scholarly journals Evaluating the efficacy of a low-cost, minimally-invasive cognitive MRI targeted biopsy protocol in the Prostate Imaging Reporting and Data System (PI-RADS) version 2 era.

2019 ◽  
Author(s):  
Yuta Takeshima ◽  
Yoshinori Tanaka ◽  
Kotaro Takemura ◽  
Shusaku Nakazono ◽  
Eiko Yamashita ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Performance ◽  
Low Cost ◽  
Multiparametric Mri ◽  
Data System ◽  
Targeted Biopsy ◽  
Prostate Imaging ◽  
Biopsy Protocol ◽  
Clinically Significant ◽  
Systematic Biopsy

Abstract Background: New MRI-guided targeting biopsy methods have increased cancer yield of prostate biopsies. However, cost and time constraints have made it difficult for many institutions to implement these newer methods. We evaluated the diagnostic performance of a low-cost, minimally-invasive, cognitive MRI-targeted biopsy protocol based on 1.5T multiparametric MRI graded with Prostate Imaging Reporting and Data System version 2 that is easily implemented in any low- to intermediate- volume center. Methods: Retrospective analysis of 255 patients who underwent prostate biopsy between December 2016 and March 2019 at a single facility. Indication for biopsy was based on clinical parameters including 1.5T multiparametric MRI. In addition to 10-core systematic biopsy, targeted cores were obtained with cognitive recognition under ultrasound. A control group of 198 patients biopsied without prior MRI from January to December 2015 was also analyzed. Results: Prostate biopsy preceded by MRI had a significantly higher probability of detecting both prostate cancer (68.1% vs. 43.6%) and clinically significant cancer (56.2% vs. 29.4%) (p values< 0.01). Combination of systematic biopsy and targeted biopsy outperformed either regimen alone for detection of prostate cancer. Multivariate analysis showed PSA density and prostate imaging reporting and data system score were independent risk factors of prostate cancer. A proposed diagnostic model showed sensitivity of 88.6%, specificity of 55%, PPV of 81.2%, NPV of 68.8%, and accuracy of 78%. Prostate imaging reporting and data system score was correlated with a higher presence of prostate cancer, clinically significant prostate cancer, and a higher pathological grade. Conclusions: Incorporation of pre-biopsy MRI imaging, scoring, and targeted biopsy improved cancer yield and achieved diagnostic performance comparable to newer methods of higher cost. Future alterations of possible benefit included increasing the number of target cores per lesion, and combining prostate imaging reporting and data system score and PSA density as indicators for biopsy.

Comparison of prostate imaging reporting and data system v2.1 and 2 in transition and peripheral zones: evaluation of interreader agreement and diagnostic performance in detecting clinically significant prostate cancer

2021 ◽  
pp. 20201434
Author(s):  
Yasuyo Urase ◽  
Yoshiko Ueno ◽  
Tsutomu Tamada ◽  
Keitaro Sofue ◽  
Satoru Takahashi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Performance ◽  
Area Under The Curve ◽  
Data System ◽  
Transition Zones ◽  
Prostate Imaging ◽  
Institutional Review ◽  
3.0 T ◽  
Clinically Significant ◽  
Interreader Agreement

