Cancer Diagnosis Program | Biorepositories and Biospecimen Research Branch

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Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer.

Author(s): Siddiqui MM, Rais-Bahrami S, Turkbey B, George AK, Rothwax J, Shakir N, Okoro C, Raskolnikov D, Parnes HL, Linehan WM, Merino MJ, Simon RM, Choyke PL, Wood BJ, Pinto PA

Publication: JAMA, 2015, Vol. 313, Page 390-7

PubMed ID: 25626035 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   The purpose of this study was to compare the efficacy of targeted multiparametric magnetic resonance imaging (MP-MRI)- and standard transrectal ultrasound (TRUS)-guided biopsy methods for the identification of high- and low-risk prostate cancer. Biopsy specimens were first procured using MP-MRI guidance by one physician, after which standard biopsies were procured using TRUS guidance by a different physician.  A mean of 12 TRUS-guided biopsy cores were obtained from each patient, while the mean number of cores obtained by MP-MRI was not reported. Case-matched biopsies were procured from 1003 patients, 170 of which later underwent a radical prostatectomy.   Tumors were classified as low-risk when a Gleason score of 6 was assigned; as intermediate risk if a Gleason score of 3+4 was assigned and 50% of more of any core contained cancerous cells or 33% or more of standard biopsy cores were positive for cancer; and as high-risk if a Gleason score of 4+3 or greater was assigned.

   Summary of Findings:

   Exact agreement between standard TRUS-guided and MP-MRI guided biopsies was observed in 69% of patients (690/1003).  While the number of cancer-positive cases were similar between biopsy methods (461 vs 469 for MP-MRI guided and TRUS-guided biopsies, respectively), the MP-MRI guided biopsy method resulted in significantly more high-risk cancers than the TRUS-guided biopsy method (173 vs 122 cases; p<0.001), but significantly fewer low-risk cancers (213 vs 258 cases; P=0.002).  When biopsies procured using different methods were considered in combination, a diagnosis of cancer increased by 22%, although 83% of these 103 cases were low-risk.  When biopsy methods were compared to results obtained with a subsequent prostatectomy in a patient subset (170 cases), 17 patients were diagnosed with prostate cancer based on the TRUS-guided biopsy, but only 3 were diagnosed as intermediate- or high-risk cancer based on the prostatectomy specimen. Similarly, 20 patients were diagnosed with prostate cancer based on the MP-MRI-guided biopsy, but only  12 were diagnosed with intermediate- or high-risk cancer based on the prostatectomy specimen. Based on this patient subset, the sensitivity of the targeted MP-MRI biopsy method was determined to be 77% compared to 53% for the standard TRUS-guided biopsy method. 

   Biospecimens

   • Tissue - Prostate

   Preservative Types

   • Formalin

   Diagnoses:

   • Neoplastic - Carcinoma

   Platform:

   Analyte	Technology Platform
   Morphology	H-and-E microscopy

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Biospecimen Acquisition	Method of tissue acquisition	Magnetic resonance imaging-guided biopsy Ultrasound-guided biopsy Surgical resection

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