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Petov VS, Bazarkin AK, Morozov AO, Taratkin MS, Ganzha TM, Danilov SP, Chernov YN, Chinenov DV, Amosov AV, Enikeev DV, Krupinov GE. [Prospective comparison of cognitive and mpMR/US fusion biopsy for prostate cancer detection]. Urologiia 2022:38-43. [PMID: 36098588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION According to the recommendations of the European Association of Urology the presence of a suspicious lesion on MRI is an indication for both primary and secondary MR-targeted biopsies. At the same time, the Russian Society of Urologists recommends to perform mpMR/US fusion biopsy only in patients with a prior negative biopsy. In clinical practice, mpMR/US fusion and cognitive biopsies are the most frequently performed. However, when comparing them, contradictory data on detection of clinically significant prostate cancer is obtained. OBJECTIVE to compare the detection rate of clinically significant prostate cancer performing cognitive and mpMR/US fusion biopsies. MATERIALS AND METHODS Inclusion criteria: PSA >2 ng/mL and/or a positive DRE, and/or a suspicious lesion on TRUS, and PI-RADSv2.1 lesion more or equal 3. At first, "unblinded" urologist performed a transperineal mpMR/ultrasound fusion and saturation biopsy. Then "blinded" urologist obtained transrectal cognitive biopsy Clinically significant cancer was defined as ISUP more or equal 2. RESULTS We enrolled 96 patients. Median age was 63 years, prostate volume - 47 cm3 and PSA - 6.82 ng/mL. MpMR/US fusion and cognitive biopsies were comparable in regard to the detection rate of clinically significant (32.3% vs 25.0%; p=0.264), clinically insignificant cancer (25.0% and 26.0%; p=0.869) and overall detection rate (57.3% and 51%;p=0.385). Both biopsies missed clinically significant cancer with equal frequency (5.2%; p=0.839). Histological efficacy also was comparable. The number of positive cores between mpMR/US fusion and cognitive biopsy was equal (34.1% and 31.1% respectively; p= 0.415). At the same time, no statistically significant difference was found with respect to maximum cancer core length (53.1% vs 47.7%, respectively; p=0.293). CONCLUSION The results suggest that both cognitive and mpMR/US fusion biopsies are equally accurate diagnostic methods for clinically significant prostate cancer detection, thus their wider introduction into clinical practice is necessary.
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Affiliation(s)
- V S Petov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Institute for clinical medicine named after N.V. Sklifosovsky, Sechenov University, Moscow, Russia
| | - A K Bazarkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Institute for clinical medicine named after N.V. Sklifosovsky, Sechenov University, Moscow, Russia
| | - A O Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Institute for clinical medicine named after N.V. Sklifosovsky, Sechenov University, Moscow, Russia
| | - M S Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Institute for clinical medicine named after N.V. Sklifosovsky, Sechenov University, Moscow, Russia
| | - T M Ganzha
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Institute for clinical medicine named after N.V. Sklifosovsky, Sechenov University, Moscow, Russia
| | - S P Danilov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Institute for clinical medicine named after N.V. Sklifosovsky, Sechenov University, Moscow, Russia
| | - Y N Chernov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Institute for clinical medicine named after N.V. Sklifosovsky, Sechenov University, Moscow, Russia
| | - D V Chinenov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Institute for clinical medicine named after N.V. Sklifosovsky, Sechenov University, Moscow, Russia
| | - A V Amosov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Institute for clinical medicine named after N.V. Sklifosovsky, Sechenov University, Moscow, Russia
| | - D V Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Institute for clinical medicine named after N.V. Sklifosovsky, Sechenov University, Moscow, Russia
| | - G E Krupinov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Institute for clinical medicine named after N.V. Sklifosovsky, Sechenov University, Moscow, Russia
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Chang AI, Park BK. New TRUS Techniques and Imaging Features of PI-RADS 4 or 5: Influence on Tumor Targeting. Front Oncol 2021; 11:608409. [PMID: 34178615 PMCID: PMC8220212 DOI: 10.3389/fonc.2021.608409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/17/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose To determine if the new transrectal ultrasound (TRUS) techniques and imaging features contribute to targeting Prostate Imaging and Reporting and Data System (PI-RADS) 4 or 5. Materials and Methods Between December 2018 and February 2020, 115 men underwent cognitive biopsy by radiologist A, who was familiar with the new TRUS findings and biopsy techniques. During the same period, 179 men underwent magnetic resonance imaging–TRUS image fusion or cognitive biopsy by radiologist B, who was unfamiliar with the new biopsy techniques. Prior to biopsy, both radiologists knew MRI findings such as the location, size, and shape of PI-RADS 4 or 5. We recorded how many target biopsies were performed without systematic biopsy and how many of these detected higher Gleason score (GS) than those detected by systematic biopsy. The numbers of biopsy cores were also obtained. Fisher Exact or Mann–Whitney test was used for statistical analysis. Results For PI-RADS 4, target biopsy alone was performed in 0% (0/84) by radiologist A and 0.8% (1/127) by radiologist B (p>0.9999). Target biopsy yielded higher GSs in 57.7% (30/52) by radiologist A and 29.5% (23/78) by radiologist B (p = 0.0019). For PI-RADS 5, target biopsy alone was performed in 29.0% (9/31) by radiologist A and 1.9% (1/52) by radiologist B (p = 0.0004). Target biopsy yielded higher GSs in 50.0% (14/28) by radiologist A and 18.2% (8/44) by radiologist B (p = 0.0079). Radiologist A sampled fewer biopsy cores than radiologist B (p = 0.0008 and 0.0023 for PI-RADS 4 and 5), respectively. Conclusions PI-RADS 4 or 5 can be more precisely targeted if the new TRUS biopsy techniques are applied.
