A comparison of magnetic resonance imaging techniques used to secure biopsies in prostate cancer patients

Analysis of false positive PI-RADS 4 lesions: experience from a single nonacademic center using cognitive fusion

BACKGROUND

We evaluated pathological findings in targeted biopsies of PI-RADS4 and PI-RADS5 lesions, and clinical data that could predict those patients with benign findings.

MATERIALS AND METHODS

A retrospective study was conducted to summarize the experience from a single nonacademic center using cognitive fusion and a 1.5 or 3.0 Tesla scanner.

RESULTS

We found a false positive rate of 29 and 3.7% for any cancer in PI-RADS 4 and 5 lesions, respectively. Diverse histologic patterns were observed among target biopsies. At multivariate analysis, size ≤ 6 mm and previous negative biopsy were independent predictors of false positive PI-RADS4 lesions. The small number of false PI-RADS5 lesions precluded further analyses.

CONCLUSION

Benign findings are common in PI-RADS4 lesions and most of them do not show obvious glandular or stromal hypercellularity as expected in hyperplastic nodules. Size ≤ 6 mm and previous negative biopsy predict a higher probability of false positive results in patients with PI-RADS 4 lesions.

Diagnostic value of combining PI-RADS v2.1 with PSAD in clinically significant prostate cancer

PURPOSE

To investigate the diagnostic value of the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) for clinically significant prostate cancer (CsPCa). We also aimed to combine PI-RADS v2.1 with prostate-specific antigen (PSA) derivatives to improve the predictive value of CsPCa.

METHODS

We retrospectively collected relevant data who underwent standard MRI examinations of the prostate and subjected to a prostate biopsy at Shenzhen People's hospital from November 2014 to November 2019. Included 125 cases of CsPCa and 383 cases of non-CsPCa. All cases were scored using the PI-RADS v2.1. The clinical data collected included age, PSA, free PSA/total PSA, prostate volume and PSA density (PSAD). A univariate analysis was performed to identify statistically significant indicators. Logistic regression was used to analyze the predictive value of the multi-parameter combination on CsPCa.

RESULTS

Except age, the difference in all of indicators between the CsPCa group and non-CsPCa group was statistically significant. The PI-RADS score and PSAD value had the highest diagnostic value. Logistic regression analysis revealed that the PI-RADS score and PSAD value were independent predictors of CsPCa, with a regression model AUC of 0.935. CsPCa detection rates were low when the PI-RADS score ≤ 2 or the PI-RADS score = 3 and the PSAD value ≤ 0.33 ng/ml/ml.

CONCLUSION

Combining the PI-RADS score and PSAD value improved the predictive performance of CsPCa. Patients with a PI-RADS score ≤ 2 or a PI-RADS score = 3 and a PSAD value ≤ 0.33 ng/ml/ml can avoid an unnecessary biopsy.

Image-Guided Targeted Prostate Biopsies

Prostate cancer is the second most common cancer in the United States. Screening for prostate cancer has increased through the usage of prostate specific antigen and biopsies. Traditionally, prostate biopsies are done using transrectal ultrasound with 10-12 cores obtained in a sextant pattern. Advances in prostate imaging with multiparametric magnetic resonance imaging has led to image guided targeted prostate biopsies. This can be done with cognitive fusion, MRI-fusion, and in-bore MRI. This article will review the indications, techniques, and outcomes for targeted image guided prostate biopsies using in-bore MRI and MRI fusion.