Objectives: To evaluate the interreader agreement and diagnostic performance of the Prostate Imaging Reporting and Data System (PI-RADS) v2.1, in comparison with v2. Methods: Institutional review board approval was obtained for this retrospective study. Seventy-seven consecutive patients who underwent a prostate multiparametric magnetic resonance imaging at 3.0 T before radical prostatectomy were included. Four radiologists (two experienced uroradiologists and two inexperienced radiologists) independently scored eight regions [six peripheral zones (PZ) and two transition zones (TZ)] using v2.1 and v2. Interreader agreement was assessed using κ statistics. To evaluate diagnostic performance for clinically significant prostate cancer (csPC), area under the curve (AUC) was estimated. Results 228 regions were pathologically diagnosed as positive for csPC. With a cutoff ≥3, the agreement among all readers was better with v2.1 than v2 in TZ, PZ, or both zones combined (κ-value: TZ, 0.509 vs 0.414; PZ, 0.686 vs 0.568; both zones combined, 0.644 vs 0.531). With a cutoff ≥4, the agreement among all readers was also better with v2.1 than v2 in the PZ or both zones combined (κ-value: PZ, 0.761 vs 0.701; both zones combined, 0.756 vs 0.709). For all readers, AUC with v2.1 was higher than with v2 (TZ, 0.826–0.907 vs 0.788–0.856; PZ, 0.857–0.919 vs 0.853–0.902). Conclusions: Our study suggests that the PI-RADS v2.1 could improve the interreader agreement and might contribute to improved diagnostic performance compared with v2. Advances in knowledge: PI-RADS v2.1 has a potential to improve interreader variability and diagnostic performance among radiologists with different levels of expertise.

The best prostate biopsy sampling system—fusion and systematic biopsy: A single center experience

2021 ◽  
pp. 039156032110371
Author(s):  
Alfonso Califano ◽  
Alessandro Caputo ◽  
Antonio D’Antonio ◽  
Vincenzo Ciccone ◽  
Marco Fabiano ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Accuracy ◽  
Diagnostic Performance ◽  
Targeted Biopsy ◽  
Sampling System ◽  
Single Center Experience ◽  
Prostate Biopsies ◽  
Clinically Significant ◽  
Prostate Cancers ◽  
Systematic Biopsy

Background: Prostate cancer is the second most commonly diagnosed cancer in men. The diagnostic accuracy in prostate cancer can be increased by employing a preliminary multiparametric MRI followed by a fusion-targeted biopsy. Methods: To compare the diagnostic accuracy of fusion-targeted biopsy with the standard systematic biopsy in prostate cancer patients, we enrolled 139 patients on which we performed 139 prostate biopsies consisting of three targeted samples followed by 12 regular systematic samples. Based on histology, we analyzed the diagnostic performance of the two methods. Results: Both methods were equally good at detecting clinically significant cancer (83.3%, 50/60), while systematic biopsy detected more clinically insignificant cancers. However, the best diagnostic performance is obtained by combining the two methods. Conclusion: The two methods are best seen as synergistic, and the addition of fusion biopsy can be used to detect more clinically significant prostate cancers than systematic biopsy alone.

scholarly journals The Role of Prostate Combination Biopsy Consisting of Targeted and Additional Systematic Biopsy

2021 ◽  
Vol 10 (21) ◽  
pp. 4804
Author(s):  
Chung Un Lee ◽  
Joongwon Choi ◽  
Si Hyun Sung ◽  
Jae Hoon Chung ◽  
Wan Song ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Multiparametric Mri ◽  
Repeat Biopsy ◽  
Targeted Biopsy ◽  
Prostate Imaging ◽  
Initial Biopsy ◽  
Biopsy Methods ◽  
Clinically Significant ◽  
Systematic Biopsy

Background: To identify the role of combination biopsy, which consists of both targeted and additional systematic cores, in the diagnosis of clinically significant prostate cancer (csPCa). Methods: We retrospectively reviewed patients with PSA levels 2.5–15 ng/mL who have a suspicious prostate lesion (with the Prostate Imaging Reporting and Data System (PI-RADS) ≥ 3) on multiparametric MRI (mpMRI) between January 2016 and December 2018. We analyzed biopsy results by PI-RADS score and biopsy methods (systematic, targeted, and combination biopsy). Results: Of the 711 total patients, an average of 4.0 ± 1.8 targeted and 8.6 ± 3.1 additional systematic biopsies were performed. The additional systematic biopsies were sampled outside the targeted biopsy area. The combination biopsies detected more csPCa (201 patients, 28.3%) than did the targeted (175 patients, 24.6%) or systematic (124 patients, 17.4%) biopsies alone (p < 0.001). In the initial biopsy samples, there was a 7% increase in the detection of csPCa than in targeted biopsy (62% to 69%). It increased by 11% in repeat biopsy (46% to 57%). There was no statistical significance in both groups (p = 0.3174). Conclusions: Combination biopsy has the benefit of detecting csPCa in both initial and repeat biopsy when there is a suspicious lesion on mpMRI.

