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MRI/TRUS fusion vs. systematic biopsy: intra-patient comparison of diagnostic accuracy for prostate cancer using PI-RADS v2

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Abstract

Objective

To evaluate the efficacy of multiparametric magnetic resonance/transrectal ultrasound fusion (MRI/TRUS fusion) biopsy versus systematic biopsy and its association with PI-RADS v2 categories in patients with suspected prostate cancer.

Materials and methods

122 patients undergoing both MRI/TRUS fusion and systematic biopsy, with suspicion of prostate cancer, with suspicious findings on MRI based on PI-RADS v2, were included between April 2016 and March 2017. Comparison of tumor detection rates using each technique and combined techniques was performed for all lesions as well as those that are traditionally difficult to access (i.e., anterior lesions).

Results

Prostate cancer was detected in 83/122 patients (68%) with 74.6% clinically significant lesions (Gleason 3 + 4 or greater). There was a statistically significant difference in presence of clinically significant prostate cancer in PI-RADS v2 categories of 3, 4, and 5 (20%, 52% and 77%, respectively, p < 0.001). Fusion biopsy was positive in a significantly higher percentage of patients versus systematic biopsy (56% versus 48%, respectively, p < 0.05). The fusion biopsy alone was positive in 20%. Of 34 patients with anterior lesions on MRI, 44% were detected only by fusion biopsy, with a joint yield of 71%. In patients with previous negative systematic biopsies, 48.7% lesions were found by fusion biopsy with 20.5% being exclusively positive by this method. The percentage of positive cores for fusion biopsies was significantly higher than for systematic biopsies (26% vs. 12.3%, p < 0.001).

Conclusion

The incorporation of MRI/TRUS fusion biopsy significantly improves the detection rate of prostate cancer versus systematic biopsy, particularly for anterior lesions.

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Funding

This project was performed at the Departments of Radiology at Clínica Alemana de Santiago (Santiago, Chile) and Duke University Medical Center (Durham, NC). There is no external or internal funding for this project.

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Authors and Affiliations

  1. Universidad del Desarrollo, Servicio de Radiologia, Facultad de Medicina Clínica Alemana De Santiago, 5951 Vitacura, 9160002, Santiago, Chile

    Andrés Labra, Fernando González, Claudio Silva & Gerhard Franz

  2. Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC, 27710, USA

    Fernando González & Rajan T. Gupta

  3. Department of Surgery, Division of Urology, Clínica Alemana de Santiago, 5951 Vitacura, 9160002, Santiago, Chile

    Rodrigo Pinochet

  4. Duke Cancer Institute Center for Prostate and Urologic Cancers, 20 Duke Medicine Circle, DUMC Box 103861, Durham, NC, 27710, USA

    Rajan T. Gupta

  5. Department of Surgery, Division of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, DUMC Box 2804, Durham, NC, 27710, USA

    Rajan T. Gupta

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  1. Andrés Labra
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Correspondence to Rajan T. Gupta.

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Fernando González, MD, Andrés Labra, MD, Claudio Silva, MD, Gerhard Franz, MD, Rodrigo Pinochet, MD—none. Rajan T. Gupta, MD—Consultant, Invivo Corp.

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Labra, A., González, F., Silva, C. et al. MRI/TRUS fusion vs. systematic biopsy: intra-patient comparison of diagnostic accuracy for prostate cancer using PI-RADS v2. Abdom Radiol 45, 2235–2243 (2020). https://doi.org/10.1007/s00261-020-02481-y

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