277. [DOI: 10.1038/s41585-019-0173-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Halstuch D, Baniel J, Lifshitz D, Sela S, Ber Y, Margel D. Characterizing the learning curve of MRI-US fusion prostate biopsies. Prostate Cancer Prostatic Dis 2019; 22:546-551. [PMID: 30842585 DOI: 10.1038/s41391-019-0137-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/27/2019] [Accepted: 02/04/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND MRI-US fusion prostate biopsies are becoming a common procedure to diagnose prostate cancer. There is a paucity of information regarding the learning curve for fusion biopsies. We aim to study the amount of experience needed to be both accurate and time-efficient in this procedure. METHODS We prospectively collected data on all MRI-US fusion biopsies performed from April 2014 to August 2017. We used two parameters to define the learning curve. Process Measurement (efficiency) was measured by time from the beginning of anesthesia to end of procedure. Outcome Measurement (accuracy) was measured by cancer detection rate for PI-RAD 3 lesions. The end of the learning curve was defined graphically and mathematically. We performed a separate analysis for transrectal and transperineal biopsies. RESULTS We completed 779 fusion biopsies (523 transrectal, 256 transperineal). Patients median age was 66 years (IQR 61-70) and median PSA 6.95 ng/ml (IQR 4.2-10.6). Prostate cancer was diagnosed in 385 (49%). Process Measurement-Procedure time decreased from 45 min in the first transrectal fusion biopsy to 15 min after 109 biopsies and remained stable (p < 0.0001). Time decreased from 55 min in the first transperineal biopsy to 18 min after 124 biopsies (p < 0.0001). Outcome Measurement-In transrectal fusion-biopsies detection rate for PI-RADS 3 lesions increased from 35 to 50% after 104 biopsies. In transperineal fusion-biopsies, detection rate increased from 40 to 55% after 119 cases for PI-RADS 3 lesions. CONCLUSIONS We measured the learning curve of fusion biopsies graphically and mathematically. We demonstrated that proficiency occurs after 110 transrectal and 125 transperineal fusion-biopsies.
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Affiliation(s)
- Daniel Halstuch
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel.
| | - Jack Baniel
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel.,Division of Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Urology clinic, Ramat Aviv Medical Center, Tel-Aviv, Israel
| | - David Lifshitz
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel.,Division of Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sivan Sela
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel
| | - Yaara Ber
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel
| | - David Margel
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel.,Division of Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Urology clinic, Ramat Aviv Medical Center, Tel-Aviv, Israel
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Affiliation(s)
- Connor Hoge
- Department of Urology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Arvin George
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Abhinav Sidana
- Department of Urology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Streicher J, Meyerson BL, Karivedu V, Sidana A. A review of optimal prostate biopsy: indications and techniques. Ther Adv Urol 2019; 11:1756287219870074. [PMID: 31489033 PMCID: PMC6713958 DOI: 10.1177/1756287219870074] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 07/15/2019] [Indexed: 12/26/2022] Open
Abstract
Prostate biopsy is the gold standard diagnostic technique for the detection of prostate cancer. Patient selection for prostate biopsy is complex and is influenced by emerging use of prebiopsy imaging. The introduction of the magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) fusion prostate biopsy has clear advantages over the historical standard of care. There are several biopsy techniques currently utilized with unique advantages and disadvantages. We review and summarize the current body of literature pertaining to when and how a prostate biopsy should be performed. We discuss current recommendations regarding patient selection for biopsy and discuss future directions regarding prebiopsy imaging. We offer a description of the MRI-TRUS fusion biopsy technique and a comparison of many of the currently available fusion software platforms. Articles pertaining to the title were obtained via PubMed index search with relevant keywords supplemented with personal collection of related publications. Prostate biopsy should be considered for patients with gross digital rectal exam (DRE) abnormality, patients with a prostate-specific antigen (PSA) greater than 4 ng/ml, and concomitant risk factors for prostate cancer or patients with lesions identified on multiparametric MRI (mpMRI) with Prostate Imaging Reporting and Data System 2 (PI-RADS2) score of 4 or 5. MRI-TRUS fusion biopsy has demonstrated advantages in cancer detection when compared with TRUS-guided biopsy. There are currently several fusion software platforms available with a variety of biopsy approaches. Future efforts should detail the role of prebiopsy imaging as a triage tool for prostate biopsy. Consensus should be sought regarding the preferred modality of fusion biopsy. Additional data describing each fusion software platform would enable a more rigorous comparison of platform sensitivities.
