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J Urol. 2016 Sep;196(3):697-702. doi: 10.1016/j.juro.2016.03.149. Epub 2016 Mar 30.

Comparative Effectiveness of Targeted Prostate Biopsy Using Magnetic Resonance Imaging Ultrasound Fusion Software and Visual Targeting: a Prospective Study.

Author information

1
Department of Urology, Weill-Cornell Medical College, New York Presbyterian Hospital, New York, New York.
2
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Urology Service, Fundacion Arturo Lopez Perez, Santiago, Chile.
3
Health Outcomes Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
4
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
5
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
6
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Health Outcomes Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: ehdaieb@mskcc.org.

Abstract

PURPOSE:

We compared the diagnostic outcomes of magnetic resonance-ultrasound fusion and visually targeted biopsy for targeting regions of interest on prostate multiparametric magnetic resonance imaging.

MATERIALS AND METHODS:

Patients presenting for prostate biopsy with regions of interest on multiparametric magnetic resonance imaging underwent magnetic resonance imaging targeted biopsy. For each region of interest 2 visually targeted cores were obtained, followed by 2 cores using a magnetic resonance-ultrasound fusion device. Our primary end point was the difference in the detection of high grade (Gleason 7 or greater) and any grade cancer between visually targeted and magnetic resonance-ultrasound fusion, investigated using McNemar's method. Secondary end points were the difference in detection rate by biopsy location using a logistic regression model and the difference in median cancer length using the Wilcoxon signed rank test.

RESULTS:

We identified 396 regions of interest in 286 men. The difference in the detection of high grade cancer between magnetic resonance-ultrasound fusion biopsy and visually targeted biopsy was -1.4% (95% CI -6.4 to 3.6, p=0.6) and for any grade cancer the difference was 3.5% (95% CI -1.9 to 8.9, p=0.2). Median cancer length detected by magnetic resonance-ultrasound fusion and visually targeted biopsy was 5.5 vs 5.8 mm, respectively (p=0.8). Magnetic resonance-ultrasound fusion biopsy detected 15% more cancers in the transition zone (p=0.046) and visually targeted biopsy detected 11% more high grade cancer at the prostate base (p=0.005). Only 52% of all high grade cancers were detected by both techniques.

CONCLUSIONS:

We found no evidence of a significant difference in the detection of high grade or any grade cancer between visually targeted and magnetic resonance-ultrasound fusion biopsy. However, the performance of each technique varied in specific biopsy locations and the outcomes of both techniques were complementary. Combining visually targeted biopsy and magnetic resonance-ultrasound fusion biopsy may optimize the detection of prostate cancer.

KEYWORDS:

image-guided biopsy; magnetic resonance imaging; prostatic neoplasms

PMID:
27038768
PMCID:
PMC5014662
DOI:
10.1016/j.juro.2016.03.149
[Indexed for MEDLINE]
Free PMC Article

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