Surface-projection-based transperineal cognitive fusion targeted biopsy of the prostate: an original technique with a good cancer detection rate

• Published in: BMC urology Vol. 19; no. 1; p. 107
• Main Authors: Wang, Lei, Wang, Xiaofei, Zhao, Wenfeng, Zhao, Zichen, Li, Zhihu, Fei, Shengmin, Zhu, He, Ji, Xiang, Yang, Bing, Li, Ningchen, Na, Yanqun
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 04.11.2019; BioMed Central; BMC
• Subjects: Aged; Cancer diagnosis; Clinically significant prostate cancer; Cognitive fusion biopsy; Humans; Image-Guided Biopsy - methods; Male; Middle Aged; Multiparametric Magnetic Resonance Imaging; Perineum; PI-RADS version 2 score; Prostate - pathology; Prostate biopsy; Prostate cancer; Prostatic Neoplasms - pathology; Retrospective Studies; Skin; Targeted biopsy; Transperineal prostate biopsy; Tuberculosis; Ultrasonography; China; Clinically significant prostate cancer; PI-RADS version 2 score; Targeted biopsy; Cognitive fusion biopsy; Transperineal prostate biopsy
• ISSN: 1471-2490; 1471-2490
• DOI: 10.1186/s12894-019-0535-8

To report a new standardized cognitive fusion technique on transperineal targeted biopsy (TB) of prostate, and to evaluate its efficacy for cancer detection combined with systematic biopsy (SB) . We present a retrospective review of consecutive patients undergoing multiparametric magnetic resonance (mpMRI) imaging of the prostate with subsequent transperineal prostate biopsy from January 2016 to December 2018. A free-hand 12-core SB was performed for each patient. PI-RADS 3-5 lesions were further targeted for biopsy with our TB technique. Firstly, a central point of suspicious lesion (B') was registered cognitively on a transverse section of transrectal ultrasound (TRUS). Then, biopsy gun punctured vertically through a fixed pioneer site (A) on skin of perineum, and deep into the TRUS section to get A'. Next, targeted site (B), the surface-projection of B', would be determined on skin of perineum by A and distance from B' to A'. Finally, puncture through B to reach B'. Pathological findings of SB and TB were analyzed. A total of 126 patients underwent transperineal prostate biopsy (47 SB only, 79 SB + TB). The age of the patients was 68.7 ± 9.2 years. The median preoperative PSA value was 11.8 ng/mL. Preoperative prostate volume was 60.5 ± 50.0 mL. The numbers of patients with PI-RADS scores of 1 through 5 were 4, 43, 27, 21 and 31, respectively. The overall detection rate of cancer was 61/126 (48.4%), and it was significantly higher in the combination cohort (56/79, 70.9%) compared with the SB only cohort (5/47, 10.6%, p<0.001). When focused on the combination cohort, TB detected a similar overall rate of PCa (53/79, 67.1% vs 52/79, 65.8%; p = 0.87) compared with SB. The clinically significant PCa (csPC) detection rate was 52/79 (65.8%), while for TB and SB the csPC/PC rate was 51/53 (96.2%) and 48/52 (92.3%), respectively(p = 0.44). TB demonstrated a better sampling performance (positive rate for each core) compared with SB (51.0% vs 31.3%, p < 0.001). Surface-projection-based transperineal cognitive fusion targeted biopsy of the prostate has a good efficacy in detecting PCa.