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Affiliation(s)
- Justin Streicher
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Vidhya Karivedu
- Division of Hematology and Oncology, University of Cincinnati, Cincinnati, USA
| | - Abhinav Sidana
- Division of Urology, University of Cincinnati Cancer Institute, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0589, Cincinnati, OH 45267, USA
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Westhoff N, Haumann H, Kriegmair MC, von Hardenberg J, Budjan J, Porubsky S, Michel MS, Honeck P, Ritter M. Association of training level and outcome of software-based image fusion-guided targeted prostate biopsies. World J Urol 2018; 37:2119-2127. [PMID: 30560300 DOI: 10.1007/s00345-018-2605-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/11/2018] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The aim of this study was to assess the impact of experience on the outcome of image fusion-guided prostate biopsies performed by urologists working at a high-volume medical center. METHODS The first 210 consecutive fusion biopsies were analyzed following installation of the software-based biopsy platform Artemis™ (Eigen, USA). The impact of training was measured in terms of changes in prostate cancer detection rates and biopsy duration over time. We sought to identify a threshold of experience for urologists, which predicts higher detection rates of targeted biopsies. The influence of various factors on prostate cancer detection rates was evaluated using bi- and multivariate analysis. RESULTS Twenty-two urologists (n = 9 senior urologists, n = 13 urological residents) performed targeted biopsies followed by systematic 12-core biopsies. Overall, targeted biopsies yielded a positive result in 39.6% of 260 suspicious MRI lesions. A subgroup analysis of the six urologists who performed more than ten biopsies was then conducted, and their level of experience (i.e., performance of more than eight biopsies) was found to be associated with higher detection rates than those with less experience (49.0% and 23.0%, respectively; p < 0.001) in the targeted biopsies. Experience was likewise a significant and independent predictor of a cancer-positive targeted biopsy (p = 0.002). Experienced senior physicians did not outperform residents in their targeted biopsy results. Further, biopsy duration correlated negatively (r = - 0.5931, p < 0.001) with the total number of biopsies performed for all subgroups during the period of assessment. CONCLUSIONS Experience is an important predictor of the rate of detection in targeted biopsies using software-based biopsy platforms with semi-robotic assistance. Moreover, the performance of just a few procedures appears sufficient to increase biopsy effectiveness significantly. Lastly, supervision by experts is recommended during the training phase.
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Affiliation(s)
- Niklas Westhoff
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68165, Germany.
| | - Henning Haumann
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68165, Germany
| | - Maximilian Christian Kriegmair
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68165, Germany
| | - Jost von Hardenberg
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68165, Germany
| | - Johannes Budjan
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68165, Germany
| | - Stefan Porubsky
- Institute of Pathology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68165, Germany
| | - Maurice Stephan Michel
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68165, Germany
| | - Patrick Honeck
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68165, Germany
| | - Manuel Ritter
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68165, Germany
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Haskins G, Kruecker J, Kruger U, Xu S, Pinto PA, Wood BJ, Yan P. Learning deep similarity metric for 3D MR-TRUS image registration. Int J Comput Assist Radiol Surg 2018; 14:417-425. [PMID: 30382457 DOI: 10.1007/s11548-018-1875-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/14/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The fusion of transrectal ultrasound (TRUS) and magnetic resonance (MR) images for guiding targeted prostate biopsy has significantly improved the biopsy yield of aggressive cancers. A key component of MR-TRUS fusion is image registration. However, it is very challenging to obtain a robust automatic MR-TRUS registration due to the large appearance difference between the two imaging modalities. The work presented in this paper aims to tackle this problem by addressing two challenges: (i) the definition of a suitable similarity metric and (ii) the determination of a suitable optimization strategy. METHODS This work proposes the use of a deep convolutional neural network to learn a similarity metric for MR-TRUS registration. We also use a composite optimization strategy that explores the solution space in order to search for a suitable initialization for the second-order optimization of the learned metric. Further, a multi-pass approach is used in order to smooth the metric for optimization. RESULTS The learned similarity metric outperforms the classical mutual information and also the state-of-the-art MIND feature-based methods. The results indicate that the overall registration framework has a large capture range. The proposed deep similarity metric-based approach obtained a mean TRE of 3.86 mm (with an initial TRE of 16 mm) for this challenging problem. CONCLUSION A similarity metric that is learned using a deep neural network can be used to assess the quality of any given image registration and can be used in conjunction with the aforementioned optimization framework to perform automatic registration that is robust to poor initialization.