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Affiliation(s)
- Amy Inji Chang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Abstract
INTRODUCTION The role of transperineal template biopsy for prostate cancer diagnosis is well established. Pre-biopsy multiparametric magnetic resonance imaging (MRI) is used in most centers for planning of prostate biopsies and staging. Cognitive and software fusion techniques are increasingly getting popular. METHODS We retrospectively reviewed patients who underwent transperineal template biopsies from January 2016 till December 2018. This included patients on active surveillance, previous negative transrectal ultrasonography biopsies with persistently raised prostate-specific antigen/abnormal prostate on digital rectal examination and de-novo template biopsies. Two specialist uro-radiologists reported all the scans and the biopsies were performed by one experienced urologist. The cognitive biopsies were performed for PIRADS 3-5 lesions on MRI. Total of 330 patients underwent transperineal template biopsies and cognitive target biopsies were carried out in 75 patients who were included in the study. We evaluated the results as positive/negative cognitive biopsies and also according to the PIRAD scoring. Only the patients with prostate cancer on template biopsy histology were included. RESULTS Fifty-seven (76%) of the cognitive biopsies were positive out of total 75.[Table: see text]. CONCLUSIONS Combined cognitive and systematic biopsies have excellent diagnostic rate especially for PIRAD 4-5 MRI areas.
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Affiliation(s)
- Zubair Bhat
- Department of Urology, Medway Maritime Hospital Hospital, Gillingham, Kent, United Kingdom
| | - Arshad Bhat
- Department of Urology, Medway Maritime Hospital Hospital, Gillingham, Kent, United Kingdom
| | - Wasim Mahmalji
- Department of Urology, Hereford County Hospital, Hereford, United Kingdom
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Patel MI, Muter S, Vladica P, Gillatt D. Robotic-assisted magnetic resonance imaging ultrasound fusion results in higher significant cancer detection compared to cognitive prostate targeting in biopsy naive men. Transl Androl Urol 2020; 9:601-608. [PMID: 32420165 PMCID: PMC7214998 DOI: 10.21037/tau.2020.01.33] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background To determine differences in cancer detection rates (CDRs) of regions of interest (ROI) on magnetic resonance imaging (MRI) with robotic-assisted (RA) targeted biopsies (RA-TB) compared to cognitive targeted biopsies (C-TB). Methods In a two-centre, retrospective outcome study, a total of 92 consecutive men who had a pre-biopsy MRI, were biopsy naïve and had a transperineal (TP) prostate biopsy between 9/2015 and 7/2017 were included. The primary analysis consists of 39 men who had C-TB and 53 men who had RA-TB. Outcomes from targeted biopsies were reported as CDR for clinically significant prostate cancer (csPC) and for any cancer. Results Targeted csCDR was higher in RA-TB vs. C-TB (32.1% vs. 10.3%, P=0.014). Targeted CDR of any cancer with Prostate Imaging Reporting and Data System (PI-RADS) 3-5 ROIs was also significantly higher in RA-TB compared to C-TB (47.2% vs. 12.8%, P=0.001). On multivariable analysis significant factors which affected the CDR for csPC was prostate volume only [odds ratio (OR) 1.04, 95% confidence interval (CI): 1.01-1.07]. For any cancer, the CDR was related to prostate volume (OR 1.03, 95% CI: 1.01-1.06) and RA-TB (OR 5.97, 95% CI: 1.69-21.07). RA biopsy results in less acute urinary retention (1.9% vs. 12.8%, P=0.03), less prolonged haematuria (7.5% vs. 38.5%, P<0.01) and shortened biopsy times (24 vs. 32 min, P<0.001). Conclusions RA targeted biopsy results in higher CDR for clinically significant cancers and any cancer. It also suffers lower complications compared to cognitive directed TP biopsy. The ease of use and standardisation of the robotic procedure may reduce the learning curve and increase biopsy accuracy.
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Affiliation(s)
- Manish I Patel
- Discipline of Surgery, University of Sydney, Sydney, Australia.,Department of Surgery, Macquarie University Hospital, Sydney, Australia
| | - Samir Muter
- Department of Surgery, Macquarie University Hospital, Sydney, Australia
| | - Philip Vladica
- Department of Radiology, Westmead Hospital, Sydney, Australia
| | - David Gillatt
- Department of Surgery, Macquarie University Hospital, Sydney, Australia
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