Advanced nanoengineered-customized point-of-care tools for prostate-specific antigen

Change in the level of human prostate-specific antigen (PSA) is a major element in the development and progression of prostate cancer (PCa). Most of the methodologies are currently restricted to their application in routine clinical screening due to the scarcity of adequate screening tools, false reading, long assay time, and cost. Innovative techniques and the integration of knowledge from a variety of domains, such as materials science and engineering, are needed to provide sustainable solutions. The convergence of precision point-of-care (POC) diagnostic techniques, which allow patients to respond in real time to changes in PSA levels, provides promising possibilities for quantitative and quantitative detection of PSA. This solution could be interesting and relevant for use in PCa diagnosis at the POC. The approaches enable low-cost real-time detection and are simple to integrate into user-friendly sensor devices. This review focuses on the investigations, prospects, and challenges associated with integrating engineering sciences with cancer biology to develop nanotechnology-based tools for PCa diagnosis. This article intends to encourage the development of new nanomaterials to construct high-performance POC devices for PCa detection. Finally, the review concludes with closing remarks and a perspective forecast.

A prospective study on inter-operator variability in semi-robotic software-based MRI/TRUS-fusion targeted prostate biopsies

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.

Diagnostic Yield of Incremental Biopsy Cores and Second Lesion Sampling for In-Gantry MRI-Guided Prostate Biopsy

BACKGROUND. In-gantry MRI-guided biopsy (MRGB) of the prostate has been shown to be more accurate than other targeted prostate biopsy methods. However, the optimal number of cores to obtain during in-gantry MRGB remains undetermined. OBJECTIVE. The purpose of this study was to assess the diagnostic yield of obtaining an incremental number of cores from the primary lesion and of second lesion sampling during in-gantry MRGB of the prostate. METHODS. This retrospective study included 128 men with 163 prostate lesions who underwent in-gantry MRGB between 2016 and 2019. The men had a total of 163 lesions sampled with two or more cores, 121 lesions sampled with three or more cores, and 52 lesions sampled with four or more cores. A total of 40 men underwent sampling of a second lesion. Upgrade on a given core was defined as a greater International Society of Urological Pathology (ISUP) grade group (GG) relative to the previously obtained cores. Clinically significant prostate cancer (csPCa) was defined as ISUP GG 2 or greater. RESULTS. The frequency of any upgrade was 12.9% (21/163) on core 2 versus 10.7% (13/121) on core 3 (p = .29 relative to core 2) and 1.9% (1/52) on core 4 (p = .03 relative to core 3). The frequency of upgrade to csPCa was 7.4% (12/163) on core 2 versus 4.1% (5/121) on core 3 (p = .13 relative to core 2) and 0% (0/52) on core 4 (p = .07 relative to core 3). The frequency of upgrade on core 2 was higher for anterior lesions (p < .001) and lesions with a higher PI-RADS score (p = .007); the frequency of upgrade on core 3 was higher for apical lesions (p = .01) and lesions with a higher PI-RADS score (p = .01). Sampling of a second lesion resulted in an upgrade in a single patient (2.5%; 1/40); both lesions were PI-RADS category 4 and showed csPCa. CONCLUSION. When performing in-gantry MRGB of the prostate, obtaining three cores from the primary lesion is warranted to optimize csPCa diagnosis. Obtaining a fourth core from the primary lesion or sampling a second lesion has very low yield in upgrading cancer diagnoses. CLINICAL IMPACT. To reduce patient discomfort and procedure times, operators may refrain from obtaining more than three cores or second lesion sampling.

Comparison of TRUS and combined MRI-targeted plus systematic prostate biopsy for the concordance between biopsy and radical prostatectomy pathology

AIM

To evaluate the accuracy in histologic grading of MRI/US image fusion biopsy by comparing conventional 12-core TRUS-Bx at radical prostatectomy specimens (RP).

METHODS

Consecutive patients diagnosed prostate cancer (127 with combination of both targeted biopsy (TBx) plus systematic biopsies (SBx) and separate patient cohort of 330 conventional TRUS-Bx without mpMRI) with a PSA level of <20 ng/mL prior to RP were included. The primary end point was the grade group concordance between biopsy and RP pathology according to biopsy technique.