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Affiliation(s)
- Grant Haskins
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA
| | | | - Uwe Kruger
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA
| | - Sheng Xu
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Peter A Pinto
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Brad J Wood
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Pingkun Yan
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA.
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The Learning Curve for Magnetic Resonance Imaging/Ultrasound Fusion-guided Prostate Biopsy. Eur Urol Oncol 2018; 2:135-140. [PMID: 31017088 DOI: 10.1016/j.euo.2018.07.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/28/2018] [Accepted: 07/16/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Magnetic resonance imaging/ultrasound-guided fusion biopsy (FBx) is more accurate at detecting clinically significant prostate cancer than conventional transrectal ultrasound-guided systematic biopsy. However, learning curves for attaining accuracy may limit the generalizability of published outcomes. OBJECTIVE To delineate and quantify the learning curve for FBx by assessing the targeted biopsy accuracy and pathological quality of systematic biopsy over time. DESIGN, SETTING, AND PARTICIPANTS We carried out a retrospective analysis of 173 consecutive men who underwent Artemis FBx with computer-template systematic sampling between July 2015 and May 2017. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The accuracy of targeted biopsy was determined by calculating the distance between planned and actual core trajectories stored on Artemis. Systematic sampling proficiency was assessed via pathological analysis of fibromuscular tissue in all cores and then comparing pathology elements from individual cores from men in the first and last tertiles. Polynomial linear regression models, change-point analysis, and piecewise linear regression were used to quantify the learning curve. RESULTS AND LIMITATION A significant improvement in targeted biopsy accuracy occurred up to 98 cases (p<0.01). There was a significant decrease in fibromuscular tissue in the systematic biopsy cores up to 84 cases (p<0.01) and an improvement in pathological quality when comparing systematic cores from the first and third tertiles. Use of a different fusion platform may limit the generalizability of our results. CONCLUSIONS There is a significant learning curve for targeted and systemic biopsy using the Artemis platform. Improvements in accuracy of targeted biopsy and better sampling for systematic biopsy can be achieved with greater experience. PATIENT SUMMARY We define the learning curve for magnetic resonance imaging/ultrasound-guided fusion biopsy (FBx) using targeted biopsy accuracy and systematic core sampling quality as measures. Our findings underscore the importance of overcoming learning curves inherent to FBx to minimize patient discomfort and biopsy risk and improve the quality of care for accurate risk stratification, active surveillance, and treatment selection.
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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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Westhoff N, Siegel F, Peter C, Hetjens S, Porubsky S, Martini T, von Hardenberg J, Michel MS, Budjan J, Ritter M. Defining the target prior to prostate fusion biopsy: the effect of MRI reporting on cancer detection. World J Urol 2018; 37:327-335. [PMID: 29967946 DOI: 10.1007/s00345-018-2400-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 06/28/2018] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Definition of targets in multiparametric MRI (mpMRI) prior to MRI/TRUS fusion prostate biopsy either by urologist or radiologist, as a prose report or by illustration is crucial for accurate targeted biopsies (TB). The objective was to analyze the effect of MRI reporting on target definition and cancer detection. METHODS 202 patients underwent MRI/TRUS fusion biopsy with Artemis™ (Eigen, USA). mpMRI results were submitted in written form to urologists, who marked the targets in the proprietary software. An expert uroradiologist reviewed and marked mpMRI targets blinded to biopsy data. We compared number, localization and volume of targets between the observers and analyzed whether variations impaired TB results by bivariate and logistic regression models. RESULTS Interobserver variability was moderate regarding number and low regarding localization of targets. Urologists overestimated target volumes significantly compared to radiologists (p = 0.045) and matching target volume between both observers was only 43.9%. Overall cancer detection rate was 69.8 and 52.0% by TB. A higher matching target volume was a significant predictor of cancer in TB (p < 0.001). Logistic regression revealed prostate volume and PI-RADS as independent predictors. Defining targets in incorrect T2w slices in the cranio-caudal axis are one presumable reason for missing cancer in TB. CONCLUSIONS A high concordance of the target definition between radiologist and urologist is mandatory for accurate TB. Optimized ROI definition is recommended to improve TB results, preferably as contouring in MRI sequences by the radiologist or, if not feasible, by precise MRI reports including specific localization in sequence and slice as well as an illustration. High prostate volume and low PI-RADS score have to be considered as limiting factors for target definition.
