M Minhaj Siddiqui1, Soroush Rais-Bahrami1, Hong Truong1, Lambros Stamatakis1, Srinivas Vourganti1, Jeffrey Nix1, Anthony N Hoang1, Annerleim Walton-Diaz1, Brian Shuch1, Michael Weintraub1, Jochen Kruecker2, Hayet Amalou3, Baris Turkbey4, Maria J Merino5, Peter L Choyke4, Bradford J Wood3, Peter A Pinto6. 1. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. 2. Philips Research North America, Briarcliff Manor, NY, USA. 3. Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. 4. Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. 5. Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. 6. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. Electronic address: pintop@mail.nih.gov.
Abstract
BACKGROUND: Gleason scores from standard, 12-core prostate biopsies are upgraded historically in 25-33% of patients. Multiparametric prostate magnetic resonance imaging (MP-MRI) with ultrasound (US)-targeted fusion biopsy may better sample the true gland pathology. OBJECTIVE: The rate of Gleason score upgrading from an MRI/US-fusion-guided prostate-biopsy platform is compared with a standard 12-core biopsy regimen alone. DESIGN, SETTING, AND PARTICIPANTS: There were 582 subjects enrolled from August 2007 through August 2012 in a prospective trial comparing systematic, extended 12-core transrectal ultrasound biopsies to targeted MRI/US-fusion-guided prostate biopsies performed during the same biopsy session. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The highest Gleason score from each biopsy method was compared. INTERVENTIONS: An MRI/US-fusion-guided platform with electromagnetic tracking was used for the performance of the fusion-guided biopsies. RESULTS AND LIMITATIONS: A diagnosis of prostate cancer (PCa) was made in 315 (54%) of the patients. Addition of targeted biopsy led to Gleason upgrading in 81 (32%) cases. Targeted biopsy detected 67% more Gleason ≥4+3 tumors than 12-core biopsy alone and missed 36% of Gleason ≤3+4 tumors, thus mitigating the detection of lower-grade disease. Conversely, 12-core biopsy led to upgrading in 67 (26%) cases over targeted biopsy alone but only detected 8% more Gleason ≥4+3 tumors. On multivariate analysis, MP-MRI suspicion was associated with Gleason score upgrading in the targeted lesions (p<0.001). The main limitation of this study was that definitive pathology from radical prostatectomy was not available. CONCLUSIONS: MRI/US-fusion-guided biopsy upgrades and detects PCa of higher Gleason score in 32% of patients compared with traditional 12-core biopsy alone. Targeted biopsy technique preferentially detects higher-grade PCa while missing lower-grade tumors.
BACKGROUND: Gleason scores from standard, 12-core prostate biopsies are upgraded historically in 25-33% of patients. Multiparametric prostate magnetic resonance imaging (MP-MRI) with ultrasound (US)-targeted fusion biopsy may better sample the true gland pathology. OBJECTIVE: The rate of Gleason score upgrading from an MRI/US-fusion-guided prostate-biopsy platform is compared with a standard 12-core biopsy regimen alone. DESIGN, SETTING, AND PARTICIPANTS: There were 582 subjects enrolled from August 2007 through August 2012 in a prospective trial comparing systematic, extended 12-core transrectal ultrasound biopsies to targeted MRI/US-fusion-guided prostate biopsies performed during the same biopsy session. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The highest Gleason score from each biopsy method was compared. INTERVENTIONS: An MRI/US-fusion-guided platform with electromagnetic tracking was used for the performance of the fusion-guided biopsies. RESULTS AND LIMITATIONS: A diagnosis of prostate cancer (PCa) was made in 315 (54%) of the patients. Addition of targeted biopsy led to Gleason upgrading in 81 (32%) cases. Targeted biopsy detected 67% more Gleason ≥4+3 tumors than 12-core biopsy alone and missed 36% of Gleason ≤3+4 tumors, thus mitigating the detection of lower-grade disease. Conversely, 12-core biopsy led to upgrading in 67 (26%) cases over targeted biopsy alone but only detected 8% more Gleason ≥4+3 tumors. On multivariate analysis, MP-MRI suspicion was associated with Gleason score upgrading in the targeted lesions (p<0.001). The main limitation of this study was that definitive pathology from radical prostatectomy was not available. CONCLUSIONS: MRI/US-fusion-guided biopsy upgrades and detects PCa of higher Gleason score in 32% of patients compared with traditional 12-core biopsy alone. Targeted biopsy technique preferentially detects higher-grade PCa while missing lower-grade tumors.
Authors: Matthew D Greer; Anna M Brown; Joanna H Shih; Ronald M Summers; Jamie Marko; Yan Mee Law; Sandeep Sankineni; Arvin K George; Maria J Merino; Peter A Pinto; Peter L Choyke; Baris Turkbey Journal: J Magn Reson Imaging Date: 2016-07-08 Impact factor: 4.813
Authors: Dima Raskolnikov; Soroush Rais-Bahrami; Arvin K George; Baris Turkbey; Nabeel A Shakir; Chinonyerem Okoro; Jason T Rothwax; Annerleim Walton-Diaz; M Minhaj Siddiqui; Daniel Su; Lambros Stamatakis; Pingkun Yan; Jochen Kruecker; Sheng Xu; Maria J Merino; Peter L Choyke; Bradford J Wood; Peter A Pinto Journal: J Urol Date: 2014-08-20 Impact factor: 7.450
Authors: Kevin C McCammack; Natalie M Schenker-Ahmed; Nathan S White; Shaun R Best; Robert M Marks; Jared Heimbigner; Christopher J Kane; J Kellogg Parsons; Joshua M Kuperman; Hauke Bartsch; Rahul S Desikan; Rebecca A Rakow-Penner; Michael A Liss; Daniel J A Margolis; Steven S Raman; Ahmed Shabaik; Anders M Dale; David S Karow Journal: Abdom Radiol (NY) Date: 2016-05
Authors: Ryan L Brunsing; Natalie M Schenker-Ahmed; Nathan S White; J Kellogg Parsons; Christopher Kane; Joshua Kuperman; Hauke Bartsch; Andrew Karim Kader; Rebecca Rakow-Penner; Tyler M Seibert; Daniel Margolis; Steven S Raman; Carrie R McDonald; Nikdokht Farid; Santosh Kesari; Donna Hansel; Ahmed Shabaik; Anders M Dale; David S Karow Journal: J Magn Reson Imaging Date: 2016-08-16 Impact factor: 4.813