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BJU Int. 2017 Nov;120(5):631-638. doi: 10.1111/bju.13711. Epub 2016 Dec 21.

Multicentre evaluation of targeted and systematic biopsies using magnetic resonance and ultrasound image-fusion guided transperineal prostate biopsy in patients with a previous negative biopsy.

Author information

1
Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
2
CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
3
Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany.
4
Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
5
Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
6
Department of Radiology, DKFZ, Heidelberg, Germany.
7
Department of Pathology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
8
Institute of Pathology, University of Heidelberg, Heidelberg, Germany.
9
Department of Urology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.

Abstract

OBJECTIVES:

To evaluate the detection rates of targeted and systematic biopsies in magnetic resonance imaging (MRI) and ultrasound (US) image-fusion transperineal prostate biopsy for patients with previous benign transrectal biopsies in two high-volume centres.

PATIENTS AND METHODS:

A two centre prospective outcome study of 487 patients with previous benign biopsies that underwent transperineal MRI/US fusion-guided targeted and systematic saturation biopsy from 2012 to 2015. Multiparametric MRI (mpMRI) was reported according to Prostate Imaging Reporting and Data System (PI-RADS) Version 1. Detection of Gleason score 7-10 prostate cancer on biopsy was the primary outcome. Positive (PPV) and negative (NPV) predictive values including 95% confidence intervals (95% CIs) were calculated. Detection rates of targeted and systematic biopsies were compared using McNemar's test.

RESULTS:

The median (interquartile range) PSA level was 9.0 (6.7-13.4) ng/mL. PI-RADS 3-5 mpMRI lesions were reported in 343 (70%) patients and Gleason score 7-10 prostate cancer was detected in 149 (31%). The PPV (95% CI) for detecting Gleason score 7-10 prostate cancer was 0.20 (±0.07) for PI-RADS 3, 0.32 (±0.09) for PI-RADS 4, and 0.70 (±0.08) for PI-RADS 5. The NPV (95% CI) of PI-RADS 1-2 was 0.92 (±0.04) for Gleason score 7-10 and 0.99 (±0.02) for Gleason score ≥4 + 3 cancer. Systematic biopsies alone found 125/138 (91%) Gleason score 7-10 cancers. In patients with suspicious lesions (PI-RADS 4-5) on mpMRI, systematic biopsies would not have detected 12/113 significant prostate cancers (11%), while targeted biopsies alone would have failed to diagnose 10/113 (9%). In equivocal lesions (PI-RADS 3), targeted biopsy alone would not have diagnosed 14/25 (56%) of Gleason score 7-10 cancers, whereas systematic biopsies alone would have missed 1/25 (4%). Combination with PSA density improved the area under the curve of PI-RADS from 0.822 to 0.846.

CONCLUSION:

In patients with high probability mpMRI lesions, the highest detection rates of Gleason score 7-10 cancer still required combined targeted and systematic MRI/US image-fusion; however, systematic biopsy alone may be sufficient in patients with equivocal lesions. Repeated prostate biopsies may not be needed at all for patients with a low PSA density and a negative mpMRI read by experienced radiologists.

KEYWORDS:

#PCSM; #ProstateCancer; image fusion; magnetic resonance imaging; prostate biopsy; prostate cancer; prostate-specific antigen density; transperineal biopsy

PMID:
27862869
DOI:
10.1111/bju.13711
[Indexed for MEDLINE]
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