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Affiliation(s)
- Niklas Westhoff
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Fabian Siegel
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Peter
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Svetlana Hetjens
- Institute of Medical Statistics and Biometry, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Stefan Porubsky
- Department of Pathology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Thomas Martini
- Department of Urology, University Medical Center Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Jost von Hardenberg
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Maurice Stephan Michel
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Johannes Budjan
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Manuel Ritter
- Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Hale GR, Czarniecki M, Cheng A, Bloom JB, Seifabadi R, Gold SA, Rayn KN, Sabarwal VK, Mehralivand S, Choyke PL, Turkbey B, Wood B, Pinto PA. Comparison of Elastic and Rigid Registration during Magnetic Resonance Imaging/Ultrasound Fusion-Guided Prostate Biopsy: A Multi-Operator Phantom Study. J Urol 2018; 200:1114-1121. [PMID: 29940248 DOI: 10.1016/j.juro.2018.06.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The relative value of rigid or elastic registration during magnetic resonance imaging/ultrasound fusion guided prostate biopsy has been poorly studied. We compared registration errors (the distance between a region of interest and fiducial markers) between rigid and elastic registration during fusion guided prostate biopsy using a prostate phantom model. MATERIALS AND METHODS Four gold fiducial markers visible on magnetic resonance imaging and ultrasound were placed throughout 1 phantom prostate model. The phantom underwent magnetic resonance imaging and the fiducial markers were labeled as regions of interest. An experienced user and a novice user of fusion guided prostate biopsy targeted regions of interest and then the corresponding fiducial markers on ultrasound after rigid and then elastic registration. Registration errors were compared. RESULTS A total of 224 registration error measurements were recorded. Overall elastic registration did not provide significantly improved registration error over rigid registration (mean ± SD 4.87 ± 3.50 vs 4.11 ± 2.09 mm, p = 0.05). However, lesions near the edge of the phantom showed increased registration errors when using elastic registration (5.70 ± 3.43 vs 3.23 ± 1.68 mm, p = 0.03). Compared to the novice user the experienced user reported decreased registration error with rigid registration (3.25 ± 1.49 vs 4.98 ± 2.10 mm, p <0.01) and elastic registration (3.94 ± 2.61 vs 6.07 ± 4.16 mm, p <0.01). CONCLUSIONS We found no difference in registration errors between rigid and elastic registration overall but rigid registration decreased the registration error of targets near the prostate edge. Additionally, operator experience reduced registration errors regardless of the registration method. Therefore, elastic registration algorithms cannot serve as a replacement for attention to detail during the registration process and anatomical landmarks indicating accurate registration when beginning the procedure and before targeting each region of interest.
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Affiliation(s)
- Graham R Hale
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Marcin Czarniecki
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Alexis Cheng
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Reza Seifabadi
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Samuel A Gold
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Kareem N Rayn
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Vikram K Sabarwal
- Department of Urology, George Washington University, Washington, D. C
| | - Sherif Mehralivand
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Department of Urology and Pediatric Urology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Germany
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Brad Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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Meng X, Rosenkrantz AB, Huang R, Deng FM, Wysock JS, Bjurlin MA, Huang WC, Lepor H, Taneja SS. The Institutional Learning Curve of Magnetic Resonance Imaging-Ultrasound Fusion Targeted Prostate Biopsy: Temporal Improvements in Cancer Detection in 4 Years. J Urol 2018; 200:1022-1029. [PMID: 29886090 DOI: 10.1016/j.juro.2018.06.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE While magnetic resonance imaging-ultrasound fusion targeted biopsy allows for improved detection of clinically significant prostate cancer, a concerning amount of clinically significant disease is still missed. We hypothesized that a number of these misses are due to the learning curve associated with magnetic resonance imaging-ultrasound fusion targeted biopsy. We report the results of repeat magnetic resonance imaging-ultrasound fusion targeted biopsy in men with continued suspicion for cancer and the institutional learning curve in the detection of clinically significant prostate cancer with time. MATERIALS AND METHODS We analyzed the records of 1,813 prostate biopsies in a prospectively acquired cohort of men who presented for prostate biopsy in a 4-year period. All men were offered prebiopsy magnetic resonance imaging and were assigned a maximum PI-RADS™ (Prostate Imaging Reporting and Data System version 2) score. Biopsy outcomes in men with a suspicious region of interest were compared. The relationship between time and clinically significant prostate cancer detection was analyzed. RESULTS The clinically significant prostate cancer detection rate increased 26% with time in men with a PI-RADS 4/5 region of interest. On repeat magnetic resonance imaging-ultrasound fusion targeted biopsy in men with continued suspicion for cancer 53% of those with a PI-RADS 4/5 region of interest demonstrated clinically significant discordance from the initial magnetic resonance imaging-ultrasound fusion targeted biopsy compared to only 23% with a PI-RADS 1/2 region of interest. Significantly less clinically significant prostate cancer was missed or under graded in the most recent biopsies compared to the earliest biopsies. CONCLUSIONS The high upgrade rate on repeat magnetic resonance imaging-ultrasound fusion targeted biopsy and the increasing cancer detection rate with time show the significant learning curve associated with magnetic resonance imaging-ultrasound fusion targeted biopsy. Men with low risk or negative biopsies with a persistent, concerning region of interest should be promptly rebiopsied. Improved targeting accuracy with operator experience can help decrease the number of missed cases of clinically significant prostate cancer.
