Urology Annals

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 12  |  Issue : 4  |  Page : 366--372

Magnetic resonance imaging–ultrasound fusion-targeted biopsy combined with systematic 12-core ultrasound-guided biopsy improves the detection of clinically significant prostate cancer: Are we ready to abandon the systematic approach?


Christopher Antonio Febres-Aldana1, Sarah Alghamdi1, Thomas A Weppelmann2, Emilio Lastarria3, Akshay Bhandari3, Yumna Omarzai4, Robert J Poppiti4 
1 Arkadi M. Rywlin Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Florida, USA
2 Department of Pathology, Herbert Wertheim College of Medicine, Florida International University, Florida, USA
3 Columbia University Division of Urology, Mount Sinai Medical Center, Miami Beach, Florida, USA
4 Arkadi M. Rywlin Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center; Department of Pathology, Herbert Wertheim College of Medicine, Florida International University, Florida, USA

Correspondence Address:
Dr. Christopher Antonio Febres-Aldana
Arkadi M. Rywlin Department of Pathology and Laboratory Medicine, 4300 Alton Road, Suite 2400, Miami Beach 33140, Florida
USA

Background: Multiparametric (mp) magnetic resonance imaging (MRI)–ultrasound fusion-targeted biopsy (TB) has improved the detection of clinically significant prostate cancer (csCaP) using the Prostate Imaging Reporting and Data System (PI-RADS) reporting system, leading some authors to conclude that TB can replace the 12-core systematic biopsy (SB). We compared the diagnostic performance of TB with SB at our institution. Methods: Eighty-three men with elevated prostate-specific antigen levels (6.6 ng/mL, interquartile range [IQR] 4.5–9.2) and abnormal mp-MRI (127 lesions, PI-RADS ≥3, median size: 1.1 cm, IQR 0.8–1.6) underwent simultaneous TB and SB. Diagnosis of any CaP (Gleason score, [GS] ≥6) and csCaP (GS ≥7) was compared using the McNemar's exact test. Results: SB showed higher, but not statistically significant, detection rates of any CaP and csCaP (51.8% and 34.9%) versus TB (44.6% and 28.9%) (P = 0.286 and P = 0.359, respectively). TB outperformed SB in the quantification of 56.6% CaP and detecting cancer in anterior sectors (7.2%). Compared to SB, TB missed twice the amount of any CaP and csCaP. SB alone detected 22.2% of all csCaPs and upgraded 20.6% of TB-detected CaP. SB identified cancer invisible on mp-MRI (13.7% of all CaP) or missed by TB due to a small size (<1 cm) and sampling error (7% of lesions). Conclusion: A combination of SB with TB remained necessary for achieving the highest cancer detection rates. Limiting prostate biopsy to TB alone can miss csCaP due to the presence of synchronous high-grade cancer invisible on MRI or failure to hit the target. TB is the best approach for anterior lesions and tumor quantification.


How to cite this article:
Febres-Aldana CA, Alghamdi S, Weppelmann TA, Lastarria E, Bhandari A, Omarzai Y, Poppiti RJ. Magnetic resonance imaging–ultrasound fusion-targeted biopsy combined with systematic 12-core ultrasound-guided biopsy improves the detection of clinically significant prostate cancer: Are we ready to abandon the systematic approach?.Urol Ann 2020;12:366-372


How to cite this URL:
Febres-Aldana CA, Alghamdi S, Weppelmann TA, Lastarria E, Bhandari A, Omarzai Y, Poppiti RJ. Magnetic resonance imaging–ultrasound fusion-targeted biopsy combined with systematic 12-core ultrasound-guided biopsy improves the detection of clinically significant prostate cancer: Are we ready to abandon the systematic approach?. Urol Ann [serial online] 2020 [cited 2020 Dec 1 ];12:366-372
Available from: https://www.urologyannals.com/article.asp?issn=0974-7796;year=2020;volume=12;issue=4;spage=366;epage=372;aulast=Febres-Aldana;type=0