scholarly journals Assessment of the Minimal Targeted Biopsy Core Number per MRI Lesion for Improving Prostate Cancer Grading Prediction

2020 ◽  
Vol 9 (1) ◽  
pp. 225 ◽  
Author(s):  
Guillaume Ploussard ◽  
Jean-Baptiste Beauval ◽  
Raphaële Renard-Penna ◽  
Marine Lesourd ◽  
Cécile Manceau ◽  
...  
Keyword(s):  
Lesion Size ◽  
Targeted Biopsy ◽  
Resonance Imaging ◽  
Grade Group ◽  
Final Grade ◽  
Prostate Imaging ◽  
Biopsy Core ◽  
Mri Characteristics ◽  
The Impact ◽  
Cancer Grading

Background: To study the impact of MRI characteristics and of targeted biopsy (TB) core number on the final grade group (GG) prediction. Materials and Methods: The cohort was 478 consecutive patients who underwent radical prostatectomy (RP) after positive mpMRI (multiparametric magnetic resonance imaging) followed by fusion TB. Endpoints were the upgrading and concordance rates between TB and RP specimens. Results: Upgrading rate after TB was 40.6%. Patients with upgrading had lower PIRADS (Prostate Imaging-Reporting and Data System) scores (p < 0.001), smaller lesion size (p = 0.017), fewer TB cores (p < 0.001), and lower TB density (p = 0.015) compared with cases with grade concordance. There was a significant continuous improvement in upgrading rate when TB core number per lesion increased from 56.3% to 25.6% when <2 or ≥5 TB cores were taken, respectively (p = 0.002). The minimal TB number per lesion to reduce upgrading risk to approximately 30%was 4 in PIRADS 3, and 3 in PIRADS 4–5 cases. Conclusions: Grade group prediction by TB is significantly improved by higher PIRADS score, larger lesion size, and increased TB per lesion. At least four TB cores should be taken in PIRADS 3 score lesions, whereas three cores seem enough in PIRADS 4–5 cases to improve GG prediction and limit upgrading risk.

scholarly journals Multiparametric magnetic resonance imaging-transrectal ultrasoundguided cognitive fusion biopsy of the prostate: Clinically significant cancer detection rates stratified by the Prostate Imaging and Data Reporting System version 2 assessment categories

2018 ◽  
Vol 12 (12) ◽  
Author(s):  
Susan John ◽  
Steven Cooper ◽  
Rodney H. Breau ◽  
Trevor A. Flood ◽  
Ilias Cagiannos ◽  
...  
Keyword(s):  
Cancer Detection ◽  
Reporting System ◽  
Lesion Size ◽  
Targeted Biopsy ◽  
Resonance Imaging ◽  
Cognitive Fusion ◽  
Detection Rates ◽  
Prostate Imaging ◽  
Clinically Significant ◽  
Targeted Biopsies

Introduction: We aimed to report the clinically significant prostate cancer (PCa) detection rate in men undergoing magnetic resonance imaging-transrectal ultrasound (MRI-TRUS)-cognitive fusion (CF) targeted biopsies stratified by the Prostate Imaging and Data Reporting System (PI-RADS) version 2 (v2) scores. Methods: With a quality assurance waiver from the institutional review board, we identified a cohort of men who underwent MRITRUS- CF and synchronous template biopsy from 2015–2017. MRI (PI-RADS v2 score, lesion size, lesion location [peripheral or transition zone (PZ/TZ)]), and CF-TRUS biopsy (operator experience, TRUS visibility, and number of biopsies) features were extracted. The primary outcome was diagnosis of clinically significant (Gleason score ≥3+4=7 or International Society of Urological Pathology [ISUP] grade group ≥2) PCa. Results: During the study period, 131 men (with 142 PI-RADS v2 score ≥3 lesions) met inclusion criteria; 98 men had previously negative template biopsy and 33 were on active surveillance for previously detected low-grade PCa. In total, 41.9% (55/131) men had clinically significant PCa — 17.6% (23/131) detected on targeted biopsy only, 8.4% (11/131) on template biopsy only, and 16.0% (21/131) on both targeted and template biopsy. Clinically significant PCa detection stratified by PI-RADS v2 scores were: 11.1% (3/27) for score 3 (indeterminate), 42.9% (24/56) for score 4 (significant cancer likely), and 35.6% (21/59) for score 5 (significant cancer very likely). Clinically significant PCa detection rates in targeted biopsies were better among PZ (41.8% [33/79]) compared to TZ (23.8% [15/63]) lesions (p=0.025) in TRUS-visible lesions (p=0.033) and in the most experienced radiologists (p=0.05), with no difference by lesion size or number of additional core biopsies performed (all p>0.05). Conclusions: CF-MRI-TRUS-guided targeted biopsy yielded substantially lower rates of clinically significant cancer in PI-RADS v2 score 4 and 5 lesions when compared to published results using in-bore MR-guided or automated MRI-TRUS fusion guidance systems. Cancer detection was worst for TZ lesions.