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Affiliation(s)
- Xiaosong Meng
- Department of Urology, New York University Langone Health, New York, New York
| | | | - Richard Huang
- Department of Urology, New York University Langone Health, New York, New York
| | - Fang-Ming Deng
- Department of Pathology, New York University Langone Health, New York, New York
| | - James S Wysock
- Department of Urology, New York University Langone Health, New York, New York
| | - Marc A Bjurlin
- Department of Urology, New York University Langone Hospital-Brooklyn, Brooklyn, New York
| | - William C Huang
- Department of Urology, New York University Langone Health, New York, New York
| | - Herbert Lepor
- Department of Urology, New York University Langone Health, New York, New York
| | - Samir S Taneja
- Department of Urology, New York University Langone Health, New York, New York; Department of Radiology, New York University Langone Health, New York, New York.
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Gold SA, Hale GR, Bloom JB, Smith CP, Rayn KN, Valera V, Wood BJ, Choyke PL, Turkbey B, Pinto PA. Follow-up of negative MRI-targeted prostate biopsies: when are we missing cancer? World J Urol 2018; 37:235-241. [PMID: 29785491 DOI: 10.1007/s00345-018-2337-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/13/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Multiparametric magnetic resonance imaging (mpMRI) has improved clinicians' ability to detect clinically significant prostate cancer (csPCa). Combining or fusing these images with the real-time imaging of transrectal ultrasound (TRUS) allows urologists to better sample lesions with a targeted biopsy (Tbx) leading to the detection of greater rates of csPCa and decreased rates of low-risk PCa. In this review, we evaluate the technical aspects of the mpMRI-guided Tbx procedure to identify possible sources of error and provide clinical context to a negative Tbx. METHODS A literature search was conducted of possible reasons for false-negative TBx. This includes discussion on false-positive mpMRI findings, termed "PCa mimics," that may incorrectly suggest high likelihood of csPCa as well as errors during Tbx resulting in inexact image fusion or biopsy needle placement. RESULTS Despite the strong negative predictive value associated with Tbx, concerns of missed disease often remain, especially with MR-visible lesions. This raises questions about what to do next after a negative Tbx result. Potential sources of error can arise from each step in the targeted biopsy process ranging from "PCa mimics" or technical errors during mpMRI acquisition to failure to properly register MRI and TRUS images on a fusion biopsy platform to technical or anatomic limits on needle placement accuracy. CONCLUSIONS A better understanding of these potential pitfalls in the mpMRI-guided Tbx procedure will aid interpretation of a negative Tbx, identify areas for improving technical proficiency, and improve both physician understanding of negative Tbx and patient-management options.
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Affiliation(s)
- Samuel A Gold
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr. Building 10, Room 1-5950, Bethesda, MD, 20892, USA
| | - Graham R Hale
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr. Building 10, Room 1-5950, Bethesda, MD, 20892, USA
| | - Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr. Building 10, Room 1-5950, Bethesda, MD, 20892, USA
| | - Clayton P Smith
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kareem N Rayn
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr. Building 10, Room 1-5950, Bethesda, MD, 20892, USA
| | - Vladimir Valera
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr. Building 10, Room 1-5950, Bethesda, MD, 20892, USA
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr. Building 10, Room 1-5950, Bethesda, MD, 20892, USA.
