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Recchimuzzi DZ, Diaz de Leon A, Pedrosa I, Travalini D, Latin H, Goldberg K, Meng X, Begovic J, Rayan J, Roehrborn CG, Rofsky NM, Costa DN. Direct MRI-guided In-Bore Targeted Biopsy of the Prostate: A Step-by-Step How To and Lessons Learned. Radiographics 2024; 44:e230142. [PMID: 38175803 DOI: 10.1148/rg.230142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Multiparametric MRI-the most accurate imaging technique for detection of prostate cancer-has transformed the landscape of prostate cancer diagnosis by enabling targeted biopsies. In a targeted biopsy, tissue samples are obtained from suspicious regions identified at prebiopsy diagnostic MRI. The authors briefly compare the different strategies available for targeting an MRI-visible suspicious lesion, followed by a step-by-step description of the direct MRI-guided in-bore approach and an illustrated review of its application in challenging clinical scenarios. In this technique, direct visualization of the needle, needle guide, and needle trajectory during the procedure provides a precise and versatile strategy to accurately sample suspicious lesions, improving detection of clinically significant cancers. Published under a CC BY 4.0 license Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Debora Z Recchimuzzi
- From the Departments of Radiology (D.Z.R., I.P., D.T., H.L., J.B., J.R., N.M.R., D.N.C.) and Urology (I.P., K.G., X.M., C.G.R., D.N.C.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390; and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (A.D.d.L.)
| | - Alberto Diaz de Leon
- From the Departments of Radiology (D.Z.R., I.P., D.T., H.L., J.B., J.R., N.M.R., D.N.C.) and Urology (I.P., K.G., X.M., C.G.R., D.N.C.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390; and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (A.D.d.L.)
| | - Ivan Pedrosa
- From the Departments of Radiology (D.Z.R., I.P., D.T., H.L., J.B., J.R., N.M.R., D.N.C.) and Urology (I.P., K.G., X.M., C.G.R., D.N.C.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390; and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (A.D.d.L.)
| | - Debbie Travalini
- From the Departments of Radiology (D.Z.R., I.P., D.T., H.L., J.B., J.R., N.M.R., D.N.C.) and Urology (I.P., K.G., X.M., C.G.R., D.N.C.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390; and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (A.D.d.L.)
| | - Heather Latin
- From the Departments of Radiology (D.Z.R., I.P., D.T., H.L., J.B., J.R., N.M.R., D.N.C.) and Urology (I.P., K.G., X.M., C.G.R., D.N.C.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390; and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (A.D.d.L.)
| | - Kenneth Goldberg
- From the Departments of Radiology (D.Z.R., I.P., D.T., H.L., J.B., J.R., N.M.R., D.N.C.) and Urology (I.P., K.G., X.M., C.G.R., D.N.C.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390; and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (A.D.d.L.)
| | - Xiaosong Meng
- From the Departments of Radiology (D.Z.R., I.P., D.T., H.L., J.B., J.R., N.M.R., D.N.C.) and Urology (I.P., K.G., X.M., C.G.R., D.N.C.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390; and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (A.D.d.L.)
| | - Jovan Begovic
- From the Departments of Radiology (D.Z.R., I.P., D.T., H.L., J.B., J.R., N.M.R., D.N.C.) and Urology (I.P., K.G., X.M., C.G.R., D.N.C.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390; and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (A.D.d.L.)
| | - Jesse Rayan
- From the Departments of Radiology (D.Z.R., I.P., D.T., H.L., J.B., J.R., N.M.R., D.N.C.) and Urology (I.P., K.G., X.M., C.G.R., D.N.C.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390; and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (A.D.d.L.)
| | - Claus G Roehrborn
- From the Departments of Radiology (D.Z.R., I.P., D.T., H.L., J.B., J.R., N.M.R., D.N.C.) and Urology (I.P., K.G., X.M., C.G.R., D.N.C.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390; and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (A.D.d.L.)
| | - Neil M Rofsky
- From the Departments of Radiology (D.Z.R., I.P., D.T., H.L., J.B., J.R., N.M.R., D.N.C.) and Urology (I.P., K.G., X.M., C.G.R., D.N.C.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390; and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (A.D.d.L.)
| | - Daniel N Costa
- From the Departments of Radiology (D.Z.R., I.P., D.T., H.L., J.B., J.R., N.M.R., D.N.C.) and Urology (I.P., K.G., X.M., C.G.R., D.N.C.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX 75390; and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (A.D.d.L.)
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Costa DN, Recchimuzzi DZ, Schieda N. Targeted Prostate Biopsies-What the Radiologist Needs to Know. Radiol Clin North Am 2024; 62:109-120. [PMID: 37973237 DOI: 10.1016/j.rcl.2023.06.011] [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: 11/19/2023]
Abstract
The emergence of multiparametric MR imaging has enabled a more reliable targeted approach to diagnosis of prostate cancer. Targeted biopsies are central to the MR imaging-dependent pathway to prostate cancer diagnosis and potentially improve the detection of clinically significant prostate cancers. In a targeted biopsy, tissue samples are obtained from suspicious regions identified on a prebiopsy diagnostic MR imaging. This article describes and compares principles, advantages, and disadvantages of the different strategies available for targeting an MR imaging-visible suspicious lesion.
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Affiliation(s)
- Daniel N Costa
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX 75390, USA; Department of Urology, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX 75390, USA.
| | - Debora Z Recchimuzzi
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX 75390, USA
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Room C159, Ottawa, Ontario K1Y 4E9, Canada
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Fang JH, Zhang L, Xie X, Zhao P, Bao L, Kong F. Comparative diagnostic accuracy of multiparametric magnetic resonance imaging-ultrasound fusion-guided biopsy versus systematic biopsy for clinically significant prostate cancer. PeerJ 2023; 11:e16614. [PMID: 38107582 PMCID: PMC10725670 DOI: 10.7717/peerj.16614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose To examine the accuracy of transperineal magnetic resonance imaging (MRI)-ultrasound (US) fusion biopsy (FB) in identifying men with prostate cancer (PCa) that has reached a clinically relevant stage. Methods This investigation enrolled 459 males. In 210 of these patients (FB group), transperineal MRI/US fusion-guided biopsies were performed on the suspicious region, and in 249 others, a systematic biopsy (SB) was performed (SB group). We compared these groups using Gleason scores and rates of cancer detection. Results PCa cases counted 198/459 (43.1%), including 94/249 (37.8%) in the SB group and 104/210 (49.5%) in the FB group. FB was associated with higher overall diagnostic accuracy relative to SB (88.5% and 72.3%, P = 0.024). FB exhibited greater sensitivity than SB (88.9% and 71.2%, P = 0.025). The area under the curve for FB and SB approaches was 0.837 and 0.737, respectively, such that FB was associated with an 11.9% increase in accuracy as determined based upon these AUC values. Relative to SB, FB was better able to detect high-grade tumors (GS ≥ 7) (78.85% vs. 60.64%, P = 0.025). Conclusion Transperineal MRI-US fusion targeted biopsy is superior to the systematic one as an approach to diagnosing clinically significant PCa, as it is a viable technical approach to prostate biopsy.
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Affiliation(s)
- Jian-hua Fang
- Department of Medical Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
| | - Liqing Zhang
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
| | - Xi Xie
- Department of Urology Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
| | - Pan Zhao
- Department of Pathology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
| | - Lingyun Bao
- Department of Medical Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
| | - Fanlei Kong
- Department of Medical Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hang Zhou, Zhejiang, China
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Kim SY, Park KJ. [MR-Guided Targeted Prostate Biopsy from Radiologists' Perspective]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:1220-1232. [PMID: 38107690 PMCID: PMC10721410 DOI: 10.3348/jksr.2023.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 12/19/2023]
Abstract
The prostate cancer diagnosis has traditionally been based on a systematic biopsy method in which tissue samples are randomly obtained from the prostate 10-12 sites. However, there are concerns as the method can fail to diagnose all prostate cancers or lead to over-detection of clinically insignificant cancers. MRI-guided prostate targeted biopsy has been proposed to address these shortcomings. This method involves identifying suspicious lesions using MRI and performing targeted biopsies under ultrasound or MRI guidance. We review the methods of MRI-based targeted biopsy and discuss recent guidelines and trends in prostate cancer diagnosis.
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Ramos F, Korets R, Fleishman A, Kaul S, Johnson M, Wei JL, Olumi AF, Tsai LL, Gershman B. Comparative Effectiveness of Magnetic Resonance Imaging-Ultrasound Fusion Versus In-bore Magnetic Resonance Imaging-targeted Prostate Biopsy. Urology 2023; 171:164-171. [PMID: 36206828 DOI: 10.1016/j.urology.2022.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the comparative effectiveness of magnetic resonance imaging-ultrasound (MRI-U/S) fusion biopsy and in-bore MRI-targeted biopsy. METHODS We identified men aged 18-89 with a diagnosis of elevated prostate specific antigen (PSA) or Gleason 6 prostate cancer on active surveillance who underwent MRI-U/S fusion prostate biopsy (12-core + targeted) in the office or in-bore MRI-targeted biopsy (MRI-IB; targeted only). The cancer detection rate (CDR; Gleason 6-10) and clinically significant CDR (csCDR; Gleason 7-10) were compared across biopsy techniques, adjusted for patient and radiographic features. RESULTS A total of 280 patients (346 lesions) were included, of whom 23.9% were on active surveillance for Gleason 6 prostate cancer. In the per-patient analyses, there was no statistically significant difference in adjusted overall CDR (64.1% vs 54.2%; P = .24) or csCDR (36.5% vs 37.9%; P = .85) between MRI-U/S and MRI-IB biopsy. In the per-lesion analyses, there was no statistically significant difference in adjusted overall CDR (45.7% vs 50.1%; P = .49) between MRI-U/S and MRI-IB biopsy, but MRI-IB biopsy was associated with a higher csCDR than MRI-U/S biopsy (32.8% vs 21.4%; P = .02). CONCLUSION We observed no statistically significant differences in cancer detection rates between MRI-U/S fusion biopsy and MRI-IB biopsy in per-patient analyses. However, MRI-IB biopsy was associated with higher csCDR when considering targeted biopsy cores only. These results suggest that systematic cores should be obtained when performing MRI-U/S fusion biopsy.