scholarly journals Extent of High-Grade Prostatic Adenocarcinoma in Multiparametric Magnetic Resonance Imaging–Targeted Biopsy Enhances Prediction of Pathologic Stage

2021 ◽  
Author(s):  
Nathan Paulson ◽  
Robin T. Vollmer ◽  
Peter A. Humphrey ◽  
Preston C. Sprenkle ◽  
John Onofrey ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Prostatic Adenocarcinoma ◽  
High Grade ◽  
Targeted Biopsy ◽  
Resonance Imaging ◽  
Grade Group ◽  
Multiparametric Magnetic Resonance Imaging ◽  
Pathologic Stage ◽  
Targeted Biopsies

Context.— Multiparametric magnetic resonance imaging (mpMRI) of prostate with targeted biopsy has enhanced detection of high-grade prostatic adenocarcinoma (HG PCa). However, utility of amount of HG PCa (Gleason pattern 4/5) in mpMRI-targeted biopsies versus standard 12-core biopsies in predicting adverse outcomes on radical prostatectomy (RP) is unknown. Objective.— To examine the utility of amount of HG PCa in mpMRI-targeted biopsies versus standard 12-core biopsies in predicting adverse RP outcomes. Design.— We performed a retrospective review of prostate biopsies, which had corresponding RP, 1 or more mpMRI-targeted biopsy, and grade group 2 disease or higher. For the 169 cases identified, total millimeters of carcinoma and HG PCa, and longest length HG PCa in a single core were recorded for 12-core biopsies and each set of mpMRI-targeted biopsies. For RP specimens, Gleason grade, extraprostatic extension, seminal vesicle involvement, and lymph node metastasis were recorded. The main outcome studied was prostate-confined disease at RP. A logistic regression model was used to test which pre-RP variables related to this outcome. Results.— Univariate analysis showed significant associations with adverse RP outcomes in 5 of 8 quantifiable variables; longest millimeter HG PCa in a single 12-core biopsy, highest grade group in any core, and total millimeter HG in mpMRI-targeted biopsies showed no statistical association (P = .54, P = .13, and P = .55, respectively). In multivariate analysis, total millimeter carcinoma in all cores, highest GrGrp in any core, and longest millimeter HG PCa in a single mpMRI-targeted core provided additional predictive value (P &lt; .001, P = .004, and P = .03, respectively). Conclusions.— Quantitation of HG PCa in mpMRI-targeted biopsies provides additional value over 12-core biopsies alone in predicting nonorgan confined prostate cancer at RP. Linear millimeters of HG PCa in mpMRI-targeted biopsies is a significant parameter associated with higher pathologic stage and could be of value in risk models.

scholarly journals Focused Submission of Tissue for Radical Prostatectomy Following Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion-Targeted Biopsy

2019 ◽  
Vol 28 (1) ◽  
pp. 44-50
Author(s):  
Danielle Fasciano ◽  
Marie-Lisa Eich ◽  
Maria del Carmen Rodriguez Pena ◽  
Soroush Rais-Bahrami ◽  
Jennifer Gordetsky
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Radical Prostatectomy ◽  
Prostate Biopsy ◽  
Margin Status ◽  
Targeted Biopsy ◽  
Resonance Imaging ◽  
Grade Group ◽  
Significant Difference

