Trans-rectal ultrasound visibility of prostate lesions identified by magnetic resonance imaging increases accuracy of image-fusion targeted biopsies.
PURPOSE
To compare the diagnostic yield of targeted prostate biopsy using image-fusion of multi-parametric magnetic resonance (mp-MR) with real-time trans-rectal ultrasound (TRUS) for clinically significant lesions that are suspicious only on mp-MR versus lesions that are suspicious on both mp-MR and TRUS.


METHODS
Pre-biopsy MRI and TRUS were each scaled on a 3-point score: highly suspicious, likely, and unlikely for clinically significant cancer (sPCa). Using an MR-TRUS elastic image-fusion system (Koelis), a 127 consecutive patients with a suspicious clinically significant index lesion on pre-biopsy mp-MR underwent systematic biopsies and MR/US-fusion targeted biopsies (01/2010-09/2013). Biopsy histological outcomes were retrospectively compared with MR suspicion level and TRUS-visibility of the MR-suspicious lesion. sPCa was defined as biopsy Gleason score ≥7 and/or maximum cancer core length ≥5 mm.


RESULTS
Targeted biopsies outperformed systematic biopsies in overall cancer detection rate (61 vs. 41 %; p = 0.007), sPCa detection rate (43 vs. 23 %; p = 0.0013), cancer core length (7.5 vs. 3.9 mm; p = 0.0002), and cancer rate per core (56 vs. 12 %; p < 0.0001), respectively. Highly suspicious lesions on mp-MR correlated with higher positive biopsy rate (p < 0.0001), higher Gleason score (p = 0.018), and greater cancer core length (p < 0.0001). Highly suspicious lesions on TRUS in corresponding to MR-suspicious lesion had a higher biopsy yield (p < 0.0001) and higher sPCa detection rate (p < 0.0001). Since majority of MR-suspicious lesions were also suspicious on TRUS, TRUS-visibility allowed selection of the specific MR-visible lesion which should be targeted from among the multiple TRUS suspicious lesions in each prostate.


CONCLUSIONS
MR-TRUS fusion-image-guided biopsies outperformed systematic biopsies. TRUS-visibility of a MR-suspicious lesion facilitates image-guided biopsies, resulting in higher detection of significant cancer.
['Ukimura|Osamu|O|', 'Marien|Arnaud|A|', 'Palmer|Suzanne|S|', 'Villers|Arnauld|A|', 'Aron|Manju|M|', 'de Castro Abreu|Andre Luis|AL|', 'Leslie|Scott|S|', 'Shoji|Sunao|S|', 'Matsugasumi|Toru|T|', 'Gross|Mitchell|M|', 'Dasgupta|Prokar|P|', 'Gill|Inderbir S|IS|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D019160:Endosonography D006801:Humans D061705:Image-Guided Biopsy D008279:Magnetic Resonance Imaging D008297:Male D008875:Middle Aged D060787:Neoplasm Grading D009367:Neoplasm Staging D011471:Prostatic Neoplasms D012007:Rectum D015203:Reproducibility of Results D012189:Retrospective Studies
Magnetic resonance imaging Image-guided biopsy Computer-assisted image processing Prostate neoplasms Ultrasonography