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Stabile A, Dell'Oglio P, Gandaglia G, Fossati N, Brembilla G, Cristel G, Dehò F, Scattoni V, Maga T, Losa A, Gaboardi F, Cardone G, Esposito A, De Cobelli F, Del Maschio A, Montorsi F, Briganti A. Not All Multiparametric Magnetic Resonance Imaging-targeted Biopsies Are Equal: The Impact of the Type of Approach and Operator Expertise on the Detection of Clinically Significant Prostate Cancer. Eur Urol Oncol 2018; 1:120-128. [PMID: 31100235 DOI: 10.1016/j.euo.2018.02.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 01/24/2018] [Accepted: 02/03/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND The extensive use of multiparametric magnetic resonance imaging (mpMRI) has led to an even more widespread use of different targeted biopsy techniques and approaches. The best way of performing targeted biopsies and the effect of operator expertise have still to be defined. OBJECTIVE To compare the rate of detection of clinically significant prostate cancer (csPCa) of different mpMRI targeted approaches and to assess the role of operator expertise in the detection of csPCa. DESIGN, SETTING, AND PARTICIPANTS We included 244 consecutive patients who underwent both 12-core transrectal ultrasound (TRUS) biopsy and mpMRI targeted biopsy with either a cognitive biopsy (CB) or fusion biopsy (FB) approach during the same session between 2013 and 2016 at a single tertiary referral centre. INTERVENTION All men underwent 1.5-T mpMRI with an endorectal coil. All biopsies were performed by three operators as their first cases of targeted biopsy. Lesions with a Prostate Imaging Recording and Data System (PI-RADS) v.2 score of ≥3 detected at mpMRI were targeted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: csPCa was defined as disease with a Gleason score at biopsy of ≥7. Operator expertise was coded as the progressive number of targeted biopsies performed by each physician. Multivariable logistic regression analyses (MVA) were used to assess the association between the targeted biopsy technique (FB vs CB) and operator expertise for detection of csPCa. Covariates consisted of prostate-specific antigen, prostate volume, PI-RADS v.2 (3 vs >3), number of targeted cores per MRI lesion, and digital rectal examination (negative vs positive). The same analyses were performed for patients undergoing FB only after accounting for the FB approach (transrectal vs transperineal). A lowess smoothing weighted function was used to graphically assess the effect of operator expertise on the probability of detecting csPCa, after accounting for all confounders. RESULTS AND LIMITATIONS Overall, 157 patients (64%) underwent FB and 87 (36%) underwent CB. The overall csPCa detection rate was 58% for FB and 45% for CB (p=0.07). A significantly higher rate of csPCa detection in targeted samples was observed for FB compared to CB (57% vs 36%; p=0.002). On MVA, FB and operator expertise were significantly associated with a higher probability of csPCa detection in targeted samples (odds ratio [OR] 2.4 and 1.7, respectively; both p≤0.03). When the same analyses were repeated for patients undergoing FB, operator expertise remained an independent predictor of csPCa detection (OR 1.9; p=0.004). An increase in the probability of detecting csPCa with the number of procedures performed was observed after accounting for all confounders. CONCLUSIONS We demonstrated that FB had higher detection rate than CB for csPCa. Moreover, operator expertise was significantly associated with higher detection rates for csPCa. PATIENT SUMMARY When different targeted biopsy techniques were compared, fusion biopsy provided a higher detection rate compared to cognitive biopsy for clinically significant prostate cancer (csPCa). Moreover, we found that operator expertise was an important predictor of the detection of csPCa, regardless of the procedure used.