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Affiliation(s)
- Francisco Ramos
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Ruslan Korets
- Harvard Medical School, Boston, MA; Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Aaron Fleishman
- Deparment of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sumedh Kaul
- Deparment of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Michael Johnson
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jesse L Wei
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Aria F Olumi
- Harvard Medical School, Boston, MA; Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Leo L Tsai
- Harvard Medical School, Boston, MA; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Boris Gershman
- Harvard Medical School, Boston, MA; Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
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Peng C, Cai Q, Chen M, Jiang X. Recent Advances in Tracking Devices for Biomedical Ultrasound Imaging Applications. MICROMACHINES 2022; 13:mi13111855. [PMID: 36363876 PMCID: PMC9695235 DOI: 10.3390/mi13111855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 05/27/2023]
Abstract
With the rapid advancement of tracking technologies, the applications of tracking systems in ultrasound imaging have expanded across a wide range of fields. In this review article, we discuss the basic tracking principles, system components, performance analyses, as well as the main sources of error for popular tracking technologies that are utilized in ultrasound imaging. In light of the growing demand for object tracking, this article explores both the potential and challenges associated with different tracking technologies applied to various ultrasound imaging applications, including freehand 3D ultrasound imaging, ultrasound image fusion, ultrasound-guided intervention and treatment. Recent development in tracking technology has led to increased accuracy and intuitiveness of ultrasound imaging and navigation with less reliance on operator skills, thereby benefiting the medical diagnosis and treatment. Although commercially available tracking systems are capable of achieving sub-millimeter resolution for positional tracking and sub-degree resolution for orientational tracking, such systems are subject to a number of disadvantages, including high costs and time-consuming calibration procedures. While some emerging tracking technologies are still in the research stage, their potentials have been demonstrated in terms of the compactness, light weight, and easy integration with existing standard or portable ultrasound machines.
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Affiliation(s)
- Chang Peng
- School of Biomedical Engineering, ShanghaiTech University, Shanghai 201210, China
| | - Qianqian Cai
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA
| | - Mengyue Chen
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA
| | - Xiaoning Jiang
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA
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A Fusion Biopsy Framework for Prostate Cancer Based on Deformable Superellipses and nnU-Net. Bioengineering (Basel) 2022; 9:bioengineering9080343. [PMID: 35892756 PMCID: PMC9394419 DOI: 10.3390/bioengineering9080343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
In prostate cancer, fusion biopsy, which couples magnetic resonance imaging (MRI) with transrectal ultrasound (TRUS), poses the basis for targeted biopsy by allowing the comparison of information coming from both imaging modalities at the same time. Compared with the standard clinical procedure, it provides a less invasive option for the patients and increases the likelihood of sampling cancerous tissue regions for the subsequent pathology analyses. As a prerequisite to image fusion, segmentation must be achieved from both MRI and TRUS domains. The automatic contour delineation of the prostate gland from TRUS images is a challenging task due to several factors including unclear boundaries, speckle noise, and the variety of prostate anatomical shapes. Automatic methodologies, such as those based on deep learning, require a huge quantity of training data to achieve satisfactory results. In this paper, the authors propose a novel optimization formulation to find the best superellipse, a deformable model that can accurately represent the prostate shape. The advantage of the proposed approach is that it does not require extensive annotations, and can be used independently of the specific transducer employed during prostate biopsies. Moreover, in order to show the clinical applicability of the method, this study also presents a module for the automatic segmentation of the prostate gland from MRI, exploiting the nnU-Net framework. Lastly, segmented contours from both imaging domains are fused with a customized registration algorithm in order to create a tool that can help the physician to perform a targeted prostate biopsy by interacting with the graphical user interface.
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Xie J, Jin C, Liu M, Sun K, Jin Z, Ding Z, Gong X. MRI/Transrectal Ultrasound Fusion-Guided Targeted Biopsy and Transrectal Ultrasound-Guided Systematic Biopsy for Diagnosis of Prostate Cancer: A Systematic Review and Meta-analysis. Front Oncol 2022; 12:880336. [PMID: 35677152 PMCID: PMC9169152 DOI: 10.3389/fonc.2022.880336] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose For men suspected of having prostate cancer (PCa), the transrectal ultrasound (TRUS)-guided systematic biopsy (SB) was performed. MRI/TRUS fusion guided-targeted biopsy (MRI-TB) could enhance PCa detection, allowing sampling of sites at higher risk which were not obvious with TRUS alone. The aim of this systematic review and meta-analysis was to compare the detection rates of prostate cancer by MRI-TB or MRI-TB plus SB versus SB, mainly for diagnosis of high-risk PCa. Methods A literature Search was performed on PubMed, Cochrane Library, and Embase databases. We searched from inception of the databases up to January 2021. Results A total of 5831 patients from 26 studies were included in the present meta-analysis. Compared to traditional TRUS-guided biopsy, MRI-TB had a significantly higher detection rate of clinically significant PCa (RR=1.27; 95%CI 1.15-1.40; p<0.001) and high-risk PCa (RR=1.41; 95% CI 1.22-1.64; p<0.001), while the detection rate of clinically insignificant PCa was lower (RR=0.65; 95%CI 0.55-0.77; p<0.001). MRI-TB and SB did not significantly differ in the detection of overall prostate cancer (RR=1.04; 95%CI 0.95-1.12; p=0.41). Compared with SB alone, we found that MRI-TB plus SB diagnosed more cases of overall, clinically significant and high-risk PCa (p<0.001). Conclusion Compared with systematic protocols, MRI-TB detects more clinically significant and high-risk PCa cases, and fewer clinically insignificant PCa cases. MRI-TB combined with SB enhances PCa detection in contrast with either alone but did not reduce the diagnosis rate of clinically insignificant PCa. Systematic Review Registration https://www.crd.york.ac.uk/prospero/#searchadvanced, CRD42021218475.
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Affiliation(s)
- Jianfeng Xie
- Department of Ultrasound, Southern University of Science and Technology Hospital, Shenzhen, China
| | - Chunchun Jin
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Mengmeng Liu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
| | - Kun Sun
- Department of Ultrasound, Southern University of Science and Technology Hospital, Shenzhen, China
| | - Zhanqiang Jin
- Department of Ultrasound, Southern University of Science and Technology Hospital, Shenzhen, China
| | - Zhimin Ding
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
| | - Xuehao Gong
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
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Movassaghi M, Ahmed F, Patel H, Luk L, Hyams E, Wenske S, Shaish H. Association of Patient and Imaging-Related Factors with False Negative MRI-Targeted Prostate Biopsies of Suspicious PI-RADS 4 and 5 Lesions. Urology 2022; 167:165-170. [DOI: 10.1016/j.urology.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
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Görtz M, Nyarangi-Dix JN, Pursche L, Schütz V, Reimold P, Schwab C, Stenzinger A, Sültmann H, Duensing S, Schlemmer HP, Bonekamp D, Hohenfellner M, Radtke JP. Impact of Surgeon's Experience in Rigid versus Elastic MRI/TRUS-Fusion Biopsy to Detect Significant Prostate Cancer Using Targeted and Systematic Cores. Cancers (Basel) 2022; 14:cancers14040886. [PMID: 35205634 PMCID: PMC8870088 DOI: 10.3390/cancers14040886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary For the transfer of suspicious lesions in magnetic resonance imaging (MRI) to ultrasound in prostate fusion biopsy, biopsy platforms can be distinguished by rigid or elastic image registration. This study evaluates the detection rate of these different platforms for transperineal fusion-guided prostate biopsy to detect clinically significant prostate cancer under consideration of the surgeon’s learning curve. In our cohort, rigid and elastic registration systems showed a similar prostate cancer detection rate in experienced surgeons, whereas novices seem to benefit from rigid fusion. In the total cohort, targeted fusion biopsy with a rigid registration system outperformed elastic registration target biopsy with a superior significant prostate cancer detection rate, each compared to systematic saturation biopsy. Thus, rigid target biopsy aided in reducing targeting errors that result in missing MRI-visualized significant prostate cancer. These results can provide valuable decision support in selecting a biopsy fusion platform to increase the detection rate and risk stratification of prostate cancer, especially at the beginning of the surgeon’s learning curve. Abstract Multiparametric magnetic resonance imaging (mpMRI) and MRI/ultrasound fusion-targeted prostate biopsy (FB) have excellent sensitivity in detecting significant prostate cancer (sPC). FB platforms can be distinguished by rigid (RTB) or elastic image registration (ETB). We compared RTB and ETB by analyzing sPC detection rates of both RTB and ETB at different stages of the surgeons’ learning curve. Patients undergoing RTB between 2015–2017 (n = 502) were compared to patients undergoing ETB from 2017–2019 (n = 437). SPC detection rates were compared by Chi-square-test on patient-basis. Combination of transperineal systematic biopsy and each TB served as reference and sub-analyses were performed for different grades of surgeon’s experience. In the RTB subgroup, 233 men (46%) had sPC, compared to 201 (46%) in the ETB subgroup. RTB alone detected 94% of men with sPC and ETB 87% (p = 0.02). However, for at least intermediate-experienced surgeons (>100 FB), no differences occurred between RTB and ETB. In the total cohort, at least intermediate-experienced surgeons detected significantly more sPC (10%, p = 0.008) than novices. Thus, targeted transperineal MRI/TRUS-FB with a RTB registration system showed a similar sPC detection rate to ETB in experienced surgeons but a superior sPC detection rate to ETB in the total cohort. Low-experienced surgeons seem to benefit from RTB.
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Affiliation(s)
- Magdalena Görtz
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
- Helmholtz Young Investigator Group ‘Multiparametric Methods for Early Detection of Prostate Carcinoma’, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Correspondence: or ; Tel.: +49-62-2156-8820
| | - Joanne Nyaboe Nyarangi-Dix
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Lars Pursche
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Philipp Reimold
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Constantin Schwab
- Institute of Pathology, University Heidelberg, 69120 Heidelberg, Germany; (C.S.); (A.S.)
| | - Albrecht Stenzinger
- Institute of Pathology, University Heidelberg, 69120 Heidelberg, Germany; (C.S.); (A.S.)
| | - Holger Sültmann
- Division of Cancer Genome Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany;
| | - Stefan Duensing
- Section of Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, 69120 Heidelberg, Germany;
| | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.-P.S.); (D.B.)
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.-P.S.); (D.B.)
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.-P.S.); (D.B.)
