Effectiveness and Accuracy of MRI-Ultrasound Fusion Targeted Biopsy Based on PI-RADS v2.1 Category in Transition/Peripheral Zone of the Prostate

Yunyun Liu; Shuai Wang; Guang Xu; Bangguo Zhou; Ying Zhang; Beibei Ye; Lihua Xiang; Yifeng Zhang; Huixiong Xu

doi:10.1002/jmri.28614

Effectiveness and Accuracy of MRI-Ultrasound Fusion Targeted Biopsy Based on PI-RADS v2.1 Category in Transition/Peripheral Zone of the Prostate

J Magn Reson Imaging. 2023 Sep;58(3):709-717. doi: 10.1002/jmri.28614. Epub 2023 Feb 11.

Authors

Yunyun Liu^{1

2

3}, Shuai Wang^{1

2

3}, Guang Xu^{1

2

3}, Bangguo Zhou^{1

2

3}, Ying Zhang^{1

2

3}, Beibei Ye^{1

2

3}, Lihua Xiang^{1

2

3}, Yifeng Zhang^{1

2

3}, Huixiong Xu⁴

Affiliations

¹ Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
² Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.
³ Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.
⁴ Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.

PMID: 36773016
DOI: 10.1002/jmri.28614

Abstract

Background: MRI-ultrasound fusion targeted biopsy (MRI-TBx) improves the clinically significant prostate cancer (csPCa) detection with fewer cores. However, whether systematic biopsy-guided by transrectal ultrasound (TRUS-SBx) can be omitted when undergoing MRI-TBx in transition zone (TZ) and peripheral zone (PZ) remains unclear.

Purpose: To assess the performance and effectiveness of MRI-TBx based on PI-RADS v2.1 for csPCa diagnosis in TZ and PZ, respectively.

Study type: Retrospective.

Subjects: A total of 309 selected cases (median age 70 years) with 356 lesions who underwent both MRI-TBx and TRUS-SBx were enrolled.

Field strength/sequence: A 3.0 T, multiparametric MRI (mp-MRI) including T2-weighted turbo-spin echo imaging (T2WI), diffusion-weighted spin-echo echo planar imaging (DWI), dynamic contrast-enhanced MRI with time-resolved T1-weighted imaging (DCE).

Assessment: Mp-MRI was assessed by two radiologists using PI-RADS v2.1. The csPCa detection rates provided by MRI-TBx, TRUS-SBx and combined biopsy in TZ and PZ were calculated, respectively.

Statistical tests: McNemar test was used to compare the csPCa detection rates in TZ and PZ, respectively. The frequencies and distribution of all detected prostate cancers by different biopsy methods were also compared. P < 0.05 was considered statistically significant.

Results: Among 356 lesions in 309 patients, 208 (68 in TZ, 140 in PZ) were pathologically confirmed as csPCa. In TZ, there were significant differences for csPCa detection with PI-RADS 3 between combined biopsy and TRUS-SBx (23.5% vs. 15.3%), MRI-TBx (23.5% vs. 16.3%), respectively. MRI-TBx detected 23% (19/83) cases missed by TRUS-SBx in which 68% (13/19) were csPCa. In PZ, there were no statistical differences between MRI-TBx and combined biopsy with PI-RADS 3-5 (P = 0.21, 0.25, 0.07, respectively). In 9% (14/152) cases only detected by MRI-TBx, 86% (12/14) were clinically significant. Five percent (7/152) of cases only detected by TRUS-SBx were completely nonclinically significant.

Data conclusion: MRI-TBx played a positive role on csPCa diagnosis in TZ, but combined biopsy might be the best choice especially in the subgroup PI-RADS 3. In PZ, MRI-TBx had an advantage over TRUS-SBx for csPCa detection.

Evidence level: 2.

Technical efficacy: Stage 2.

Keywords: MRI-ultrasound fusion targeted biopsy; PI-RADS; prostate cancer; systematic biopsy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Humans
Image-Guided Biopsy / methods
Magnetic Resonance Imaging / methods
Male
Prostate* / diagnostic imaging
Prostate* / pathology
Prostatic Neoplasms* / diagnostic imaging
Prostatic Neoplasms* / pathology
Retrospective Studies