Mri/Us Fusion Prostate Biopsies: Cancer Detection Rates

You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 2011846 MRI/US FUSION PROSTATE BIOPSIES: CANCER DETECTION RATES Ardeshir Rastinehad, Jochen Kruecker, Compton Benjamin, Paul Chung, Baris Turkbey, Sheng Xu, Julia Locklin, Stacey Gates, Carey Buckner, Marston Linehan, Gennady Bratslavsky, Neil Glossop, Peter Choyke, Bradford Wood, and Peter Pinto Ardeshir RastinehadArdeshir Rastinehad Bethesda, MD More articles by this author , Jochen KrueckerJochen Kruecker Bethesda, MD More articles by this author , Compton BenjaminCompton Benjamin Bethesda, MD More articles by this author , Paul ChungPaul Chung Bethesda, MD More articles by this author , Baris TurkbeyBaris Turkbey Bethesda, MD More articles by this author , Sheng XuSheng Xu Bethesda, MD More articles by this author , Julia LocklinJulia Locklin Bethesda, MD More articles by this author , Stacey GatesStacey Gates Bethesda, MD More articles by this author , Carey BucknerCarey Buckner Bethesda, MD More articles by this author , Marston LinehanMarston Linehan Bethesda, MD More articles by this author , Gennady BratslavskyGennady Bratslavsky Bethesda, MD More articles by this author , Neil GlossopNeil Glossop Bethesda, MD More articles by this author , Peter ChoykePeter Choyke Bethesda, MD More articles by this author , Bradford WoodBradford Wood Bethesda, MD More articles by this author , and Peter PintoPeter Pinto Bethesda, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.667AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The fusion platform combines the benefits of MRI and real time TRUS imaging to perform image guided biopsies. We report the cancer detection rates for the system. METHODS Two radiologists reviewed multiparametric MRI in patients with suspicion or diagnosis of prostate cancer (CaP), 193 patient encounters were evaluated. The MRI of the prostate included T2, DCE, DWI, and spectroscopy images. All lesions were identified and graded by number of sequences positive: low (<2), moderate (3) and high (4) suspicion. An EM generator was placed above the pelvis which allows for real-time tracking of a biopsy guide with an embedded EM tracking sensor (Philips Healthcare, Canada). A manual 2D prostate sweep was reconstructed in 3D, registered and fused to the prostate MR images and assigned targets for biopsy. The ‘protocol' biopsy included a standard 12 core biopsy followed by a MRI/US fusion biopsy of the suspicious MR targeted lesions. RESULTS The mean age was 61.5 + 8.1 years with a median PSA 5.8 ng/ml, and 15/193 (7.7%) patients had a positive DRE. A chi-squared analysis revealed a direct correlation with the degree of MR suspicion and incidence of CaP detected per patient and per MR target lesion (p<0.01) (Table 1). A comparison between the 22 patients only positive on the 12 core biopsy and the 20 patients only positive on the MR/US biopsy revealed that the 12 core biopsy failed to diagnose 9 patients with Gleason 6, 7 patients with Gleason 7, and 4 patients with Gleason >8. The fusion biopsy system missed no patients with Gleason > 8 (p=0.005). (Chart 1) MRI Suspicion NO CANCER DETECTED CANCER DETECTED LOW Patient 63.9% 46/72 36.1% 26/72 Lesion 85% 255/300 15.0% 45/300 MODERATE Patient 41.6% 32/77 58.4% 45/77 Lesion 65.1% 114/175 34.5% 60/174 HIGH Patient 15.9% 7/44 84.1% 37/44 Lesion 33.8% 23/68 67.6% 46/68 CONCLUSIONS The fusion platform can stratify patients in to 3 groups which have a statistically different incidence of CaP. 84.1% of patients with a high suspicion lesion(s) were found to have CaP on the ‘protocol' biopsy. Secondly, when the platform fails to detect cancer compared to the 12 core biopsy, the cancer missed was statistically lower risk. This platform will help improve the quantification of a patient's CaP and possibly improve the selection of patients for focal therapy, active surveillance and/or whole gland therapy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e340 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ardeshir Rastinehad Bethesda, MD More articles by this author Jochen Kruecker Bethesda, MD More articles by this author Compton Benjamin Bethesda, MD More articles by this author Paul Chung Bethesda, MD More articles by this author Baris Turkbey Bethesda, MD More articles by this author Sheng Xu Bethesda, MD More articles by this author Julia Locklin Bethesda, MD More articles by this author Stacey Gates Bethesda, MD More articles by this author Carey Buckner Bethesda, MD More articles by this author Marston Linehan Bethesda, MD More articles by this author Gennady Bratslavsky Bethesda, MD More articles by this author Neil Glossop Bethesda, MD More articles by this author Peter Choyke Bethesda, MD More articles by this author Bradford Wood Bethesda, MD More articles by this author Peter Pinto Bethesda, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...