- Department of Urology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany
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11
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Bazot M, Spagnoli F, Guerriero S. Magnetic resonance imaging and ultrasound fusion technique in gynecology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:141-145. [PMID: 34435404 PMCID: PMC9305114 DOI: 10.1002/uog.24754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 08/05/2021] [Accepted: 08/16/2021] [Indexed: 05/20/2023]
Affiliation(s)
- M. Bazot
- Department of Radiology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP‐HP)Sorbonne UniversityParisFrance
- Groupe de Recherche Clinique (GRC‐6), Centre Expert en Endométriose (C3E), Assistance Publique des Hôpitaux de ParisTenon University Hospital, Sorbonne UniversityParisFrance
| | - F. Spagnoli
- GE HealthcareUniversity Panthéon Sorbonne (Paris I)ParisFrance
| | - S. Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico‐Ginecologica, University of CagliariPoliclinico Universitario Duilio CasulaMonserratoCagliariItaly
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12
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Liu Y, Zheng H, Liang Z, Miao Q, Brisbane WG, Marks LS, Raman SS, Reiter RE, Yang G, Sung K. Textured-Based Deep Learning in Prostate Cancer Classification with 3T Multiparametric MRI: Comparison with PI-RADS-Based Classification. Diagnostics (Basel) 2021; 11:1785. [PMID: 34679484 PMCID: PMC8535024 DOI: 10.3390/diagnostics11101785] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022] Open
Abstract
The current standardized scheme for interpreting MRI requires a high level of expertise and exhibits a significant degree of inter-reader and intra-reader variability. An automated prostate cancer (PCa) classification can improve the ability of MRI to assess the spectrum of PCa. The purpose of the study was to evaluate the performance of a texture-based deep learning model (Textured-DL) for differentiating between clinically significant PCa (csPCa) and non-csPCa and to compare the Textured-DL with Prostate Imaging Reporting and Data System (PI-RADS)-based classification (PI-RADS-CLA), where a threshold of PI-RADS ≥ 4, representing highly suspicious lesions for csPCa, was applied. The study cohort included 402 patients (60% (n = 239) of patients for training, 10% (n = 42) for validation, and 30% (n = 121) for testing) with 3T multiparametric MRI matched with whole-mount histopathology after radical prostatectomy. For a given suspicious prostate lesion, the volumetric patches of T2-Weighted MRI and apparent diffusion coefficient images were cropped and used as the input to Textured-DL, consisting of a 3D gray-level co-occurrence matrix extractor and a CNN. PI-RADS-CLA by an expert reader served as a baseline to compare classification performance with Textured-DL in differentiating csPCa from non-csPCa. Sensitivity and specificity comparisons were performed using Mcnemar's test. Bootstrapping with 1000 samples was performed to estimate the 95% confidence interval (CI) for AUC. CIs of sensitivity and specificity were calculated by the Wald method. The Textured-DL model achieved an AUC of 0.85 (CI [0.79, 0.91]), which was significantly higher than the PI-RADS-CLA (AUC of 0.73 (CI [0.65, 0.80]); p < 0.05) for PCa classification, and the specificity was significantly different between Textured-DL and PI-RADS-CLA (0.70 (CI [0.59, 0.82]) vs. 0.47 (CI [0.35, 0.59]); p < 0.05). In sub-analyses, Textured-DL demonstrated significantly higher specificities in the peripheral zone (PZ) and solitary tumor lesions compared to the PI-RADS-CLA (0.78 (CI [0.66, 0.90]) vs. 0.42 (CI [0.28, 0.57]); 0.75 (CI [0.54, 0.96]) vs. 0.38 [0.14, 0.61]; all p values < 0.05). Moreover, Textured-DL demonstrated a high negative predictive value of 92% while maintaining a high positive predictive value of 58% among the lesions with a PI-RADS score of 3. In conclusion, the Textured-DL model was superior to the PI-RADS-CLA in the classification of PCa. In addition, Textured-DL demonstrated superior performance in the specificities for the peripheral zone and solitary tumors compared with PI-RADS-based risk assessment.
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Affiliation(s)
- Yongkai Liu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA; (H.Z.); (Q.M.); (S.S.R.); (K.S.)
- Physics and Biology in Medicine IDP, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Haoxin Zheng
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA; (H.Z.); (Q.M.); (S.S.R.); (K.S.)
| | - Zhengrong Liang
- Departments of Radiology and Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Qi Miao
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA; (H.Z.); (Q.M.); (S.S.R.); (K.S.)
| | - Wayne G. Brisbane
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA; (W.G.B.); (L.S.M.); (R.E.R.)
| | - Leonard S. Marks
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA; (W.G.B.); (L.S.M.); (R.E.R.)
| | - Steven S. Raman
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA; (H.Z.); (Q.M.); (S.S.R.); (K.S.)
| | - Robert E. Reiter
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA; (W.G.B.); (L.S.M.); (R.E.R.)
| | - Guang Yang
- National Heart and Lung Institute, Imperial College London, South Kensington, London SW7 2AZ, UK;
| | - Kyunghyun Sung
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA; (H.Z.); (Q.M.); (S.S.R.); (K.S.)
- Physics and Biology in Medicine IDP, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
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13
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Comparison of Accuracies between Real-Time Nonrigid and Rigid Registration in the MRI-US Fusion Biopsy of the Prostate. Diagnostics (Basel) 2021; 11:diagnostics11081481. [PMID: 34441415 PMCID: PMC8392836 DOI: 10.3390/diagnostics11081481] [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: 07/26/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/17/2022] Open
Abstract
Magnetic resonance imaging (MRI) is increasingly important in the detection and localization of prostate cancer. Regarding suspicious lesions on MRI, a targeted biopsy using MRI fused with ultrasound (US) is widely used. To achieve a successful targeted biopsy, a precise registration between MRI and US is essential. The purpose of our study was to show any decrease in errors using a real-time nonrigid registration technique for prostate biopsy. Nineteen patients with suspected prostate cancer were prospectively enrolled in this study. Registration accuracy was calculated by the measuring distance of corresponding points by rigid and nonrigid registration between MRI and US, and compared for rigid and nonrigid registration methods. Overall cancer detection rates were also evaluated by patient and by core. Prostate volume was measured automatically from MRI and manually from US, and compared to each other. Mean distances between the corresponding points in MRI and US were 5.32 ± 2.61 mm for rigid registration and 2.11 ± 1.37 mm for nonrigid registration (p < 0.05). Cancer was diagnosed in 11 of 19 patients (57.9%), and in 67 of 266 biopsy cores (25.2%). There was no significant difference in prostate-volume measurement between the automatic and manual methods (p = 0.89). In conclusion, nonrigid registration reduces targeting errors.
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Sokolakis I, Pyrgidis N, Koneval L, Krebs M, Thurner A, Kübler H, Hatzichristodoulou G. Usability and diagnostic accuracy of different MRI/ultrasound-guided fusion biopsy systems for the detection of clinically significant and insignificant prostate cancer: a prospective cohort study. World J Urol 2021; 39:4101-4108. [PMID: 34142231 DOI: 10.1007/s00345-021-03761-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/10/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To explore the usability and diagnostic accuracy for prostate cancer of three multiparametric magnetic resonance imaging (mpMRI)/transrectal ultrasound (TRUS)-guided fusion biopsy systems operated by the same urologists. METHODS We performed a prospective, observational study including patients that underwent prostate biopsy due to a visible lesion in mpMRI (PI-RADS ≥ 3). We consecutively assessed two platforms with a rigid image registration (BioJet, D&K Technologies and UroNav, Invivo Corporation) and one with an elastic registration (Trinity, KOELIS). Four urologists evaluated each fusion system in terms of usability based on the System Usability Scale and diagnostic accuracy based on the detection of prostate cancer. RESULTS We enrolled 60 consecutive patients that received mpMRI/TRUS-guided prostate biopsy with the BioJet (n = 20), UroNav (n = 20) or Trinity (n = 20) fusion system. Comparing the rigid with the elastic registration systems, the rigid registration systems were more user-friendly compared to the elastic registration systems (p = 0.012). Similarly, the prostate biopsy with the rigid registration systems had a shorter duration compared to the elastic registration system (p < 0.001). Overall, 40 cases of prostate cancer were detected. Of them, both the BioJet and UroNav fusion systems detected 13 prostate cancer cases, while the Trinity detected 14. No significant differences were demonstrated among the three fusion biopsy systems in terms of highest ISUP Grade Group (p > 0.99). CONCLUSIONS Rigid fusion biopsy systems are easier to use and provide shorter operative time compared to elastic systems, while both types of platforms display similar detection rates for prostate cancer. Still, further high-quality, long-term results are mandatory.
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Affiliation(s)
- Ioannis Sokolakis
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany. .,Department of Urology, Martha-Maria Hospital Nuremberg, Stadenstraße 58, 90491, Nuremberg, Germany.
| | - Nikolaos Pyrgidis
- Department of Urology, Martha-Maria Hospital Nuremberg, Stadenstraße 58, 90491, Nuremberg, Germany
| | - Lukas Koneval
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Markus Krebs
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Annette Thurner
- Department of Diagnostic and Interventional Radiology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Hubert Kübler
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Georgios Hatzichristodoulou
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany.,Department of Urology, Martha-Maria Hospital Nuremberg, Stadenstraße 58, 90491, Nuremberg, Germany
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15
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Impact of the Number of Cores on the Prostate Cancer Detection Rate in Men Undergoing in-Bore Magnetic Resonance Imaging-Guided Targeted Biopsies. J Comput Assist Tomogr 2021; 45:203-209. [PMID: 33273160 DOI: 10.1097/rct.0000000000001115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the incremental detection rate of clinically significant prostate cancer (csPCa) provided by sequential cores during in-bore magnetic resonance imaging (MRI)-guided prostate biopsies. METHODS Single-center, retrospective interpretation of prospectively acquired data in men without previous diagnosis of csPCa who underwent in-bore MRI-guided prostate biopsy between May 2017 and December 2019. Endpoints included detection of csPCa (grade group [GG] ≥ 2) and rate of GG upgrade provided by additional cores. Descriptive statistics presented as mean and standard deviation for the continuous variables, and frequency and percentage for the categorical variables. RESULTS Four hundred and forty-three men with 747 lesions met eligibility criteria. Clinically significant prostate cancer was detected in 43.1% (322/747) of the biopsied lesions and GG 2 PCa or greater was identified by the first core in 78.3% (252/322) of them. On a per-core basis, cores 2, 3, 4, and 5 found new csPCa in 6% (42/744), 4% (26/719), 1% (2/137), and 0% (0/11) of the cases. Core biopsy 2, 3, 4, and 5 resulted in GG upgrade in 12% (91/744), 7% (49/719), 7% (9/137), and 0% (0/11) of the lesions, respectively. Each additional core was associated with a mean increase of 5 minutes in the duration of the biopsy. CONCLUSIONS In men undergoing in-bore MRI-guided prostate biopsies, 3 targeted cores per lesion provide an optimal trade-off between detection of clinically significant tumors and biopsy duration.
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16
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Costa DN, Cai Q, Xi Y, Recchimuzzi DZ, Subramanian N, Bagrodia A, Rofsky NM, Roehrborn CG, Hornberger B, Shah RB, Goldberg K, Diaz de Leon A, Pedrosa I. Gleason Grade Group Concordance between Preoperative Targeted Biopsy and Radical Prostatectomy Histopathologic Analysis: A Comparison Between In-Bore MRI-guided and MRI-Transrectal US Fusion Prostate Biopsies. Radiol Imaging Cancer 2021; 3:e200123. [PMID: 33817652 PMCID: PMC8011452 DOI: 10.1148/rycan.2021200123] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/02/2020] [Accepted: 01/04/2021] [Indexed: 11/11/2022]
Abstract
Purpose To determine and compare rates of grade group (GG) discrepancies between different targeted biopsy techniques (in-bore vs fusion) after propensity score weighting using whole-mount radical prostatectomy (RP) histopathologic analysis as the reference standard. Materials and Methods This retrospective study evaluated men who underwent targeted (fusion or in-bore) biopsy between April 2017 and January 2019 followed by prostatectomy. The primary endpoint of the study was a change in GG from biopsy to RP at a patient level. For downgrade and upgrade analysis, men with biopsy GG1 (downgrade not possible) and GG5 (upgrade not possible) were excluded, respectively. GG upgrade, downgrade, and concordance rates of each targeting approach were compared using propensity score weighting and logistic regression with inverse probability of treatment weighting. Significance level was set at .05. Index lesion GG on RP specimen served as the reference standard. Results A total of 191 men (90 in the in-bore [mean age, 63 years ± 7 (standard deviation)] and 101 in the fusion biopsy group [mean age, 65 years ± 7]) were eligible and included. Fewer GG upgrades were noted in the in-bore biopsy group (14%; 12 of 85) compared with the fusion plus systematic biopsy group (30%; 28 of 93) (P = .012). The incidence of GG downgrade in the in-bore group (25%; 21 of 84) was higher than in the fusion group (17%; 16 of 93); however, the difference was not statistically significant (P = .2). Of the 77 men misclassified by both biopsy techniques, the majority (56%, n = 43) had a change in GG of 2 to 3 or 3 to 2. Conclusion Superior sampling accuracy with MRI-guided in-bore biopsies offers a lower incidence of GG upgrades compared with MRI-transrectal US fusion biopsies upon RP.Keywords: Biopsy/Needle Aspiration, MR-Imaging, Oncology, Pathology, Prostate Supplemental material is available for this article.© RSNA, 2021.