The CADMUS trial: A paired cohort, blinded study comparing multiparametric ultrasound targeted biopsies with multiparametric MRI targeted biopsies in the detection of clinically significant prostate cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 5008-5008
Author(s):  
Alistair Grey ◽  
Rebecca Scott ◽  
Bina Shah ◽  
Peter Acher ◽  
Sidath Liyanage ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Performance ◽  
Point Of Care ◽  
Low Cost ◽  
Reporting Quality ◽  
Multiparametric Mri ◽  
Lesion Detection ◽  
Gleason Grade ◽  
Clinically Significant ◽  
Targeted Biopsies

5008 Background: Multiparametric MRI (mpMRI) of the prostate followed by targeted biopsy is recommended in men at risk of prostate cancer. Dissemination of this pathway may be limited by cost, variable scan and reporting quality, and contraindicated in the presence of metallic implants and claustrophobia. Multi-parametric ultrasound (mpUSS) is a point of care test with low cost that combines b-mode, colour Doppler, elastography and contrast enhancement. CADMUS compared the diagnostic performance of mpUSS to mpMRI. Methods: CADMUS recruited 370 patients from seven sites to a prospective, multicentre, paired-cohort trial (ISRCTN 38541912). Ethics committee approval was obtained. Patients underwent both mpUSS and mpMRI independently, each with a positive test defined as a Likert score of >3. Those with either a positive mpUSS or mpMRI, or both, were advised to undergo targeted biopsies. Reporting of each scan was carried out blind to the other and prior to biopsy; patients advised for biopsy were blinded to which test was positive. The order of mpUSS and mpMRI targeting was randomised. Primary outcomes were proportion of positive tests and detection of clinically significant cancer (csPCa) defined as Gleason >4+3 of any length and/or maximum cancer core length of >6mm of any grade [PROMIS definition1]. Results: 306 completed both mpUSS and mpMRI. Agreement in lesion detection between mpUSS and mpMRI was 73.2% (kappa 0.06, p = 0.14). 257 with positive results on mpUSS, mpMRI or both had targeted biopsies. Agreement on detection of csPCa was 91.1% (expected 59.8%, kappa 0.78, p < 0.01). Overall, mpUSS detected 4.3% fewer csPCa than mpMRI (95% CI = [-8.3%, -1.5%]; p = 0.042 [Bonferroni correction]). mpUSS detected 7.2% (6/83) csPCa missed by mpMRI; mpMRI detected 20.5% (17/83) csPCa that mpUSS missed. At a less stringent definition of significant cancer, Gleason grade >3+4 of any length (definition 3), agreement was 89.1% (expected 55.6%, kappa 0.75, p < 0.01) mpUSS detected 5.4% fewer definition 3 cancers than mpMRI overall. mpUSS detected 7% (7/99) definition 3 cancers that mpMRI missed; mpMRI detected 21% (21/99) definition 3 cancers that mpUSS missed. Conclusions: The CADMUS trial shows mpUSS has a diagnostic performance approaching that of mpMRI and significant cancer detection is improved by the use of both scans over mpMRI alone. Clinical trial information: 38541912. [Table: see text]

Multiparametric MRI Lesion Classified as Prostate Imaging-Reporting and Data System 5 but Histopathologically Described as Benign: A Case Report and Review of Literature

2021 ◽  
pp. 1-5
Author(s):  
Maria Apfelbeck ◽  
Boris Schlenker ◽  
Michael Chaloupka ◽  
Christian G. Stief ◽  
Dirk-André Clevert
Keyword(s):  
Prostate Cancer ◽  
Case Report ◽  
False Positive ◽  
Multiparametric Mri ◽  
Data System ◽  
Case Description ◽  
Review Of Literature ◽  
Targeted Biopsy ◽  
Prostate Imaging ◽  
Common Malignancy

