Spatial distribution of biopsy cores and the detection of intra-lesion pathologic heterogeneity.
Ther Adv Urol 2019;
11:1756287219842485. [PMID:
31065294 PMCID:
PMC6488778 DOI:
10.1177/1756287219842485]
[Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/13/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives:
The objective of this study was to determine if spatial distribution of
multiparametric magnetic resonance imaging–transrectal ultrasound
(mpMRI-TRUS) fusion biopsy cores to the index lesion reveals trends in the
detection of intra-lesion Gleason heterogeneity and a more optimal prostate
biopsy strategy.
Methods:
Index lesion was the lesion with longest diameter on T2-weighted (T2W)-MRI.
In cohort 1, fusion biopsy cores biopsies were taken in areas in the center
of the target as well as 1 cm laterally on each side. For cohort 2, targeted
biopsies were taken from the center of the lesion only. Heterogeneity was
defined as difference in maximum Gleason score obtained from fusion cores in
the center of the index lesion versus cores obtained from
the periphery (cohort 1), or any difference in maximum Gleason score
obtained from fusion cores targeted to the index lesion (cohort 2) compared
with systematic 12 cores TRUS biopsy.
Results:
Ninety-nine consecutive patients (35 and 64 in cohorts 1 and 2, respectively)
with median age (SD) and prostate-specific antigen (PSA) of 66.9 (±5.9) and
9.7 (±8.2) respectively, were included. Age, PSA, Prostate Imaging Reporting
and Data System (PI-RADS) score, and preoperative MRI lesion size were not
significantly different between cohorts. Gleason heterogeneity was observed
at a significantly higher rate in cohort 1 versus cohort 2
(58% versus 24%; p = 0.041). In cohort 1,
cores obtained from the center of the lesion had higher Gleason score than
cores obtained from the periphery of the targeted lesion in 57% of
cases.
Conclusions:
We demonstrate that there is observable tumor heterogeneity in biopsy
specimens, and that increased number of cores, as well as cores focused on
the center and periphery of the largest lesion in the prostate, provide more
comprehensive diagnostic information about the patient’s clinical risk
category than taking nonspecific cores targeted within the tumor.
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