Prebiopsy Magnetic Resonance Imaging and Prostate Cancer Detection: Comparison of Random and Targeted Biopsies

• Published in: The Journal of urology Vol. 189; no. 2; pp. 493 - 499
• Main Authors: Delongchamps, Nicolas Barry, Peyromaure, Michaël, Schull, Alexandre, Beuvon, Frédéric, Bouazza, Naïm, Flam, Thierry, Zerbib, Marc, Muradyan, Naira, Legman, Paul, Cornud, François
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2013; Elsevier
• Subjects: Biological and medical sciences; biopsy; Biopsy, Needle - methods; Gynecology. Andrology. Obstetrics; Humans; Magnetic Resonance Imaging; Male; Male genital diseases; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Preoperative Care; Prospective Studies; prostate; Prostate - pathology; prostatic neoplasms; Prostatic Neoplasms - pathology; Tumors; Tumors of the urinary system; ultrasonography; Urinary tract. Prostate gland; Urology; magnetic resonance imaging; magnetic resonance; MR imaging; targeted biopsy; microfocal cancer; ultrasonography; MRI; PZ; diffusion weighted; MFC; T2-weighted; DW; dynamic contrast enhanced; transrectal ultrasound; MR; DCE; random biopsy; TB; RB; peripheral zone; prostatic neoplasms; biopsy; T2W; prostate; TRUS; Sonography; Prostate tumor; Nephrology; Urinary system disease; Prostate disease; Targeting; Malignant tumor; Nuclear magnetic resonance imaging; Urology; Anatomic pathology; Biopsy; Echography; Medical imagery; Diagnosis; Urogenital system; Male genital diseases; Prostate cancer; Prostate; Comparative study; Cancer
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1016/j.juro.2012.08.195

Purpose We compared the accuracy of visual targeted biopsies vs computerized transrectal ultrasound-magnetic resonance imaging registration using a rigid (Esaote®, nondeformable) or elastic (Koelis®, deformable) approach. Materials and Methods A total of 391 consecutive patients with suspected localized prostate cancer were prospectively included in analysis. All patients underwent prostate magnetic resonance imaging, followed by 10 to 12-core random prostate biopsies. When magnetic resonance imaging detected suspicious findings, targeted biopsy was performed, including visual, rigid system and elastic system targeted biopsies in the first 127 patients, the next 131 and the last 133, respectively. Cancer detection rates were assessed by conditional logistic regression. Targeted biopsies alone and random biopsies were further compared for the amount of tissue sampled and microfocal cancer detection, the latter defined as a single core with 5 mm or less of Gleason 6 cancer. Results Patient characteristics and random biopsy detection rates were similar among the groups. Magnetic resonance imaging detected at least 1 suspicious area in 54 (42%), 78 (59%) and 82 patients (62%) in groups 1, 2 and 3, respectively. The cancer detection rates of rigid and elastic system targeted biopsies were significantly higher than the random biopsy rate (p = 0.0065 and 0.0016, respectively). Visual targeted biopsy did not perform better than random biopsy (p = 0.66). Rigid and elastic system targeted biopsies allowed for decreasing the number of cores and the detection of microfocal cancer, while increasing the detection of high grade cancer. Conclusions When performed with computerized magnetic resonance imaging-transrectal ultrasound image registration, targeted biopsy alone improved cancer detection over random biopsies, decreased the detection rate of microfocal cancer and increased the detection rate of cancer with a Gleason score of greater than 6.