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J Urol. 2014 Nov;192(5):1367-73. doi: 10.1016/j.juro.2014.04.094. Epub 2014 May 1.

Magnetic resonance imaging-ultrasound fusion biopsy for prediction of final prostate pathology.

Author information

1
Department of Urology, University of California, Los Angeles, California.
2
David Geffen School of Medicine, University of California, Los Angeles, California.
3
Department of Pathology, University of California, Los Angeles, California.
4
Department of Urology, Stanford University, Stanford, California.
5
Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, California.
6
Department of Radiology, University of California, Los Angeles, California.
7
Department of Urology, University of California, Los Angeles, California. Electronic address: lmarks@mednet.ucla.edu.

Abstract

PURPOSE:

We explored the impact of magnetic resonance imaging-ultrasound fusion prostate biopsy on the prediction of final surgical pathology.

MATERIALS AND METHODS:

A total of 54 consecutive men undergoing radical prostatectomy at UCLA after fusion biopsy were included in this prospective, institutional review board approved pilot study. Using magnetic resonance imaging-ultrasound fusion, tissue was obtained from a 12-point systematic grid (mapping biopsy) and from regions of interest detected by multiparametric magnetic resonance imaging (targeted biopsy). A single radiologist read all magnetic resonance imaging, and a single pathologist independently rereviewed all biopsy and whole mount pathology, blinded to prior interpretation and matched specimen. Gleason score concordance between biopsy and prostatectomy was the primary end point.

RESULTS:

Mean patient age was 62 years and median prostate specific antigen was 6.2 ng/ml. Final Gleason score at prostatectomy was 6 (13%), 7 (70%) and 8-9 (17%). A tertiary pattern was detected in 17 (31%) men. Of 45 high suspicion (image grade 4-5) magnetic resonance imaging targets 32 (71%) contained prostate cancer. The per core cancer detection rate was 20% by systematic mapping biopsy and 42% by targeted biopsy. The highest Gleason pattern at prostatectomy was detected by systematic mapping biopsy in 54%, targeted biopsy in 54% and a combination in 81% of cases. Overall 17% of cases were upgraded from fusion biopsy to final pathology and 1 (2%) was downgraded. The combination of targeted biopsy and systematic mapping biopsy was needed to obtain the best predictive accuracy.

CONCLUSIONS:

In this pilot study magnetic resonance imaging-ultrasound fusion biopsy allowed for the prediction of final prostate pathology with greater accuracy than that reported previously using conventional methods (81% vs 40% to 65%). If confirmed, these results will have important clinical implications.

KEYWORDS:

biopsy; magnetic resonance imaging; prostatectomy; prostatic neoplasms; ultrasonography

PMID:
24793118
PMCID:
PMC4201866
DOI:
10.1016/j.juro.2014.04.094
[Indexed for MEDLINE]
Free PMC Article

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