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Affiliation(s)
- Daniel N. Costa
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Qi Cai
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Yin Xi
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Debora Z. Recchimuzzi
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Naveen Subramanian
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Aditya Bagrodia
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Neil M. Rofsky
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Claus G. Roehrborn
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Brad Hornberger
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Rajal B. Shah
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Kenneth Goldberg
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Alberto Diaz de Leon
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
| | - Ivan Pedrosa
- From the Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390
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17
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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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18
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Abbasi AA, Hussain L, Awan IA, Abbasi I, Majid A, Nadeem MSA, Chaudhary QA. Detecting prostate cancer using deep learning convolution neural network with transfer learning approach. Cogn Neurodyn 2020; 14:523-533. [PMID: 32655715 PMCID: PMC7334337 DOI: 10.1007/s11571-020-09587-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 01/24/2020] [Accepted: 03/27/2020] [Indexed: 01/20/2023] Open
Abstract
Prostate Cancer in men has become one of the most diagnosed cancer and also one of the leading causes of death in United States of America. Radiologists cannot detect prostate cancer properly because of complexity in masses. In recent past, many prostate cancer detection techniques were developed but these could not diagnose cancer efficiently. In this research work, robust deep learning convolutional neural network (CNN) is employed, using transfer learning approach. Results are compared with various machine learning strategies (Decision Tree, SVM different kernels, Bayes). Cancer MRI database are used to train GoogleNet model and to train Machine Learning classifiers, various features such as Morphological, Entropy based, Texture, SIFT (Scale Invariant Feature Transform), and Elliptic Fourier Descriptors are extracted. For the purpose of performance evaluation, various performance measures such as specificity, sensitivity, Positive predictive value, negative predictive value, false positive rate and receive operating curve are calculated. The maximum performance was found with CNN model (GoogleNet), using Transfer learning approach. We have obtained reasonably good results with various Machine Learning Classifiers such as Decision Tree, Support Vector Machine RBF kernel and Bayes, however outstanding results were obtained by using deep learning technique.
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Affiliation(s)
- Adeel Ahmed Abbasi
- Department of Computer Science and IT, The University of Azad Jammu and Kashmir, City Campus, Muzaffarabad, 13100 Pakistan
| | - Lal Hussain
- Department of Computer Science and IT, The University of Azad Jammu and Kashmir, City Campus, Muzaffarabad, 13100 Pakistan
| | - Imtiaz Ahmed Awan
- Department of Computer Science and IT, The University of Azad Jammu and Kashmir, City Campus, Muzaffarabad, 13100 Pakistan
| | - Imran Abbasi
- Department of Computer Science and IT, The University of Azad Jammu and Kashmir, City Campus, Muzaffarabad, 13100 Pakistan
| | - Abdul Majid
- Department of Computer Science and IT, The University of Azad Jammu and Kashmir, City Campus, Muzaffarabad, 13100 Pakistan
| | - Malik Sajjad Ahmed Nadeem
- Department of Computer Science and IT, The University of Azad Jammu and Kashmir, City Campus, Muzaffarabad, 13100 Pakistan
| | - Quratul-Ain Chaudhary
- Department of Computer Science and IT, The University of Azad Jammu and Kashmir, City Campus, Muzaffarabad, 13100 Pakistan
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Labra A, González F, Silva C, Franz G, Pinochet R, Gupta RT. MRI/TRUS fusion vs. systematic biopsy: intra-patient comparison of diagnostic accuracy for prostate cancer using PI-RADS v2. Abdom Radiol (NY) 2020; 45:2235-2243. [PMID: 32249349 DOI: 10.1007/s00261-020-02481-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the efficacy of multiparametric magnetic resonance/transrectal ultrasound fusion (MRI/TRUS fusion) biopsy versus systematic biopsy and its association with PI-RADS v2 categories in patients with suspected prostate cancer. MATERIALS AND METHODS 122 patients undergoing both MRI/TRUS fusion and systematic biopsy, with suspicion of prostate cancer, with suspicious findings on MRI based on PI-RADS v2, were included between April 2016 and March 2017. Comparison of tumor detection rates using each technique and combined techniques was performed for all lesions as well as those that are traditionally difficult to access (i.e., anterior lesions). RESULTS Prostate cancer was detected in 83/122 patients (68%) with 74.6% clinically significant lesions (Gleason 3 + 4 or greater). There was a statistically significant difference in presence of clinically significant prostate cancer in PI-RADS v2 categories of 3, 4, and 5 (20%, 52% and 77%, respectively, p < 0.001). Fusion biopsy was positive in a significantly higher percentage of patients versus systematic biopsy (56% versus 48%, respectively, p < 0.05). The fusion biopsy alone was positive in 20%. Of 34 patients with anterior lesions on MRI, 44% were detected only by fusion biopsy, with a joint yield of 71%. In patients with previous negative systematic biopsies, 48.7% lesions were found by fusion biopsy with 20.5% being exclusively positive by this method. The percentage of positive cores for fusion biopsies was significantly higher than for systematic biopsies (26% vs. 12.3%, p < 0.001). CONCLUSION The incorporation of MRI/TRUS fusion biopsy significantly improves the detection rate of prostate cancer versus systematic biopsy, particularly for anterior lesions.
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Affiliation(s)
- Andrés Labra
- Universidad del Desarrollo, Servicio de Radiologia, Facultad de Medicina Clínica Alemana De Santiago, 5951 Vitacura, 9160002, Santiago, Chile
| | - Fernando González
- Universidad del Desarrollo, Servicio de Radiologia, Facultad de Medicina Clínica Alemana De Santiago, 5951 Vitacura, 9160002, Santiago, Chile
- Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC, 27710, USA
| | - Claudio Silva
- Universidad del Desarrollo, Servicio de Radiologia, Facultad de Medicina Clínica Alemana De Santiago, 5951 Vitacura, 9160002, Santiago, Chile
| | - Gerhard Franz
- Universidad del Desarrollo, Servicio de Radiologia, Facultad de Medicina Clínica Alemana De Santiago, 5951 Vitacura, 9160002, Santiago, Chile
| | - Rodrigo Pinochet
- Department of Surgery, Division of Urology, Clínica Alemana de Santiago, 5951 Vitacura, 9160002, Santiago, Chile
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC, 27710, USA.
- Duke Cancer Institute Center for Prostate and Urologic Cancers, 20 Duke Medicine Circle, DUMC Box 103861, Durham, NC, 27710, USA.
- Department of Surgery, Division of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, DUMC Box 2804, Durham, NC, 27710, USA.
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Medina-González A, Eiró-Díaz N, Fernández-Gómez J, Ovidio-González L, Jalón-Monzón A, Casas-Nebra J, Escaf-Barmadah S. Comparative analysis of the expression of metalloproteases (MMP-2, MMP-9, MMP-11 and MMP-13) and the tissue inhibitor of metalloprotease 3 (TIMP-3) between previous negative biopsies and radical prostatectomies. Actas Urol Esp 2020; 44:78-85. [PMID: 31899007 DOI: 10.1016/j.acuro.2019.10.004] [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: 04/09/2019] [Revised: 09/18/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
Metalloproteases (MMPs) and tissue inhibitor of metalloprotease-3 (TIMP-3) have been associated to the risk of having cancer and tumor aggressiveness. When facing the difficulties of prostate cancer diagnosis, the expression of MMPs and TIMP-3 in negative biopsies could be helpful to evaluate a diagnostic suspicion. Our objective is to carry out a comparative study of the expression of MMPs and TIMP-3 in previous negative biopsies and radical prostatectomies (RP). MATERIAL AND METHODS Retrospective analysis of a hospital-based cohort including 21 patients with suspicion of prostate carcinoma, whose expressions of MMP-2, 9, 11 and 13 and TIMP-3 were evaluated by immunohistochemistry in the tumor area from previous negative biopsies and RP. RESULTS Immunohistochemical staining values (Score) for MMPs (-11 and -13) and TIMP-3 showed no significant differences when comparing the areas of negative biopsies where tumors subsequently developed with those of the RP. However, we did observe a significant difference in the increased expression of MMP-2 (P=.002) and MMP-9 (P=.001) in the tumor area of the RP with respect to the corresponding area of the previous negative biopsy. CONCLUSIONS Our data indicate a higher overall expression of MMP-2 and MMP-9 in the tumor area of the RP compared to the corresponding areas of the negative previous biopsy, which seems to be associated to the process of malignant transformation.
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Hamm CA, Beetz NL, Savic LJ, Penzkofer T. [Artificial intelligence and radiomics in MRI-based prostate diagnostics]. Radiologe 2020; 60:48-55. [PMID: 31802148 DOI: 10.1007/s00117-019-00613-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CLINICAL/METHODICAL ISSUE In view of the diagnostic complexity and the large number of examinations, modern radiology is challenged to identify clinically significant prostate cancer (PCa) with high sensitivity and specificity. Meanwhile overdiagnosis and overtreatment of clinically nonsignificant carcinomas need to be avoided. STANDARD RADIOLOGICAL METHODS Increasingly, international guidelines recommend multiparametric magnetic resonance imaging (mpMRI) as first-line investigation in patients with suspected PCa. METHODICAL INNOVATIONS Image interpretation according to the PI-RADS criteria is limited by interobserver variability. Thus, rapid developments in the field of automated image analysis tools, including radiomics and artificial intelligence (AI; machine learning, deep learning), give hope for further improvement in patient care. PERFORMANCE AI focuses on the automated detection and classification of PCa, but it also attempts to stratify tumor aggressiveness according to the Gleason score. Recent studies present good to very good results in radiomics or AI-supported mpMRI diagnosis. Nevertheless, these systems are not widely used in clinical practice. ACHIEVEMENTS AND PRACTICAL RECOMMENDATIONS In order to apply these innovative technologies, a growing awareness for the need of structured data acquisition, development of robust systems and an increased acceptance of AI as diagnostic support are needed. If AI overcomes these obstacles, it may play a key role in the quantitative and reproducible image-based diagnosis of ever-increasing prostate MRI examination volumes.
