Detection of Clinically Significant Prostate Cancer Using Magnetic Resonance Imaging-Ultrasound Fusion Targeted Biopsy: A Systematic Review.
Author(s): Valerio M, Donaldson I, Emberton M, Ehdaie B, Hadaschik BA, Marks LS, Mozer P, Rastinehad AR, Ahmed HU
Publication: Eur Urol, 2015, Vol. 68, Page 8-19
PubMed ID: 25454618 PubMed Review Paper? Yes
Purpose of Paper
The purpose of this review was to investigate the effect of using magnetic resonance imaging (MRI) to target transrectal ultrasound (TRUS)-guided prostate biopsies on the detection of prostate cancer and the number of cores necessary to achieve diagnosis.
Conclusion of Paper
Clinically significant prostate cancer was detected in 23.6% of TRUS biopsies and 33.3% of MRI-TRUS-guided biopsies. While the overall cancer detection rate was 43.4% in TRUS-guided biopsies and 50.5% in MRI-TRUS guided biopsies; clinically insignificant cancer was more often detected by standard biopsy in four of the fourteen studies. Importantly, the number of cores needed to detect clinically significant disease was lower in MRI-TRUS guided biopsy than standard TRUS biopsy (9.2 versus 37.1 cores).
Studies
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Study Purpose
The purpose of this review was to investigate the effect of using magnetic resonance imaging (MRI) to target transrectal ultrasound (TRUS)-guided prostate biopsies on the detection of prostate cancer and the number of cores necessary to achieve diagnosis. Data from thirteen papers was combined to determine if MRI-targeting affects prostate cancer diagnosis rates. Results from a total of 2,293 men whose preprocedure MRI was aligned with intraprocedure TRUS to determine biopsy location were included. In total, eight different image fusion platforms were used in which some were considered rigid (direct overlay) and others were non-rigid (compensated for changes in prostate shape and position). The authors note that there was discrepancy between studies in the definition of clinically significant disease, which was generally defined as the presence of Gleason pattern 4, but in eight studies the maximum core length was also considered with thresholds ranging from 3 -10 mm.
Summary of Findings:
Clinically significant prostate cancer was detected in 23.6% of TRUS biopsies and 33.3% of MRI-TRUS guided biopsies. While the overall cancer detection rate was 43.4% in TRUS-guided biopsies and 50.5% in MRI-TRUS guided biopsies; clinically insignificant cancer was more often detected by standard biopsy in four of the fourteen studies. Importantly, the number of cores needed to detect clinically significant disease was lower in MRI-TRUS guided biopsy than standard TRUS biopsy (9.2 versus 37.1 cores).
Biospecimens
Preservative Types
- Formalin
Diagnoses:
- Neoplastic - Carcinoma
Platform:
Analyte Technology Platform Morphology Light microscopy Morphology H-and-E microscopy Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Biospecimen Acquisition Method of tissue acquisition Ultrasound-guided biopsy
Magnetic resonance imaging-guided biopsy
Multiple targeting methods compared
Biospecimen Aliquots and Components Biospecimen heterogeneity Intratumoral sampling (exact positions not specified)