Prostate cancer can be difficult to appreciate grossly and therefore partial sampling of the gland can lead to incorrect grading, staging, or margin status. However, submitting the entire prostate is more time consuming and costly. We investigated the use of magnetic resonance imaging/ultrasound-targeted biopsy for the selective submission of prostatectomy specimens. We performed a retrospective review for patients with cancer on targeted prostate biopsy who underwent subsequent radical prostatectomy. Prostatectomy specimens were submitted in their entirety and assessed for Grade Group, extraprostatic extension (EPE), margins, and number of blocks. For Targeted-Grossing (TG) assessment, apex margin, bladder neck margin, seminal vesicles, and vas deferens sections were included. For the remainder of the prostate, only sections from areas shown to be positive for cancer on targeted biopsy were included in the analysis. With total tissue submission, EPE was found in 39/81 (48.1%) cases and positive margins in 19/81 (23.5%) cases. The TG method required significantly fewer blocks: 15.8 ± 5.9 versus 44.9 ± 11.9 ( P < .0001). The TG method would have diagnosed the correct stage in 73/81 (90.1%) cases, Grade Group in 74/81 (91.4%) cases, and margin status in 79/81 (97.5%) cases. EPE was missed completely by the TG method in 7 cases ( P = .008), of which 5/7 (71.4%) had focal EPE. There was no significant difference in stage ( P = .24), Grade Group ( P = .95), or margin status ( P = .16) between the 2 methods. Grossing utilizing selective tissue submission from areas found to be positive for prostate cancer on magnetic resonance imaging/ultrasound-targeted prostate biopsy remains inferior to complete submission of tissue for radical prostatectomy specimens.

scholarly journals Pitfalls in Prostate Cancer Magnetic Resonance Imaging

2021 ◽  
Vol 42 (01) ◽  
pp. 080-088
Author(s):  
Kuldeep Yadav ◽  
Binit Sureka ◽  
Poonam Elhence ◽  
Gautam Ram Choudhary ◽  
Himanshu Pandey
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Wide Spectrum ◽  
Strong Predictor ◽  
Targeted Biopsy ◽  
Resonance Imaging ◽  
Prostate Imaging ◽  
Prostate Biopsies ◽  
Pictorial Essay

AbstractImage-guided prostate biopsies are changing the outlook of prostate cancer (PCa) diagnosis, with the degree of suspicion on multiparametric magnetic resonance imaging (mp-MRI) being a strong predictor of targeted biopsy outcome. It is important not only to detect these suspicious lesions but also to be aware of the potential pitfalls in mp-MRI prostate imaging. The aim of this pictorial essay is to show a wide spectrum of representative cases, which are frequently misdiagnosed as PIRADS ⅘ while reporting mp-MRI of the prostate. We provide some valuable recommendations to avoid these fallacies and improve mp-MRI of prostate evaluation.

Does size matter? Lesion size as an indicator of number of cores needed to detect clinically significant prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 283-283
Author(s):  
Amir H. Lebastchi ◽  
Luke P. O'Connor ◽  
Alex Z. Wang ◽  
Nitin Yerram ◽  
Sandeep Gurram ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Lesion Size ◽  
Time Interval ◽  
Targeted Biopsy ◽  
Biopsy Core ◽  
Multiple Cores ◽  
Clinically Significant ◽  
Size Matter ◽  
Continuous Predictor

283 Background: MRI/US fusion guided prostate biopsy (FBx) has been shown to detect clinically significant prostate cancer (csCaP) at higher rates and with fewer cores than standard prostate biopsy. Size plays an important role in assigning a suspicion level (PI-RADS) to lesions identified on MRI. However, tumor characteristics may pose challenges to accurately characterizing the lesion despite the size. This study sought to determine if there are size cutoffs at which a lesion may be accurately characterized as clinically significant cancer with a single biopsy core. Methods: A retrospective analysis of a prospectively maintained database of all patients undergoing FBx at an academic referral center between May 2014 and January 2018 was conducted. At least two FBx cores were taken from each lesion identified on mpMRI. GEE-based univariate logistic regression model with exchangeable correlation was used determine if size was a significant predictor of positive and negative agreement. Predictability of size as a significant continuous predictor was quantified by AUC. Size thresholds at which multiple cores per lesion are needed to avoid missing > 2% of csCaP were calculated, allowing for a 25% discordance rate. Results: An analysis of a total of 1141 FBx of 2200 lesions was performed during the study time interval. Size was a significant predictor of both positive (OR = 2.43, 1.83-3.23, p < 0.01) and negative (OR = 0.58, 0.44-0.76, p < 0.01) agreement of csCaP. AUC% for positive and negative agreement was 65.8 and 57.6, respectively. Size thresholds of 0.65 and 1.70 cm limited CS cancers missed by skipping a second targeted biopsy core to 2% while allowing for a 25% discordance. Conclusions: These data indicate that clinically significant prostate cancer in lesions less than 0.65 cm and greater than 1.70 cm may be characterized with a single targeted biopsy core, sparing 33.5% of lesions (21% patients) a double core targeted biopsy.