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Affiliation(s)
- Charlie Alexander Hamm
- Institute of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Nick Lasse Beetz
- Institute of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Lynn Jeanette Savic
- Institute of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Tobias Penzkofer
- Institute of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Deutschland. .,Berlin Institute of Health, 10178, Berlin, Deutschland.
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22
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Advances of Zinc Signaling Studies in Prostate Cancer. Int J Mol Sci 2020; 21:ijms21020667. [PMID: 31963946 PMCID: PMC7014440 DOI: 10.3390/ijms21020667] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 12/16/2022] Open
Abstract
Prostate cancer (PCa) is one of the most common cancers and the second leading cause of cancer-related death among men worldwide. Despite progresses in early diagnosis and therapeutic strategies, prognosis for patients with advanced PCa remains poor. Noteworthily, a unique feature of healthy prostate is its highest level of zinc content among all soft tissues in the human body, which dramatically decreases during prostate tumorigenesis. To date, several reviews have suggested antitumor activities of zinc and its potential as a therapeutic strategy of PCa. However, an overview about the role of zinc and its signaling in PCa is needed. Here, we review literature related to the content, biological function, compounds and clinical application of zinc in PCa. We first summarize zinc content in prostate tissue and sera of PCa patients with their clinical relevance. We then elaborate biological functions of zinc signaling in PCa on three main aspects, including cell proliferation, death and tumor metastasis. Finally, we discuss clinical applications of zinc-containing compounds and proteins involved in PCa signaling pathways. Based on currently available studies, we conclude that zinc plays a tumor suppressive role and can serve as a biomarker in PCa diagnosis and therapies.
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Giganti F, Rosenkrantz AB, Villeirs G, Panebianco V, Stabile A, Emberton M, Moore CM. The Evolution of MRI of the Prostate: The Past, the Present, and the Future. AJR Am J Roentgenol 2019; 213:384-396. [PMID: 31039022 DOI: 10.2214/ajr.18.20796] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE. The purpose of this article is to discuss the evolution of MRI in prostate cancer from the early 1980s to the current day, providing analysis of the key studies on this topic. CONCLUSION. The rapid diffusion of MRI technology has meant that residual variability remains between centers regarding the quality of acquisition and the quality and standardization of reporting.
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Affiliation(s)
- Francesco Giganti
- 1 Department of Radiology, University College London Hospital NHS Foundation Trust, London, United Kingdom
- 2 Division of Surgery and Interventional Science, University College London, 3rd Fl, Charles Bell House, 43-45 Foley St, London W1W 7TS, United Kingdom
| | | | - Geert Villeirs
- 4 Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Valeria Panebianco
- 5 Department of Radiological Sciences, Oncology, and Pathology, Sapienza University of Rome, Rome, Italy
| | - Armando Stabile
- 2 Division of Surgery and Interventional Science, University College London, 3rd Fl, Charles Bell House, 43-45 Foley St, London W1W 7TS, United Kingdom
- 6 Department of Urology, Division of Experiemental Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Mark Emberton
- 2 Division of Surgery and Interventional Science, University College London, 3rd Fl, Charles Bell House, 43-45 Foley St, London W1W 7TS, United Kingdom
- 7 Department of Urology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Caroline M Moore
- 2 Division of Surgery and Interventional Science, University College London, 3rd Fl, Charles Bell House, 43-45 Foley St, London W1W 7TS, United Kingdom
- 7 Department of Urology, University College London Hospital NHS Foundation Trust, London, United Kingdom
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Magnetic Resonance Imaging–guided In-bore and Magnetic Resonance Imaging-transrectal Ultrasound Fusion Targeted Prostate Biopsies: An Adjusted Comparison of Clinically Significant Prostate Cancer Detection Rate. Eur Urol Oncol 2019; 2:397-404. [DOI: 10.1016/j.euo.2018.08.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/19/2018] [Accepted: 08/25/2018] [Indexed: 11/13/2022]
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Harmon SA, Tuncer S, Sanford T, Choyke PL, Türkbey B. Artificial intelligence at the intersection of pathology and radiology in prostate cancer. Diagn Interv Radiol 2019; 25:183-188. [PMID: 31063138 PMCID: PMC6521904 DOI: 10.5152/dir.2019.19125] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 03/08/2019] [Accepted: 03/23/2019] [Indexed: 01/30/2023]
Abstract
Pathologic grading plays a key role in prostate cancer risk stratification and treatment selection, traditionally assessed from systemic core needle biopsies sampled throughout the prostate gland. Multiparametric magnetic resonance imaging (mpMRI) has become a well-established clinical tool for detecting and localizing prostate cancer. However, both pathologic and radiologic assessment suffer from poor reproducibility among readers. Artificial intelligence (AI) methods show promise in aiding the detection and assessment of imaging-based tasks, dependent on the curation of high-quality training sets. This review provides an overview of recent advances in AI applied to mpMRI and digital pathology in prostate cancer which enable advanced characterization of disease through combined radiology-pathology assessment.
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Affiliation(s)
- Stephanie A. Harmon
- From the Clinical Research Directorate (S.A.H. ), Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA; Molecular Imaging Program (S.A.H.,T.S., P.L.C., B.T.), National Cancer Institute, NIH, Bethesda, MD, USA; Department of Radiology (S.T.), İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Sena Tuncer
- From the Clinical Research Directorate (S.A.H. ), Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA; Molecular Imaging Program (S.A.H.,T.S., P.L.C., B.T.), National Cancer Institute, NIH, Bethesda, MD, USA; Department of Radiology (S.T.), İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Thomas Sanford
- From the Clinical Research Directorate (S.A.H. ), Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA; Molecular Imaging Program (S.A.H.,T.S., P.L.C., B.T.), National Cancer Institute, NIH, Bethesda, MD, USA; Department of Radiology (S.T.), İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Peter L. Choyke
- From the Clinical Research Directorate (S.A.H. ), Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA; Molecular Imaging Program (S.A.H.,T.S., P.L.C., B.T.), National Cancer Institute, NIH, Bethesda, MD, USA; Department of Radiology (S.T.), İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Barış Türkbey
- From the Clinical Research Directorate (S.A.H. ), Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA; Molecular Imaging Program (S.A.H.,T.S., P.L.C., B.T.), National Cancer Institute, NIH, Bethesda, MD, USA; Department of Radiology (S.T.), İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
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Display colour scale effects on diagnostic performance and reader agreement in cardiac CT and prostate apparent diffusion coefficient assessment. Clin Radiol 2019; 74:79.e1-79.e9. [DOI: 10.1016/j.crad.2018.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/30/2018] [Indexed: 11/21/2022]
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Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol 2018; 20:100-109. [PMID: 30470502 DOI: 10.1016/s1470-2045(18)30569-2] [Citation(s) in RCA: 663] [Impact Index Per Article: 110.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Whether multiparametric MRI improves the detection of clinically significant prostate cancer and avoids the need for systematic biopsy in biopsy-naive patients remains controversial. We aimed to investigate whether using this approach before biopsy would improve detection of clinically significant prostate cancer in biopsy-naive patients. METHODS In this prospective, multicentre, paired diagnostic study, done at 16 centres in France, we enrolled patients aged 18-75 years with prostate-specific antigen concentrations of 20 ng/mL or less, and with stage T2c or lower prostate cancer. Eligible patients had been referred for prostate multiparametric MRI before a first set of prostate biopsies, with a planned interval of less than 3 months between MRI and biopsies. An operator masked to multiparametric MRI results did a systematic biopsy by obtaining 12 systematic cores and up to two cores targeting hypoechoic lesions. In the same patient, another operator targeted up to two lesions seen on MRI with a Likert score of 3 or higher (three cores per lesion) using targeted biopsy based on multiparametric MRI findings. Patients with negative multiparametric MRI (Likert score ≤2) had systematic biopsy only. The primary outcome was the detection of clinically significant prostate cancer of International Society of Urological Pathology grade group 2 or higher (csPCa-A), analysed in all patients who received both systematic and targeted biopsies and whose results from both were available for pathological central review, including patients who had protocol deviations. This study is registered with ClinicalTrials.gov, number NCT02485379, and is closed to new participants. FINDINGS Between July 15, 2015, and Aug 11, 2016, we enrolled 275 patients. 24 (9%) were excluded from the analysis. 53 (21%) of 251 analysed patients had negative (Likert ≤2) multiparametric MRI. csPCa-A was detected in 94 (37%) of 251 patients. 13 (14%) of these 94 patients were diagnosed by systematic biopsy only, 19 (20%) by targeted biopsy only, and 62 (66%) by both techniques. Detection of csPCa-A by systematic biopsy (29·9%, 95% CI 24·3-36·0) and targeted biopsy (32·3%, 26·5-38·4) did not differ significantly (p=0·38). csPCa-A would have been missed in 5·2% (95% CI 2·8-8·7) of patients had systematic biopsy not been done, and in 7·6% (4·6-11·6) of patients had targeted biopsy not been done. Four grade 3 post-biopsy adverse events were reported (3 cases of prostatitis, and 1 case of urinary retention with haematuria). INTERPRETATION There was no difference between systematic biopsy and targeted biopsy in the detection of ISUP grade group 2 or higher prostate cancer; however, this detection was improved by combining both techniques and both techniques showed substantial added value. Thus, obtaining a multiparametric MRI before biopsy in biopsy-naive patients can improve the detection of clinically significant prostate cancer but does not seem to avoid the need for systematic biopsy. FUNDING French National Cancer Institute.
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Tae JH, Shim JS, Jin HJ, Yoon SG, No TI, Kim JY, Kang SH, Cheon J, Kang SG. Initial experience of magnetic resonance imaging/ultrasonography fusion transperineal biopsy: Biopsy techniques and results for 75 patients. Investig Clin Urol 2018; 59:363-370. [PMID: 30402568 PMCID: PMC6215777 DOI: 10.4111/icu.2018.59.6.363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/19/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose The aim of this study is to describe the technique and to report early results of transperineal magnetic resonance imaging and ultrasonography (MRI-US) fusion biopsy. Materials and Methods A total of 75 patients underwent MRI-US fusion transperineal biopsy. Targeted biopsy via MRI-US fusion imaging was carried out for cancer-suspicious lesions with additional systematic biopsy. Detection rates for overall and clinically significant prostate cancer (csPCa) were evaluated and compared between systematic and targeted biopsy. In addition, further investigation into the detection rate according to prostate imaging reporting and data system (PI-RADS) score was done. Results of repeat biopsies were also evaluated. Results Overall cancer detection rate was 61.3% (46 patients) and the detection rate for csPCa was 42.7% (32 patients). Overall detection rates for systematic and targeted biopsy were 41.3% and 57.3% (p<0.05), respectively. Detection rates for csPCa were 26.7% and 41.3%, respectively (p<0.05). The cancer detection rates via MRI fusion target biopsy were 30.8% in PI-RADS 3, 62.1% in PI-RADS 4 and 89.4% in PI-RADS 5. Rates of csPCa missed by targeted biopsy and systematic biopsy were 0.0% and 25.0%, respectively. The cancer detection rate in repeat biopsies was 61.1% (11 among 18 patients) in which 55.5% of cancer suspected lesions were located in the anterior portion. Conclusions Transperineal MRI-US fusion biopsy is useful for improving overall cancer detection rate and especially detection of csPCa. Transperineal MRI-US targeted biopsy show potential benefits to improve cancer detection rate in patients with high PI-RADS score, tumor located at the anterior portion and in repeat biopsies.
