Abstract No. 114: Smart prostate biopsy with fusion image guidance improves cancer detection rates

PurposeProstate biopsy is performed blindly without focal imaging guidance other than ultrasound to aim the needle towards the peripheral zone or a specific sextant region of the prostate organ. This conventional technique is both blind and random, and does not use MRI imaging information that might localize tumors. A multimodality fusion navigation system for prostate biopsy allows for real-time mapping and referencing to pre-procedural MRI images.Materials and MethodsA ultrasound + MRI fusion platform for prostate biopsy guidance was custom fabricated and demonstrated in phantoms, animals, and 360 patients. Patients underwent multiparametric prostate MRI, and identified lesions were assigned a suspicion for cancer as low, moderate or high. Patients underwent standard 12 sextant US biopsies, followed by fusion guided US biopsy of targets defined by pre-procedural MRI. Tissue was correlated with imaging features by mapping the biopsy location to the image. Standard blind sextant biopsies were analyzed with and without the addition of targeted fusion biopsies.ResultsThe addition of fusion targeted prostate biopsy to conventional random biopsy in patients with focal targets on MRI yielded marked increase in cancer detection rates. Targeted prostate biopsies added clinical value to standard blind prostate biopsies in the setting of previous negative biopsy and anterior or central gland lesions visible on MRI, that might not otherwise be sampled by conventional ultrasound guided biopsy. Imaging suspicion levels correlated with Gleason scores. Prior biopsy location was used to map subsequent biopsy location in the setting of patients with low Gleason scores undergoing surveillance biopsy.ConclusionReal-time multimodality feedback with fusion guidance for prostate biopsy using prior MRI images is feasible and does not require the presence of the MRI itself. Cancer detection rates are markedly improved with the addition of targeted fusion biopsy to conventional blind random biopsies. PurposeProstate biopsy is performed blindly without focal imaging guidance other than ultrasound to aim the needle towards the peripheral zone or a specific sextant region of the prostate organ. This conventional technique is both blind and random, and does not use MRI imaging information that might localize tumors. A multimodality fusion navigation system for prostate biopsy allows for real-time mapping and referencing to pre-procedural MRI images. Prostate biopsy is performed blindly without focal imaging guidance other than ultrasound to aim the needle towards the peripheral zone or a specific sextant region of the prostate organ. This conventional technique is both blind and random, and does not use MRI imaging information that might localize tumors. A multimodality fusion navigation system for prostate biopsy allows for real-time mapping and referencing to pre-procedural MRI images. Materials and MethodsA ultrasound + MRI fusion platform for prostate biopsy guidance was custom fabricated and demonstrated in phantoms, animals, and 360 patients. Patients underwent multiparametric prostate MRI, and identified lesions were assigned a suspicion for cancer as low, moderate or high. Patients underwent standard 12 sextant US biopsies, followed by fusion guided US biopsy of targets defined by pre-procedural MRI. Tissue was correlated with imaging features by mapping the biopsy location to the image. Standard blind sextant biopsies were analyzed with and without the addition of targeted fusion biopsies. A ultrasound + MRI fusion platform for prostate biopsy guidance was custom fabricated and demonstrated in phantoms, animals, and 360 patients. Patients underwent multiparametric prostate MRI, and identified lesions were assigned a suspicion for cancer as low, moderate or high. Patients underwent standard 12 sextant US biopsies, followed by fusion guided US biopsy of targets defined by pre-procedural MRI. Tissue was correlated with imaging features by mapping the biopsy location to the image. Standard blind sextant biopsies were analyzed with and without the addition of targeted fusion biopsies. ResultsThe addition of fusion targeted prostate biopsy to conventional random biopsy in patients with focal targets on MRI yielded marked increase in cancer detection rates. Targeted prostate biopsies added clinical value to standard blind prostate biopsies in the setting of previous negative biopsy and anterior or central gland lesions visible on MRI, that might not otherwise be sampled by conventional ultrasound guided biopsy. Imaging suspicion levels correlated with Gleason scores. Prior biopsy location was used to map subsequent biopsy location in the setting of patients with low Gleason scores undergoing surveillance biopsy. The addition of fusion targeted prostate biopsy to conventional random biopsy in patients with focal targets on MRI yielded marked increase in cancer detection rates. Targeted prostate biopsies added clinical value to standard blind prostate biopsies in the setting of previous negative biopsy and anterior or central gland lesions visible on MRI, that might not otherwise be sampled by conventional ultrasound guided biopsy. Imaging suspicion levels correlated with Gleason scores. Prior biopsy location was used to map subsequent biopsy location in the setting of patients with low Gleason scores undergoing surveillance biopsy. ConclusionReal-time multimodality feedback with fusion guidance for prostate biopsy using prior MRI images is feasible and does not require the presence of the MRI itself. Cancer detection rates are markedly improved with the addition of targeted fusion biopsy to conventional blind random biopsies. Real-time multimodality feedback with fusion guidance for prostate biopsy using prior MRI images is feasible and does not require the presence of the MRI itself. Cancer detection rates are markedly improved with the addition of targeted fusion biopsy to conventional blind random biopsies.