Outcomes of magnetic resonance imaging fusion-targeted biopsy of prostate imaging reporting and data system 3 lesions

2018 ◽  
Vol 37 (8) ◽  
pp. 1581-1586 ◽  
Author(s):  
Tae Jin Kim ◽  
Min Seung Lee ◽  
Sung Il Hwang ◽  
Hak Jong Lee ◽  
Sung Kyu Hong
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Data System ◽  
Targeted Biopsy ◽  
Resonance Imaging ◽  
Prostate Imaging

scholarly journals Race and prostate imaging: implications for targeted biopsy and image-based prostate cancer interventions

2019 ◽  
Vol 1 (1) ◽  
pp. e000010
Author(s):  
Michael D Gross ◽  
Bashir Al Hussein Al Awamlh ◽  
Jonathan E Shoag ◽  
Elizabeth Mauer ◽  
Samprit Banerjee ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Asian Americans ◽  
Asian American ◽  
Specific Antigen ◽  
Gleason Grade ◽  
Targeted Biopsy ◽  
Grade Group ◽  
Prostate Mri ◽  
Prostate Imaging ◽  
Asian American Men

PurposeFor men with an elevated prostate-specific antigen (PSA), there is a strong evidence for prostate MRI to assess the risk of clinically significant prostate cancer (CSPC) and guide targeted-biopsy interventions. Prostate MRI is assessed using the Prostate Imaging-Reporting and Data System (PI-RADS), which is scored from 1 to 5. Equivocal or suspicious findings (PI-RADS 3–5) are recommended for subsequent targeted biopsy, for which the risk of infection and sepsis is increasing. However, PI-RADS was developed primarily in men of European descent. We sought to elucidate PI-RADS and MRI-targeted biopsy outcomes in Asian men, a rapidly growing population in the USA, Europe, Australia and internationally.Materials and methodsA prospective cohort of 544 men with elevated PSA without a diagnosis of prostate cancer who underwent MRI-targeted biopsy at our institution from January 2012 to December 2018 was analyzed. We categorized the cohort by self-designated race then used a validated algorithm which uses surname lists to identify a total of 78 (14%) Asian-Americans. The primary outcome was the likelihood of diagnosing CSPC (Gleason grade group >1) in Asian-Americans versus non-Asian-Americans. Multivariable logistic regression was used to determine the association of demographic and other characteristics with CSPC.ResultsOverall, MRI-targeted biopsy identified CSPC in 17% of Asian-American men versus 39% of non-Asian-American men (p<0.001). Notably for PI-RADS 3, only 6% of Asian-Americans versus 15% of others were diagnosed with CSPC. In adjusted analyses, Asian-American men were less likely to be diagnosed on MRI-targeted biopsy with CSPC (OR 0.30, 95% CI 0.14 to 0.65, p=0.002) and indolent prostate cancer (OR 0.37, 95% CI 0.15 to 0.91, p=0.030) than other races. Regardless of race those who were biopsy naïve were more likely (OR 2.25, 95% CI 1.45 to 3.49, p<0.001) to be diagnosed with CSPC.ConclusionWe found that PI-RADS underperforms in Asian-American men. For instance, only 2 of 35 (6%) Asian-American men with PI-RADS 3 were diagnosed with CSPC on MRI targeted biopsy. This has significant implications for overuse of diagnostic and image-guided interventional approaches in Asian-Americans, given the increasing risk of infectious complications from biopsy. Additional validation studies are needed to confirm our findings.

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