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Affiliation(s)
- Jong Hyun Tae
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Ji Sung Shim
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Hyun Jung Jin
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Sung Goo Yoon
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Tae Il No
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Jae Yoon Kim
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Jun Cheon
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
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Zhang Z, Xu H, Xue Y, Li J, Ye Q. Risk Stratification of Prostate Cancer Using the Combination of Histogram Analysis of Apparent Diffusion Coefficient Across Tumor Diffusion Volume and Clinical Information: A Pilot Study. J Magn Reson Imaging 2018; 49:556-564. [PMID: 30173421 DOI: 10.1002/jmri.26235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/06/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The effectiveness of quantitative MRI and clinical information in the risk stratification of prostate cancer (PCa) patients was evaluated separately in previous research; however, the differentiation power of combining quantitative MRI and clinical information has yet to be investigated. PURPOSE To investigate the power of combining histogram analysis of apparent diffusion coefficient (ADC) of tumor diffusion volume (tDv) with clinical information for the differentiation of low-grade (Gleason score [GS] ≤6) and high-grade (GS ≥7) PCa. STUDY TYPE Retrospective. POPULATION Fifty-nine PCa patients who underwent preoperative diffusion-weighted imaging (DWI) (acquired with b = 0, 1000 mm2 /s) and followed by radical prostatectomy within 6 months. SEQUENCES T2 -weighted, DWI, and ADC images at 3.0T. ASSESSMENT tDv defined with different ADC thresholds were analyzed for each patient and combined with age and prostate-specific antigen (PSA) level. Binary logistic regression with backward feature selection was applied to determine the best discrimination and corresponding combination of parameters. STATISTICAL TESTS Kolmogorov-Smirnov test; independent samples t-test; Mann-Whitney U-test; Spearman's rank correlation; receiver operating characteristic (ROC) analysis; binary logistical regression. RESULTS PSA and the 10th percentile ADC value of tDv defined with different diffusion thresholds were significantly different between low-grade and high-grade PCa groups (P < 0.05 for all). Median ADC of tDv based on a threshold of 1.008 × 10-3 mm2 /s exhibited the best performance (AUC = 0.86, 95% confidence interval [CI]: 0.75-0.94), whereas binary logistic regression with backward feature selection achieved 97.20% accuracy with AUC = 0.978 (95% CI: 0.929-0.997). DATA CONCLUSION The discriminatory power of a single histogram variable of ADC in tDv was not significantly superior to that of a single clinical parameter. The combination of histogram analysis of ADC of tDv and clinical information using logistic regression might significantly improve the risk stratification of PCa and achieve reasonably high accuracy. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:556-564.
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Affiliation(s)
- Zhao Zhang
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, ZheJiang Province, P.R. China
| | - Huazhi Xu
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, ZheJiang Province, P.R. China
| | - Yingnan Xue
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, ZheJiang Province, P.R. China
| | - Jiance Li
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, ZheJiang Province, P.R. China
| | - Qiong Ye
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, ZheJiang Province, P.R. China
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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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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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Improved Magnetic Resonance Imaging-Pathology Correlation With Imaging-Derived, 3D-Printed, Patient-Specific Whole-Mount Molds of the Prostate. Invest Radiol 2018; 52:507-513. [PMID: 28379863 DOI: 10.1097/rli.0000000000000372] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to compare the anatomical registration of preoperative magnetic resonance imaging (MRI) and prostate whole-mount obtained with 3D-printed, patient-specific, MRI-derived molds (PSM) versus conventional whole-mount sectioning (WMS). MATERIALS AND METHODS Based on an a priori power analysis, this institutional review board-approved study prospectively included 50 consecutive men who underwent 3 T multiparametric prostate MRI followed by radical prostatectomy. Two blinded and independent readers (R1 and R2) outlined the contours of the prostate, tumor, peripheral, and transition zones in the MRI scans using regions of interest. These were compared with the corresponding regions of interest from the whole-mounted histopathology, the reference standard, using PSM whole-mount results obtained in the study group (n = 25) or conventional WMS in the control group (n = 25). The spatial overlap across the MRI and histology data sets was calculated using the Dice similarity coefficient (DSC) for the prostate overall (DSCprostate), tumor (DSCtumor), peripheral (DSCPZ), and transition (DSCTZ) zone. Results in the study and control groups were compared using Wilcoxon rank sum test. RESULTS The MRI histopathology anatomical registration for the prostate gland overall, tumor, peripheral, and transition zones were significantly superior with the use of PSMs (DSCs for R1: 0.95, 0.86, 0.84, and 0.89; for R2: 0.93, 0.75, 0.78, and 0.85, respectively) than with the use of standard WMS (R1: 0.85, 0.46, 0.66, and 0.69; R2: 0.85, 0.46, 0.66, and 0.69) (P < 0.0001). CONCLUSIONS The use of PSMs for prostate specimen whole-mount sectioning provides significantly superior anatomical registration of in vivo multiparametric MRI and ex vivo prostate whole-mounts than conventional WMS.
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Eiber M, Herrmann K, Calais J, Hadaschik B, Giesel FL, Hartenbach M, Hope T, Reiter R, Maurer T, Weber WA, Fendler WP. Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE): Proposed miTNM Classification for the Interpretation of PSMA-Ligand PET/CT. J Nucl Med 2017; 59:469-478. [PMID: 29123012 DOI: 10.2967/jnumed.117.198119] [Citation(s) in RCA: 335] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/05/2017] [Indexed: 11/16/2022] Open
Abstract
Prostate-specific membrane antigen (PSMA)-ligand PET imaging provides unprecedented accuracy for whole-body staging of prostate cancer. As PSMA-ligand PET/CT is increasingly adopted in clinical trials and routine practice worldwide, a unified language for image reporting is urgently needed. We propose a molecular imaging TNM system (miTNM, version 1.0) as a standardized reporting framework for PSMA-ligand PET/CT or PET/MRI. miTNM is designed to organize findings in comprehensible categories to promote the exchange of information among physicians and institutions. Additionally, flowcharts integrating findings of PSMA-ligand PET and morphologic imaging have been designed to guide image interpretation. Specific applications, such as assessment of prognosis or impact on management, should be evaluated in future trials. miTNM is a living framework that evolves with clinical experience and scientific data.
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Affiliation(s)
- Matthias Eiber
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ken Herrmann
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.,Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen, Germany
| | - Jeremie Calais
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Boris Hadaschik
- Department of Urology, Universitätsklinikum Essen, Essen, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg and DKFZ Heidelberg, Heidelberg, Germany
| | - Markus Hartenbach
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Robert Reiter
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Tobias Maurer
- Department of Urology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wolfgang A Weber
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Wolfgang P Fendler
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California .,Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
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Li J, Weng Z, Xu H, Zhang Z, Miao H, Chen W, Liu Z, Zhang X, Wang M, Xu X, Ye Q. Support Vector Machines (SVM) classification of prostate cancer Gleason score in central gland using multiparametric magnetic resonance images: A cross-validated study. Eur J Radiol 2017; 98:61-67. [PMID: 29279171 DOI: 10.1016/j.ejrad.2017.11.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/02/2017] [Accepted: 11/04/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE To assess the performance of Support Vector Machines (SVM) classification to stratify the Gleason Score (GS) of prostate cancer (PCa) in the central gland (CG) based on image features across multiparametric magnetic resonance imaging (mpMRI). MATERIALS AND METHODS This retrospective study was approved by the institutional review board, and informed consent was waived. One hundred fifty-two CG cancerous ROIs were identified through radiological-pathological correlation. Eleven parameters were derived from the mpMRI and histogram analysis, including mean, median, the 10th percentile, skewness and kurtosis, was performed for each parameter. In total, fifty-five variables were calculated and processed in the SVM classification. The classification model was developed with 10-fold cross-validation and was further validated mutually across two separated datasets. RESULTS With six variables selected by a feature-selection and variation test, the prediction model yielded an area under the receiver operating characteristics curve (AUC) of 0.99 (95% CI: 0.98, 1.00) when trained in dataset A2 and 0.91 (95% CI: 0.85, 0.95) for the validation in dataset B2. When the data sets were reversed, an AUC of 0.99 (95% CI: 0.99, 1.00) was obtained when the model was trained in dataset B2 and 0.90 (95% CI: 0.85, 0.95) for the validation in dataset A2. CONCLUSION The SVM classification based on mpMRI derived image features obtains consistently accurate classification of the GS of PCa in the CG.
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Affiliation(s)
- Jiance Li
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, PR China
| | - Zhiliang Weng
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, PR China
| | - Huazhi Xu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, PR China
| | - Zhao Zhang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, PR China
| | - Haiwei Miao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, PR China
| | - Wei Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, PR China
| | - Zheng Liu
- ICSC World Laboratory, Geneva, Switzerland
| | - Xiaoqin Zhang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, PR China
| | - Meihao Wang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, PR China
| | | | - Qiong Ye
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, PR China.
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Lay N, Tsehay Y, Greer MD, Turkbey B, Kwak JT, Choyke PL, Pinto P, Wood BJ, Summers RM. Detection of prostate cancer in multiparametric MRI using random forest with instance weighting. J Med Imaging (Bellingham) 2017. [PMID: 28630883 DOI: 10.1117/1.jmi.4.2.024506] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A prostate computer-aided diagnosis (CAD) based on random forest to detect prostate cancer using a combination of spatial, intensity, and texture features extracted from three sequences, T2W, ADC, and B2000 images, is proposed. The random forest training considers instance-level weighting for equal treatment of small and large cancerous lesions as well as small and large prostate backgrounds. Two other approaches, based on an AutoContext pipeline intended to make better use of sequence-specific patterns, were considered. One pipeline uses random forest on individual sequences while the other uses an image filter described to produce probability map-like images. These were compared to a previously published CAD approach based on support vector machine (SVM) evaluated on the same data. The random forest, features, sampling strategy, and instance-level weighting improve prostate cancer detection performance [area under the curve (AUC) 0.93] in comparison to SVM (AUC 0.86) on the same test data. Using a simple image filtering technique as a first-stage detector to highlight likely regions of prostate cancer helps with learning stability over using a learning-based approach owing to visibility and ambiguity of annotations in each sequence.
