Incremental diagnostic value of targeted biopsy using mpMRI-TRUS fusion versus 14-fragments prostatic biopsy: a prospective controlled study

• Published in: European radiology Vol. 28; no. 1; pp. 11 - 16
• Main Authors: Mariotti, Guilherme C., Falsarella, Priscila M., Garcia, Rodrigo G., Queiroz, Marcos R. G., Lemos, Gustavo C., Baroni, Ronaldo H.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2018; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Biopsy; Biopsy, Large-Core Needle; Cancer; Cores; Diagnosis; Diagnostic Radiology; Diagnostic systems; Endoscopic Ultrasound-Guided Fine Needle Aspiration - methods; Endosonography - methods; Humans; Imaging; Internal Medicine; Interventional Radiology; Lesions; Magnetic resonance imaging; Magnetic Resonance Imaging, Interventional - methods; Male; Medical diagnosis; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; NMR; Nuclear magnetic resonance; Patients; Prospective Studies; Prostate cancer; Prostatic Neoplasms - diagnosis; Radiology; Statistical analysis; Tumors; Ultrasound; Urogenital; Magnetic Resonance Imaging/methods; Prospective Studies; Prostatic Neoplasms/diagnosis; Ultrasonography, Interventional; Needle biopsy
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-017-4939-0

Objectives To compare the incremental diagnostic value of targeted biopsy using real-time multiparametric magnetic resonance imaging and transrectal ultrasound (mpMRI-TRUS) fusion to conventional 14-cores biopsy. Patients and Methods Uni-institutional, institutional review board (IRB) approved prospective blinded study comparing TRUS-guided random and targeted biopsy using mpMRI-TRUS fusion, in 100 consecutive men. We included men with clinical-laboratorial suspicious for prostate cancer and Likert score ≥ 3 mp-MRI. Patients previously diagnosed with prostate cancer were excluded. All patients were submitted to 14-cores TRUS-guided biopsy (mpMRI data operator-blinded), followed by targeted biopsy using mpMRI-TRUS fusion. Results There was an overall increase in cancer detection rate, from 56% with random technique to 62% combining targeted biopsy using mpMRI-TRUS fusion; incremental diagnosis was even more relevant for clinically significant lesions (Gleason ≥ 7), diagnosing 10% more clinically significant lesions with fusion biopsy technique. Diagnosis upgrade occurred in 5 patients that would have negative results in random biopsies and had clinically significant tumours with the combined technique, and in 5 patients who had the diagnosis of significant tumours after fusion biopsy and clinically insignificant tumours in random biopsies(p=0.0010). Conclusions Targeted biopsy using mpMRI-TRUS fusion has incremental diagnostic value in comparison to conventional random biopsy, better detecting clinically significant prostate cancers. Key Points • mpMRI - TRUS targeted biopsy increases overall cancer detection rate , but not statistically significant . • mpMRI - TRUS targeted biopsy actually improves the diagnosis of clinically significant PCa . • There was no evidence to acquire the mpMRI - TRUS fusion cores alone .