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Affiliation(s)
- Armando Stabile
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Paolo Dell'Oglio
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Fossati
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Brembilla
- Department of Radiology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Cristel
- Department of Radiology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Dehò
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Scattoni
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Tommaso Maga
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Losa
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Franco Gaboardi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianpiero Cardone
- Department of Radiology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- Department of Radiology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Del Maschio
- Department of Radiology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
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In-bore 3.0-T Magnetic Resonance Imaging-guided Transrectal Targeted Prostate Biopsy in a Repeat Biopsy Population: Diagnostic Performance, Complications, and Learning Curve. Urology 2018; 114:139-146. [DOI: 10.1016/j.urology.2017.12.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/23/2017] [Accepted: 12/27/2017] [Indexed: 11/18/2022]
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49
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Bloom JB, Gold SA, Hale GR, Rayn KN, Sabarwal VK, Bakhutashvili I, Valera V, Turkbey B, Pinto PA, Wood BJ. "Super-active surveillance": MRI ultrasound fusion biopsy and ablation for less invasive management of prostate cancer. Gland Surg 2018; 7:166-187. [PMID: 29770311 DOI: 10.21037/gs.2018.03.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Multiparametric magnetic resonance imaging (mpMRI) of the prostate has allowed clinicians to better visualize and target suspicious lesions during biopsy. Targeted prostate biopsies give a more accurate representation of the true cancer volume and stage so that appropriate treatment or active surveillance can be selected. Advances in technology have led to the development of MRI and ultrasound fusion platforms used for targeted biopsies, monitoring cancer progression, and more recently for the application of focal therapy. Lesions visualized on mpMRI can be targeted for ablation with a variety of energy sources employed under both local and general anesthesia. Focal ablation may offer an alternative option for treating prostate cancer as compared to the well-established interventions of whole-gland radiation or prostatectomy. Focal ablation may also be an option for patients on active surveillance who wish to be even more "active" in their surveillance. In this review, we describe the advancements and development of fusion biopsies, the rationale behind focal therapy, and introduce focal ablative techniques for indolent prostate cancers ("super-active surveillance"), including cryoablation and focal laser ablation (FLA) and the subsequent MRI/biopsy surveillance.
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Affiliation(s)
- Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Samuel A Gold
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Graham R Hale
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Kareem N Rayn
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Vikram K Sabarwal
- Department of Urology, George Washington University, Washington, DC, USA
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, National Cancer Institute, Bethesda, MD, USA
| | - Vladimir Valera
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, Bethesda, MD, USA
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50
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Calio BP, Sidana A, Sugano D, Gaur S, Maruf M, Jain AL, Merino MJ, Choyke PL, Wood BJ, Pinto PA, Turkbey B. Risk of Upgrading from Prostate Biopsy to Radical Prostatectomy Pathology-Does Saturation Biopsy of Index Lesion during Multiparametric Magnetic Resonance Imaging-Transrectal Ultrasound Fusion Biopsy Help? J Urol 2018; 199:976-982. [PMID: 29154904 DOI: 10.1016/j.juro.2017.10.048] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE We sought to determine whether saturation of the index lesion during magnetic resonance imaging-transrectal ultrasound fusion guided biopsy would decrease the rate of pathological upgrading from biopsy to radical prostatectomy. MATERIALS AND METHODS We analyzed a prospectively maintained, single institution database for patients who underwent fusion and systematic biopsy followed by radical prostatectomy in 2010 to 2016. Index lesion was defined as the lesion with largest diameter on T2-weighted magnetic resonance imaging. In patients with a saturated index lesion transrectal fusion biopsy targets were obtained at 6 mm intervals along the long axis of the index lesion. In patients with a nonsaturated index lesion only 1 target was obtained from the lesion. Gleason 6, 7 and 8-10 were defined as low, intermediate and high risk, respectively. RESULTS Included in the study were 208 consecutive patients, including 86 with a saturated and 122 with a nonsaturated lesion. Median patient age was 62.0 years (IQR 10.0) and median prostate specific antigen was 7.1 ng/ml (IQR 8.0). The median number of biopsy cores per index lesion was higher in the saturated lesion group (4 vs 2, p <0.001). The risk category upgrade rate from systematic only, fusion only, and combined fusion and systematic biopsy results to prostatectomy was 40.9%, 23.6% and 13.8%, respectively. The risk category upgrade from combined fusion and systematic biopsy results was lower in the saturated than in the nonsaturated lesion group (7% vs 18%, p = 0.021). There was no difference in the upgrade rate based on systematic biopsy between the 2 groups. However, fusion biopsy results were significantly less upgraded in the saturated lesion group (Gleason upgrade 20.9% vs 36.9%, p = 0.014 and risk category upgrade 14% vs 30.3%, p = 0.006). CONCLUSIONS Our results demonstrate that saturation of the index lesion significantly decreases the risk of upgrading on radical prostatectomy by minimizing the impact of tumor heterogeneity.
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Affiliation(s)
- Brian P Calio
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Abhinav Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Division of Urology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Dordaneh Sugano
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sonia Gaur
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mahir Maruf
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Amit L Jain
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maria J Merino
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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