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Affiliation(s)
- Nathan Lay
- National Institutes of Health, Clinical Center, Imaging Biomarkers and Computer Aided Diagnosis Laboratory, Bethesda, Maryland, United States
| | - Yohannes Tsehay
- National Institutes of Health, Clinical Center, Imaging Biomarkers and Computer Aided Diagnosis Laboratory, Bethesda, Maryland, United States
| | - Matthew D Greer
- National Institutes of Health, National Cancer Institute, Urologic Oncology Branch and Molecular Imaging Program, Bethesda, Maryland, United States
| | - Baris Turkbey
- National Institutes of Health, National Cancer Institute, Urologic Oncology Branch and Molecular Imaging Program, Bethesda, Maryland, United States
| | - Jin Tae Kwak
- National Institutes of Health, Clinical Center, Center for Interventional Oncology, Bethesda, Maryland, United States
| | - Peter L Choyke
- National Institutes of Health, National Cancer Institute, Urologic Oncology Branch and Molecular Imaging Program, Bethesda, Maryland, United States
| | - Peter Pinto
- National Institutes of Health, National Cancer Institute, Urologic Oncology Branch and Molecular Imaging Program, Bethesda, Maryland, United States
| | - Bradford J Wood
- National Institutes of Health, Clinical Center, Center for Interventional Oncology, Bethesda, Maryland, United States
| | - Ronald M Summers
- National Institutes of Health, Clinical Center, Imaging Biomarkers and Computer Aided Diagnosis Laboratory, Bethesda, Maryland, United States
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Vilanova J, Catalá V. La resonancia magnética en el nuevo paradigma del diagnóstico del cáncer de próstata. RADIOLOGIA 2017; 59:94-99. [DOI: 10.1016/j.rx.2016.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/28/2016] [Accepted: 10/29/2016] [Indexed: 11/29/2022]
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Ellis CL, Harik LR, Cohen C, Osunkoya AO. Biomarker, Molecular, and Technologic Advances in Urologic Pathology, Oncology, and Imaging. Arch Pathol Lab Med 2017; 141:499-516. [PMID: 28157406 DOI: 10.5858/arpa.2016-0263-sa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Urologic pathology is evolving rapidly. Emerging trends include the expanded diagnostic utility of biomarkers and molecular testing, as well as adapting to the plethora of technical advances occurring in genitourinary oncology, surgical practice, and imaging. We illustrate those trends by highlighting our approach to the diagnostic workup of a few selected disease entities that pathologists may encounter, including newly recognized subtypes of renal cell carcinoma, pheochromocytoma, and prostate cancer, some of which harbor a distinctive chromosomal translocation, gene loss, or mutation. We illustrate applications of immunohistochemistry for differential diagnosis of needle core renal biopsies, intraductal carcinoma of the prostate, and amyloidosis and cite encouraging results from early studies using targeted gene expression panels to predict recurrence after prostate cancer surgery. At our institution, pathologists are working closely with urologic surgeons and interventional radiologists to explore the use of intraoperative frozen sections for margins and nerve sparing during robotic prostatectomy, to pioneer minimally invasive videoscopic inguinal lymphadenectomy, and to refine image-guided needle core biopsies and cryotherapy of prostate cancer as well as blue-light/fluorescence cystoscopy. This collaborative, multidisciplinary approach enhances clinical management and research, and optimizes the care of patients with urologic disorders.
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Affiliation(s)
| | | | | | - Adeboye O Osunkoya
- From the Departments of Pathology (Drs Ellis, Harik, Cohen, and Osunkoya), Urology (Dr Osunkoya), and the Winship Cancer Institute (Dr Osunkoya), Emory University School of Medicine, Atlanta, Georgia; and the Department of Pathology, Veterans Affairs Medical Center, Atlanta, Georgia (Dr Osunkoya)
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Burke CJ, Bencardino J, Adler R. The Potential Use of Ultrasound-Magnetic Resonance Imaging Fusion Applications in Musculoskeletal Intervention. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:217-224. [PMID: 27914184 DOI: 10.7863/ultra.16.02024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/03/2016] [Indexed: 06/06/2023]
Abstract
We sought to assess the potential use of an application allowing real-time ultrasound spatial registration with previously acquired magnetic resonance imaging in musculoskeletal procedures. The ultrasound fusion application was used to perform a range of outpatient procedures including piriformis, sacroiliac joint, pudendal and intercostal nerve perineurial injections, hamstring-origin calcific tendonopathy barbotage, and 2 soft tissue biopsies at our institution in 2015. The application was used in a total of 7 procedures in 7 patients, all of which were technically successful. The ages of patients ranged from 19 to 86 years. Particular use of the fusion application compared to sonography alone was noted in the biopsy of certain soft tissue lesions and in perineurial therapeutic injections.
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Affiliation(s)
- Christopher J Burke
- New York University Langone Medical Center, Hospital for Joint Diseases, New York, New York, USA
| | - Jenny Bencardino
- New York University Langone Medical Center, Hospital for Joint Diseases, New York, New York, USA
| | - Ronald Adler
- New York University Langone Medical Center, Hospital for Joint Diseases, New York, New York, USA
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Gomez-Iturriaga A, Casquero F, Lopez J, Urresola A, Ezquerro A, Buscher D, Bilbao P, Crook J. Transperineal biopsies of MRI-detected aggressive index lesions in low- and intermediate-risk prostate cancer patients: Implications for treatment decision. Brachytherapy 2017; 16:201-206. [DOI: 10.1016/j.brachy.2016.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/02/2016] [Accepted: 11/02/2016] [Indexed: 11/17/2022]
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Moldovan P, Udrescu C, Ravier E, Souchon R, Rabilloud M, Bratan F, Sanzalone T, Cros F, Crouzet S, Gelet A, Chapet O, Rouvière O. Accuracy of Elastic Fusion of Prostate Magnetic Resonance and Transrectal Ultrasound Images under Routine Conditions: A Prospective Multi-Operator Study. PLoS One 2016; 11:e0169120. [PMID: 28033423 PMCID: PMC5199076 DOI: 10.1371/journal.pone.0169120] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/12/2016] [Indexed: 12/27/2022] Open
Abstract
Purpose To evaluate in unselected patients imaged under routine conditions the co-registration accuracy of elastic fusion between magnetic resonance (MR) and ultrasound (US) images obtained by the Koelis Urostation™. Materials and Methods We prospectively included 15 consecutive patients referred for placement of intraprostatic fiducials before radiotherapy and who gave written informed consent by signing the Institutional Review Board-approved forms. Three fiducials were placed in the prostate under US guidance in standardized positions (right apex, left mid-gland, right base) using the Koelis Urostation™. Patients then underwent prostate MR imaging. Four operators outlined the prostate on MR and US images and an elastic fusion was retrospectively performed. Fiducials were used to measure the overall target registration error (TRE3D), the error along the antero-posterior (TREAP), right-left (TRERL) and head-feet (TREHF) directions, and within the plane orthogonal to the virtual biopsy track (TRE2D). Results Median TRE3D and TRE2D were 3.8–5.6 mm, and 2.5–3.6 mm, respectively. TRE3D was significantly influenced by the operator (p = 0.013), fiducial location (p = 0.001) and 3D axis orientation (p<0.0001). The worst results were obtained by the least experienced operator. TRE3D was smaller in mid-gland and base than in apex (average difference: -1.21 mm (95% confidence interval (95%CI): -2.03; -0.4) and -1.56 mm (95%CI: -2.44; -0.69) respectively). TREAP and TREHF were larger than TRERL (average difference: +1.29 mm (95%CI: +0.87; +1.71) and +0.59 mm (95%CI: +0.1; +0.95) respectively). Conclusions Registration error values were reasonable for clinical practice. The co-registration accuracy was significantly influenced by the operator’s experience, and significantly poorer in the antero-posterior direction and at the apex.
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Affiliation(s)
- Paul Moldovan
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, France
| | - Corina Udrescu
- Hospices Civils de Lyon, Department of Radiation Oncology, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Emmanuel Ravier
- Hospices Civils de Lyon, Department of Urology, Hôpital Edouard Herriot, Lyon, France
| | | | - Muriel Rabilloud
- Hospices Civils de Lyon, Service de Biostatistique et Bioinformatique, Lyon, France
- Université de Lyon, Lyon, France
- CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Flavie Bratan
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, France
| | - Thomas Sanzalone
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, France
| | - Fanny Cros
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, France
| | - Sébastien Crouzet
- Hospices Civils de Lyon, Department of Urology, Hôpital Edouard Herriot, Lyon, France
- Inserm, U1032, LabTau, Lyon, France
- Université de Lyon, Lyon, France
| | - Albert Gelet
- Hospices Civils de Lyon, Department of Urology, Hôpital Edouard Herriot, Lyon, France
- Inserm, U1032, LabTau, Lyon, France
- Université de Lyon, Lyon, France
| | - Olivier Chapet
- Hospices Civils de Lyon, Department of Radiation Oncology, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Olivier Rouvière
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, France
- Inserm, U1032, LabTau, Lyon, France
- Université de Lyon, Lyon, France
- * E-mail:
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An initial negative round of targeted biopsies in men with highly suspicious multiparametric magnetic resonance findings does not exclude clinically significant prostate cancer-Preliminary experience. Urol Oncol 2016; 35:149.e15-149.e21. [PMID: 27939349 DOI: 10.1016/j.urolonc.2016.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/19/2016] [Accepted: 11/09/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Targeted prostate biopsies are changing the landscape of prostate cancer (PCa) diagnosis with the degree of suspicion on multiparametric magnetic resonance imaging (mpMRI) being a strong predictor of targeted biopsy outcome. Data regarding the rate and potential causes of false-negative magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion-targeted biopsy in patients with highly suspicious mpMRI findings are lacking. OBJECTIVES To determine the rate of clinically significant PCa detection in repeat targeted biopsy or surgery in patients with highly suspicious mpMRI findings and in an initial negative MRI-TRUS fusion-targeted biopsy. MATERIALS AND METHODS In this single-center, retrospective study of prospectively generated data, men with highly suspicious lesions (Likert 5 score) on mpMRI and an initial negative MRI-TRUS fusion-targeted biopsy were reviewed. The rate of PCa detection in a subsequent MRI-TRUS fusion-targeted biopsy or radical prostatectomy was determined. Tumors in the intermediate- and high-risk groups according to the National Comprehensive Cancer Network criteria were considered clinically significant. RESULTS A total of 32 men with 38 Likert 5 lesions were identified. Repeat targeted biopsy or surgery detected cancer in 42% (16/38) of the Likert 5 lesions with initial negative targeted biopsy. Most of these cancers were intermediate- (69%; 11/16) or high-risk (25%; 4/16) tumors. CONCLUSION A negative round of targeted biopsies does not exclude clinically significant PCa in men with highly suspicious mpMRI findings. Patients with imaging-pathology disagreement should be carefully reviewed and considered for repeat biopsy or for strict surveillance.
