Single-Center Experience in Targeted Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging-Transrectal Ultrasound Elastic Fusion Technique

Background: Targeted prostate biopsy is challenging because no single currently established imaging modality is both accurate for prostate cancer diagnosis and cost-effective for real-time procedure guidance. A system that fuses real-time transrectal ultrasound (US) images with previously acquired magnetic resonance imaging (MRI) images for prostate biopsy guidance is presented here. Multiparametric MRI-transrectal US (mpMRI-TRUS) fusion targeted biopsy of the prostate gland, a relatively newly performed technique, has shown the potential to gradually replace random TR US-guided prostate biopsy. Targeting suspicious lesions described on MRI has resulted in an increased detection of clinically significant cancer, decreased detection of low-risk cancer, and potential improvement in patient outcome. Methods: A total of 34 patients underwent mp-MRI; 25 performed at our center and 9 at other centers. Of all the 34 patients, 19 patients were classified by mp-MRI as having Prostate Imaging Reporting and Data System (PIRADS) 4/5, 10 patients as PIRADS 3, and 5 patients as PIRADS 2. All these patients underwent targeted and nontargeted registered mpMRI-TRUS elastic fusion biopsy between the end of January and December 2017. All patients had negative recent urine culture and underwent bowel preparation and received antibiotic coverage. Anticoagulation and antiplatelet therapy, when applicable, were withheld prior to biopsy. Elastic image fusion and organ-based tracking technique were used. It enabled freehand, three-dimensional TR biopsy mapping and accurate tracking of the prostate, compensating for patient- and probe-induced mobility. Results: Sixteen patients had positive biopsies for prostate cancer; positive results of targeted biopsies were found in 14 patients having PIRADS 4/5 (14 out of 19). Of these patients, three also had positive specimens from nontargeted areas; positive results were found in two patients in nontargeted areas. One of these was classified as PIRADS 4 and the other as PIRADS 3. These results show that 79% of patients classified by mp-MRI as PIRADS 4/5 and 10% of patients classified as PIRADS 3 had positive biopsies for prostate cancer. No reported complications, uncontrolled bleeding, or sepsis were noted in all biopsied patients. Conclusion: MpMRI-TRUS fusion biopsy is a safe and accurate method for targeted biopsy of prostate lesions. Despite the modest number of patients, our preliminary results are comparable to the published international numbers, showing a good correlation between the mp-MRI PIRADS classification and the pathological results of mpMRI-TRUS fusion biopsies.

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Artikel online veröffentlicht:
11. Mai 2021