Ashkan Mortezavi1, Olivia Märzendorfer1, Olivio F Donati2, Gianluca Rizzi1, Niels J Rupp3, Marian S Wettstein4, Oliver Gross1, Tullio Sulser1, Thomas Hermanns1, Daniel Eberli5. 1. Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 2. Institutes of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 3. Surgical Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 4. Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 5. Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. Electronic address: Daniel.Eberli@usz.ch.
Abstract
PURPOSE: We evaluated the diagnostic accuracy of multiparametric magnetic resonance imaging and multiparametric magnetic resonance imaging/transrectal ultrasound fusion guided targeted biopsy against that of transperineal template saturation prostate biopsy to detect prostate cancer. MATERIALS AND METHODS: We retrospectively analyzed the records of 415 men who consecutively presented for prostate biopsy between November 2014 and September 2016 at our tertiary care center. Multiparametric magnetic resonance imaging was performed using a 3 Tesla device without an endorectal coil, followed by transperineal template saturation prostate biopsy with the BiopSee® fusion system. Additional fusion guided targeted biopsy was done in men with a suspicious lesion on multiparametric magnetic resonance imaging, defined as Likert score 3 to 5. Any Gleason pattern 4 or greater was defined as clinically significant prostate cancer. The detection rates of multiparametric magnetic resonance imaging and fusion guided targeted biopsy were compared with the detection rate of transperineal template saturation prostate biopsy using the McNemar test. RESULTS: We obtained a median of 40 (range 30 to 55) and 3 (range 2 to 4) transperineal template saturation prostate biopsy and fusion guided targeted biopsy cores, respectively. Of the 124 patients (29.9%) without a suspicious lesion on multiparametric magnetic resonance imaging 32 (25.8%) were found to have clinically significant prostate cancer on transperineal template saturation prostate biopsy. Of the 291 patients (70.1%) with a Likert score of 3 to 5 clinically significant prostate cancer was detected in 129 (44.3%) by multiparametric magnetic resonance imaging fusion guided targeted biopsy, in 176 (60.5%) by transperineal template saturation prostate biopsy and in 187 (64.3%) by the combined approach. Overall 58 cases (19.9%) of clinically significant prostate cancer would have been missed if fusion guided targeted biopsy had been performed exclusively. The sensitivity of multiparametric magnetic resonance imaging and fusion guided targeted biopsy for clinically significant prostate cancer was 84.6% and 56.7% with a negative likelihood ratio of 0.35 and 0.46, respectively. CONCLUSIONS: Multiparametric magnetic resonance imaging alone should not be performed as a triage test due to a substantial number of false-negative cases with clinically significant prostate cancer. Systematic biopsy outperformed fusion guided targeted biopsy. Therefore, it will remain crucial in the diagnostic pathway of prostate cancer.
PURPOSE: We evaluated the diagnostic accuracy of multiparametric magnetic resonance imaging and multiparametric magnetic resonance imaging/transrectal ultrasound fusion guided targeted biopsy against that of transperineal template saturation prostate biopsy to detect prostate cancer. MATERIALS AND METHODS: We retrospectively analyzed the records of 415 men who consecutively presented for prostate biopsy between November 2014 and September 2016 at our tertiary care center. Multiparametric magnetic resonance imaging was performed using a 3 Tesla device without an endorectal coil, followed by transperineal template saturation prostate biopsy with the BiopSee® fusion system. Additional fusion guided targeted biopsy was done in men with a suspicious lesion on multiparametric magnetic resonance imaging, defined as Likert score 3 to 5. Any Gleason pattern 4 or greater was defined as clinically significant prostate cancer. The detection rates of multiparametric magnetic resonance imaging and fusion guided targeted biopsy were compared with the detection rate of transperineal template saturation prostate biopsy using the McNemar test. RESULTS: We obtained a median of 40 (range 30 to 55) and 3 (range 2 to 4) transperineal template saturation prostate biopsy and fusion guided targeted biopsy cores, respectively. Of the 124 patients (29.9%) without a suspicious lesion on multiparametric magnetic resonance imaging 32 (25.8%) were found to have clinically significant prostate cancer on transperineal template saturation prostate biopsy. Of the 291 patients (70.1%) with a Likert score of 3 to 5 clinically significant prostate cancer was detected in 129 (44.3%) by multiparametric magnetic resonance imaging fusion guided targeted biopsy, in 176 (60.5%) by transperineal template saturation prostate biopsy and in 187 (64.3%) by the combined approach. Overall 58 cases (19.9%) of clinically significant prostate cancer would have been missed if fusion guided targeted biopsy had been performed exclusively. The sensitivity of multiparametric magnetic resonance imaging and fusion guided targeted biopsy for clinically significant prostate cancer was 84.6% and 56.7% with a negative likelihood ratio of 0.35 and 0.46, respectively. CONCLUSIONS: Multiparametric magnetic resonance imaging alone should not be performed as a triage test due to a substantial number of false-negative cases with clinically significant prostate cancer. Systematic biopsy outperformed fusion guided targeted biopsy. Therefore, it will remain crucial in the diagnostic pathway of prostate cancer.
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Authors: Basil Kaufmann; Karim Saba; Tobias S Schmidli; Stephanie Stutz; Leon Bissig; Anna Jelena Britschgi; Evodia Schaeren; Alexander Gu; Nicole Langenegger; Tullio Sulser; Daniel Eberli; Etienne X Keller; Thomas Hermanns; Cédric Poyet Journal: Prostate Date: 2021-12-16 Impact factor: 4.012
Authors: Joseph M Norris; Lina M Carmona Echeverria; Simon R J Bott; Louise C Brown; Nick Burns-Cox; Tim Dudderidge; Ahmed El-Shater Bosaily; Eleni Frangou; Alex Freeman; Maneesh Ghei; Alastair Henderson; Richard G Hindley; Richard S Kaplan; Alex Kirkham; Robert Oldroyd; Chris Parker; Raj Persad; Shonit Punwani; Derek J Rosario; Iqbal S Shergill; Vasilis Stavrinides; Mathias Winkler; Hayley C Whitaker; Hashim U Ahmed; Mark Emberton Journal: Eur Urol Date: 2020-05-01 Impact factor: 20.096