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
The purpose of this paper was to compare the efficacy of targeted multiparametric magnetic resonance imaging (MP-MRI)-guided and standard transrectal ultrasound (TRUS)- guided biopsy methods for the identification of high- and low-risk prostate cancer.
Conclusion of Paper
Exact agreement between standard transrectal ultrasound (TRUS)-guided and targeted multiparametric magnetic resonance imaging (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- 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 biopsy methods were compared to results obtained with a subsequent prostatectomy in a patient subset (170 cases), the sensitivity of the targeted MP-MRI biopsy method was determined to be 77% compared to 53% for the standard TRUS-guided biopsy method.
Studies
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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
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