<b><i>Introduction:</i></b> Prostate cancer (PCa) is the most common malignancy in men. The multiparametric MRI (mpMRI) significantly improved the diagnostic approach of PCa. Although PCa is highly likely to be present in prostate imaging-reporting and data system (PI-RADS) 5 lesions, there are up to 18% of PI-RADS 5 lesions with benign histopathology after targeted biopsy. <b><i>Case Description:</i></b> We present the case of a 66-year-old man who was referred to our hospital for MRI/ultrasound fusion-based targeted biopsy due to an elevated PSA and a PI-RADS 5 lesion described in the mpMRI. After 2 consecutive biopsies, the mpMRI target showed no malignancy. The lesion was described as PI-RADS 2 two years later. <b><i>Conclusion:</i></b> This case demonstrates the risk of false-positive classified PI-RADS 5 lesions in the mpMRI and the challenge in some cases to distinguish between BPH nodules and cancer. Until today, a limited amount of studies exists concerning this issue. However, further studies are required to evaluate further characteristics associated with a higher possibility of histopathologically benign findings in PI-RADS 5 lesions.

scholarly journals Study protocol for a single-centre non-inferior randomised controlled trial on a novel three-dimensional matrix positioning-based cognitive fusion-targeted biopsy and software-based fusion-targeted biopsy for the detection rate of clinically significant prostate cancer in men without a prior biopsy

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041427
Author(s):  
Biming He ◽  
Rongbing Li ◽  
Dongyang Li ◽  
Liqun Huang ◽  
Xiaofei Wen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Detection Rate ◽  
Three Dimensional ◽  
Multiparametric Mri ◽  
Fusion Method ◽  
Targeted Biopsy ◽  
Cognitive Fusion ◽  
Single Centre ◽  
Clinically Significant ◽  
Randomised Controlled

IntroductionThe classical pathway for diagnosing prostate cancer is systematic 12-core biopsy under the guidance of transrectal ultrasound, which tends to underdiagnose the clinically significant tumour and overdiagnose the insignificant disease. Another pathway named targeted biopsy is using multiparametric MRI to localise the tumour precisely and then obtain the samples from the suspicious lesions. Targeted biopsy, which is mainly divided into cognitive fusion method and software-based fusion method, is getting prevalent for its good performance in detecting significant cancer. However, the preferred targeted biopsy technique in detecting clinically significant prostate cancer between cognitive fusion and software-based fusion is still beyond consensus.Methods and analysisThis trial is a prospective, single-centre, randomised controlled and non-inferiority study in which all men suspicious to have clinically significant prostate cancer are included. This study aims to determine whether a novel three-dimensional matrix positioning cognitive fusion-targeted biopsy is non-inferior to software-based fusion-targeted biopsy in the detection rate of clinically significant cancer in men without a prior biopsy. The main inclusion criteria are men with elevated serum prostate-specific antigen above 4–20 ng/mL or with an abnormal digital rectal examination and have never had a biopsy before. A sample size of 602 participants allowing for a 10% loss will be recruited. All patients will undergo a multiparametric MRI examination, and those who fail to be found with a suspicious lesion, with the anticipation of half of the total number, will be dropped. The remaining participants will be randomly allocated to cognitive fusion-targeted biopsy (n=137) and software-based fusion-targeted biopsy (n=137). The primary outcome is the detection rate of clinically significant prostate cancer for cognitive fusion-targeted biopsy and software-based fusion-targeted biopsy in men without a prior biopsy. The clinically significant prostate cancer will be defined as the International Society of Urological Pathology grade group 2 or higher.Ethics and disseminationEthical approval was obtained from the ethics committee of Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China. The results of the study will be disseminated and published in international peer-reviewed journals.Trial registration numberClinicalTrials.gov Registry (NCT04271527).

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