Accuracy of Magnetic Resonance Imaging-Ultrasound Fusion-Guided and Systematic Biopsy of the Prostate

Thomas In de Braekt; Sanne B T van Rooij; Alette W Daniels-Gooszen; Wout A Scheepens; Rik de Jongh; Steven L Bosch; Joost Nederend

doi:10.1093/bjr/tqae080

Accuracy of Magnetic Resonance Imaging-Ultrasound Fusion-Guided and Systematic Biopsy of the Prostate

Br J Radiol. 2024 Apr 16:tqae080. doi: 10.1093/bjr/tqae080. Online ahead of print.

Authors

Thomas In de Braekt¹, Sanne B T van Rooij², Alette W Daniels-Gooszen¹, Wout A Scheepens³, Rik de Jongh³, Steven L Bosch⁴, Joost Nederend¹

Affiliations

¹ Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands.
² Department of Radiology, Antwerp University Hospital, Antwerpen, Belgium.
³ Department of Urology, Catharina Hospital, Eindhoven, The Netherlands.
⁴ Department of Pathology, Eurofins-PAMM, Eindhoven, The Netherlands.

PMID: 38627253
DOI: 10.1093/bjr/tqae080

Abstract

Objectives: Prostate multiparametric magnetic resonance imaging (mpMRI) with subsequent targeted biopsy of suspicious lesions have a critical role in the diagnostic workup of prostate cancer. The objective was to evaluate the diagnostic accuracy of systematic biopsies, targeted biopsies, and the combination of both in prostate cancer detection.

Methods: From 1-1-2013 to 1-6-2022, biopsy-naïve and prior biopsy-negative patients who underwent both systematic and targeted biopsies were included. MRIs were evaluated according to PI-RADS with biopsy threshold set at PI-RADS ≥3. Systematic biopsies consisted of 8-12 cores, based on prostate volume. Overall prostate cancer and clinically significant cancer (Gleason Score ≥3 + 4) detection rates were stratified based on PI-RADS and location within the prostate, and compared between biopsy types using McNemar's test.

Results: Among 867 patients, 615 had prostate cancer, with 434 clinically significant cases. Overall detection rates were: PI-RADS 3 48%, PI-RADS 4 72% and PI-RADS 5 90%. Detection rates for clinically significant cancer were 21%, 53% and 72%, respectively. The combination of biopsy methods was most accurate in detecting clinically significant prostate cancer (P < 0.001). Targeted biopsies alone detected more clinically significant prostate cancer than systematic biopsies alone (43.1% versus 40.3%, P = 0.046). For posterior PI-RADS 5 lesions, no statistically significant difference was found between all biopsy methods.

Conclusions: In the detection of clinically significant prostate cancer, the combination of systematic and targeted biopsies proves most effective. Targeted biopsies rarely missed significant cancer for posterior PI-RADS 5 lesions, suggesting systematic biopsies could be reserved for instances where targeted biopsy results are negative.

Advances in knowledge: This study emphasizes on the efficacy of mpMRI and targeted biopsies in suspected prostate cancer in real-world clinical context. For PI-RADS 5 lesions, systematic biopsies provide limited clinical benefit and may only be necessary when targeted biopsy results are negative.