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Abstract
Objective Targeted magnetic resonance/ultrasound fusion prostate biopsy has been shown to improve the detection of high-grade prostate cancer and to reduce sampling errors. Our objective is to assess MR-TRUS targeted fusion biopsy versus standard biopsy for the detection of clinically significant tumors. Materials and Methods Patients were referred for abnormal digital rectal examination (DRE) or risen prostate-specific antigen (PSA). If an MRI-visible lesion was detected, they were included in the study. In total, 102 men underwent MRI followed by MR-TRUS fusion biopsy between November 2014 and January 2016. Tumor grading was done with the clinical relevance in mind; a cutoff was used at Gleason 7 or higher. Standard biopsy results were collected from clinical practice during 2005 at the same institution to provide baseline values. Results A comparable rate of prostate cancer is found whether sampling is done at random (42.4%) or with the use of fusion biopsy (44.1%). However, these percentages are histologically different: fewer low-grade tumors are detected with MR-TRUS fusion biopsy (-19.1%), while more high-grade tumors are diagnosed (+26%). If there is an ultrasound-visible lesion in the prostate, the gain of combined MRI and fusion biopsy is less impressive. Conclusion Fusion biopsy can provide more accurate information for optimal patient management, as it detects a higher percentage of high-grade prostate cancers than random sampling. Furthermore, nonrelevant tumors are less commonly detected using fusion biopsy.
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Mariotti GC, Costa DN, Pedrosa I, Falsarella PM, Martins T, Roehrborn CG, Rofsky NM, Xi Y, M. Andrade TC, Queiroz MR, Lotan Y, Garcia RG, Lemos GC, Baroni RH. Magnetic resonance/transrectal ultrasound fusion biopsy of the prostate compared to systematic 12-core biopsy for the diagnosis and characterization of prostate cancer: multi-institutional retrospective analysis of 389 patients. Urol Oncol 2016; 34:416.e9-416.e14. [DOI: 10.1016/j.urolonc.2016.04.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/12/2016] [Accepted: 04/13/2016] [Indexed: 11/26/2022]
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Zinc-sensitive MRI contrast agent detects differential release of Zn(II) ions from the healthy vs. malignant mouse prostate. Proc Natl Acad Sci U S A 2016; 113:E5464-71. [PMID: 27562169 DOI: 10.1073/pnas.1609450113] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Many secretory tissues release Zn(II) ions along with other molecules in response to external stimuli. Here we demonstrate that secretion of Zn(II) ions from normal, healthy prostate tissue is stimulated by glucose in fasted mice and that release of Zn(II) can be monitored by MRI. An ∼50% increase in water proton signal enhancement is observed in T1-weighted images of the healthy mouse prostate after infusion of a Gd-based Zn(II) sensor and an i.p. bolus of glucose. Release of Zn(II) from intracellular stores was validated in human epithelial prostate cells in vitro and in surgically exposed prostate tissue in vivo using a Zn(II)-sensitive fluorescent probe known to bind to the extracellular surface of cells. Given the known differences in intracellular Zn(II) stores in healthy versus malignant prostate tissues, the Zn(II) sensor was then evaluated in a transgenic adenocarcinoma of the mouse prostate (TRAMP) model in vivo. The agent proved successful in detecting small malignant lesions as early as 11 wk of age, making this noninvasive MR imaging method potentially useful for identifying prostate cancer in situations where it may be difficult to detect using current multiparametric MRI protocols.
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Ramsay E, Mougenot C, Staruch R, Boyes A, Kazem M, Bronskill M, Foster H, Sugar L, Haider M, Klotz L, Chopra R. Evaluation of Focal Ablation of Magnetic Resonance Imaging Defined Prostate Cancer Using Magnetic Resonance Imaging Controlled Transurethral Ultrasound Therapy with Prostatectomy as the Reference Standard. J Urol 2016; 197:255-261. [PMID: 27545572 DOI: 10.1016/j.juro.2016.06.100] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2016] [Indexed: 01/02/2023]
Abstract
PURPOSE We evaluated magnetic resonance imaging controlled transurethral ultrasound therapy as a treatment for magnetic resonance imaging defined focal prostate cancer using subsequent prostatectomy and histology as the reference standard. MATERIALS AND METHODS Five men completed this pilot study, which was approved by the institutional review board. Prior to radical prostatectomy focal tumors identified by magnetic resonance imaging were treated by coagulating targeted subtotal 3-dimensional volumes of prostate tissue using magnetic resonance imaging controlled transurethral focused ultrasound. Treatment was performed with a 3 Tesla clinical magnetic resonance imaging unit combined with modified clinical planning software for high intensity focused ultrasound therapy. After prostatectomy whole mount histological sections parallel to the magnetic resonance imaging treatment planes were used to compare magnetic resonance imaging measurements with thermal damage at the cellular level and, thus, evaluate treatment and target accuracy. RESULTS Three-dimensional target volumes of 4 to 20 cc and with radii up to 35 mm from the urethra were treated successfully. Mean ± SD temperature control accuracy at the target boundary was -1.6 ± 4.8C and the mean spatial targeting accuracy achieved was -1.5 ± 2.8 mm. Mean treatment accuracy with respect to histology was -0.4 ± 1.7 mm with all index tumors falling inside the histological outer limit of thermal injury. CONCLUSIONS Magnetic resonance imaging guided transurethral ultrasound therapy is capable of generating thermal coagulation and tumor destruction in targeted 3-dimensional angular sectors out to the prostate capsule for prostate glands up to 70 cc in volume. Ultrasound parameters needed to achieve ablation at the prostate capsule were determined, providing a foundation for future studies.
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Affiliation(s)
- Elizabeth Ramsay
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Robert Staruch
- Philips Research North America, Cambridge, Massachusetts
| | - Aaron Boyes
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Mohammad Kazem
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Michael Bronskill
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Harry Foster
- Department of Anaesthesiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto
| | - Linda Sugar
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Masoom Haider
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Laurence Klotz
- Department of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rajiv Chopra
- Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas.
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Yuan Q, Costa DN, Sénégas J, Xi Y, Wiethoff AJ, Rofsky NM, Roehrborn C, Lenkinski RE, Pedrosa I. Quantitative diffusion-weighted imaging and dynamic contrast-enhanced characterization of the index lesion with multiparametric MRI in prostate cancer patients. J Magn Reson Imaging 2016; 45:908-916. [DOI: 10.1002/jmri.25391] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/01/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Qing Yuan
- Department of Radiology; UT Southwestern Medical Center; Dallas Texas USA
| | - Daniel N. Costa
- Department of Radiology; UT Southwestern Medical Center; Dallas Texas USA
- Advanced Imaging Research Center; UT Southwestern Medical Center; Dallas Texas USA
| | | | - Yin Xi
- Department of Radiology; UT Southwestern Medical Center; Dallas Texas USA
| | - Andrea J. Wiethoff
- Advanced Imaging Research Center; UT Southwestern Medical Center; Dallas Texas USA
- Philips Research North America; Cambridge Massachusetts USA
| | - Neil M. Rofsky
- Department of Radiology; UT Southwestern Medical Center; Dallas Texas USA
- Advanced Imaging Research Center; UT Southwestern Medical Center; Dallas Texas USA
| | - Claus Roehrborn
- Department of Urology; UT Southwestern Medical Center; Dallas Texas USA
| | - Robert E. Lenkinski
- Department of Radiology; UT Southwestern Medical Center; Dallas Texas USA
- Advanced Imaging Research Center; UT Southwestern Medical Center; Dallas Texas USA
| | - Ivan Pedrosa
- Department of Radiology; UT Southwestern Medical Center; Dallas Texas USA
- Advanced Imaging Research Center; UT Southwestern Medical Center; Dallas Texas USA
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Samji K, Alrashed A, Shabana WM, McInnes MDF, Bayram E, Schieda N. Comparison of high-resolution T1W 3D GRE (LAVA) with 2-point Dixon fat/water separation (FLEX) to T1W fast spin echo (FSE) in prostate cancer (PCa). Clin Imaging 2016; 40:407-13. [DOI: 10.1016/j.clinimag.2015.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 11/10/2015] [Accepted: 11/19/2015] [Indexed: 01/06/2023]
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Abstract
Image-guided interventional procedures, particularly image guided biopsy and ablation, serve an important role in the care of the oncology patient. The need for tumor genomic and proteomic profiling, early tumor response assessment and confirmation of early recurrence are common scenarios that may necessitate successful biopsies of targets, including those that are small, anatomically unfavorable or inconspicuous. As image-guided ablation is increasingly incorporated into interventional oncology practice, similar obstacles are posed for the ablation of technically challenging tumor targets. Navigation tools, including image fusion and device tracking, can enable abdominal interventionalists to more accurately target challenging biopsy and ablation targets. Image fusion technologies enable multimodality fusion and real-time co-displays of US, CT, MRI, and PET/CT data, with navigational technologies including electromagnetic tracking, robotic, cone beam CT, optical, and laser guidance of interventional devices. Image fusion and navigational platform technology is reviewed in this article, including the results of studies implementing their use for interventional procedures. Pre-clinical and clinical experiences to date suggest these technologies have the potential to reduce procedure risk, time, and radiation dose to both the patient and the operator, with a valuable role to play for complex image-guided interventions.
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Comparison of prostate cancer detection at 3-T MRI with and without an endorectal coil: A prospective, paired-patient study. Urol Oncol 2016; 34:255.e7-255.e13. [PMID: 26971190 DOI: 10.1016/j.urolonc.2016.02.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/02/2016] [Accepted: 02/06/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To compare the sensitivity of 2 different non-endorectal coil strategies vs. endorectal coil (ERC) magnetic resonance imaging (MRI) for detection of prostate cancer (PCa). METHODS In this prospective, single-center, paired-patient, paired-reader study, 49 men with a clinical indication for MRI underwent non-ERC (phased-array coil only) T2-weighted imaging and diffusion-weighted imaging followed by the same sequences using both ERC and phased-array coils (ERC Protocol). Patients were randomized into 1 of 2 arms: standard non-ERC protocol and augmented non-ERC protocol. Lesions with Likert score≥3 were defined as suspicious for cancer. Radical prostatectomy specimen or combined systematic plus targeted biopsies served as the standard of reference. Cancers were stratified into risk groups according to the National Comprehensive Cancer Network guidelines. Generalized estimating equations with Bonferroni correction were used for comparisons. The level of reader confidence was inferred by the Likert scores assigned to index lesions. RESULTS The ERC protocol provided sensitivity (78%) superior to MRI without ERC for PCa detection, both with a standard (43%) (P<0.0001) or augmented (60%) (P<0.01) protocol. The ERC MRI missed less-intermediate or high-risk index lesions (4%) than standard non-ERC (42%) (P = 0.02) and augmented non-ERC MRI (25%), although the latter did not reach significance (P = 0.09). The ERC improved radiologist confidence for the detection of PCa (average Likert score = 4.2±1.4) compared to standard (2.3±2.3) and augmented (2.9±2.1) non-ERC (P = 0.001). CONCLUSIONS The use of combined ERC and pelvic phased-array coil for T2-weighted imaging and diffusion-weighted imaging provides superior sensitivity for the detection of PCa compared to an examination performed without the ERC.
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