RESULTS

Clinically significant prostate cancer detection was 51.2% for TRUS-Bx, 49.5% for SBx, 67% for TBx and 75.7% for TBx + SBx. Upgrading and downgrading of at least one Gleason Grade Group (GGG) was recorded in 43.3%/ 6.7% patients of the TRUS-Bx and in 20.5%/ 22% of the TBX + SBx group, respectively (all P < .001). Concordance level was detected to be significantly higher for ISUP 1 in combined TBx + SBx method compared to conventional TRUS-Bx (61.3% vs 37.9%, P = .014). In ISUP 1 exclusively, significant upgrading was seen in TRUS-Bx (62.1%) when compared to TBx (41.4%) and TBx + SBx (38.7%).

CONCLUSIONS

MRI-targeted biopsies detected more significant PCa than TRUS-Bx but, superiority in significant cancer detection appears as a result of inadvertant selective sampling of small higher grade areas. Within an otherwise low grade cancer and does not reflect accurate GGG final surgical pathology. TBx + SBx has the greatest concordance in ISUP Grade 1 with less upgrading which is utmost important for active surveillance.

Real life data of MRI-targeted biopsy - experience from a single nonacademic centre using cognitive fusion and 1.5 tesla scanning

OBJECTIVES

To date, it is unknown whether systematic biopsies can be safely omitted in patients with unsuspicious MRI findings or if systematic biopsies should be required when targeting focal lesions (PI-RADS 3-5).

METHODS

A series of 366 patients (249 without a previous biopsy) were examined in a 1.5 Tesla MRI scanner. All patients were submitted to systematic biopsies (12-14 regions) with additional targeted biopsies (by cognitive fusion) of focal PI-RADS lesions (PI-RADS 3-5).

RESULTS

In our series, patients with PI-RADS 1/2 findings had rates of adenocarcinoma of any grade, >GG1 and GG4/5 of 34%, 14% and 3%, respectively. The use of MRI prior to biopsy in our series increased the detection of clinically significant prostate cancer (CSPCa) in 28% of patients with focal lesions, and focal lesions were present in 293/366 (80%) of all patients. For CSPCa (>GG1), targeted biopsies improved the diagnosis in 28% of patients, while systematic biopsies resulted in an additional 19% of cancer cases in the series.

CONCLUSION

Systematic biopsies should still be considered in patients with PI-RADS 1/2 findings. Our findings also suggest a stronger benefit of the combined strategy of targeted and systematic biopsies than the findings of previous studies concerning the detection of CSPCa in biopsy-naïve patients.

Micro-Ultrasound Imaging for Accuracy of Diagnosis in Clinically Significant Prostate Cancer: A Meta-Analysis

Background: Prostate cancer is a frequently diagnosed malignant solid tumor in men. The accuracy of diagnosis is becoming increasingly important. This meta-analysis evaluated the accuracy of micro-ultrasound in the diagnosis of clinically significant prostate cancer. Methods: We searched PubMed, Embase, Web of Science, and Cochrane Library databases to recruit studies in English. The quality assessment of diagnostic accuracy studies-2 protocol was used to evaluate the literature quality. Publication bias was analyzed using Deeks' funnel plot asymmetry test. We calculated the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and 95% confidence interval (95% CI) for studies of micro-ultrasound imaging for prostate cancer. The results were assessed by the summary receiver-operating characteristic curve (SROC). Ultimately, a univariable meta-regression and subgroup analysis, Fagan plot, and a likelihood matrix were conducted. Results: A total of seven studies containing 769 patients were included in this meta-analysis. Micro-ultrasound had a pooled sensitivity, specificity, DOR, and an area under the SROC of 0.91, 0.49, 10, and 0.82, respectively. Based on these findings, micro-ultrasound has superior ability to diagnose clinically significant prostate cancer. Conclusion: Micro-ultrasound is a more convenient and cost-effective method in real-time imaging during the biopsy procedure in detecting clinically significant prostate cancer. Although micro-ultrasound has shown promising results, more clinical data and comprehensive analysis are still needed.