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Maddah MM, Hedayatizadeh-Omran A, Moosazadeh M, Alizadeh-Navaei R. Evaluation of the Prognostic Role of TP53 Gene Mutations in Prostate Cancer Outcome: A Systematic Review and Meta-Analysis. Clin Genitourin Cancer 2024; 22:102226. [PMID: 39393313 DOI: 10.1016/j.clgc.2024.102226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 08/31/2024] [Accepted: 09/07/2024] [Indexed: 10/13/2024]
Abstract
INTRODUCTION Prostate cancer, 1 of the most common cancers in men, is influenced by age, genetics, race, and lifestyle. The TP53 gene, encoding the p53 protein crucial for cell cycle regulation and DNA repair, is frequently mutated in metastatic prostate cancers. These mutations impact prognosis and resistance to treatments, underscoring the role of genetic factors in disease progression and therapeutic challenges. METHODS Databases such as PubMed, Scopus, and ISI were searched using the keywords "prostate cancer," "P53," "TP53," "survival," and "prognosis," along with manual searches in other sources. Initial screening and selection of articles were conducted independently and blinded by 2 reviewers, focusing on titles abstracts, and full texts when necessary. The Newcastle-Ottawa Scale (NOS) was used for full-text evaluation. Data were analyzed using STATA 11, with heterogeneity assessed using the I² index. RESULTS Overall survival (OS) for prostate cancer patients with TP53 mutations was approximately 13% lower than for those without mutations at 1 year, 20% lower at 3 years, and 16% lower at 5 years. TP53 mutations were also associated with faster disease progression and a 15% reduction in progression-free survival (PFS) over 1 year. The hazard ratio (HR) for death in patients with TP53 mutations was 1.76, and for PFS, it was 1.62, indicating a 76% increased risk of death and a 62% increased risk of disease progression. CONCLUSION TP53 mutations are associated with shorter survival and faster disease progression in prostate cancer, underscoring the importance of precise evaluation and management of these mutations in treatment.
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Affiliation(s)
- Mohammad Moein Maddah
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Science, Sari, Iran
| | - Akbar Hedayatizadeh-Omran
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Science, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Science, Sari, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Science, Sari, Iran.
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Sawhney V, Huang R, Huang WC, Lepor H, Taneja SS, Wysock J. Reply to Editorial Comment on "Predictors of Contralateral Disease in Men With Unilateral Lesions on Multiparametric MRI". Urology 2024; 193:155-156. [PMID: 39237011 DOI: 10.1016/j.urology.2024.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 09/07/2024]
Affiliation(s)
- Vyom Sawhney
- Department of Urology, NYU Langone Health, New York, NY.
| | - Richard Huang
- Department of Urology, NYU Langone Health, New York, NY
| | | | - Herbert Lepor
- Department of Urology, NYU Langone Health, New York, NY
| | | | - James Wysock
- Department of Urology, NYU Langone Health, New York, NY
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Lenfant L, Beitone C, Troccaz J, Beaugerie A, Rouprêt M, Seisen T, Renard-Penna R, Voros S, Mozer PC. Impact of Relative Volume Difference Between Magnetic Resonance Imaging and Three-dimensional Transrectal Ultrasound Segmentation on Clinically Significant Prostate Cancer Detection in Fusion Magnetic Resonance Imaging-targeted Biopsy. Eur Urol Oncol 2024; 7:430-437. [PMID: 37599199 DOI: 10.1016/j.euo.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/10/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Segmentation of three-dimensional (3D) transrectal ultrasound (TRUS) images is known to be challenging, and the clinician often lacks a reliable and easy-to-use indicator to assess its accuracy during the fusion magnetic resonance imaging (MRI)-targeted prostate biopsy procedure. OBJECTIVE To assess the effect of the relative volume difference between 3D-TRUS and MRI segmentation on the outcome of a targeted biopsy. DESIGN, SETTING, AND PARTICIPANTS All adult males who underwent an MRI-targeted prostate biopsy for clinically suspected prostate cancer between February 2012 and July 2021 were consecutively included. INTERVENTION All patients underwent a fusion MRI-targeted prostate biopsy with a Koelis device. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Three-dimensional TRUS and MRI prostate volumes were calculated using 3D prostate models issued from the segmentations. The primary outcome was the relative segmentation volume difference (SVD) between transrectal ultrasound and MRI divided by the MRI volume (SVD = MRI volume - TRUS volume/MRI volume) and its correlation with clinically significant prostate cancer (eg, International Society of Urological Pathology [ISUP] ≥2) positiveness on targeted biopsy cores. RESULTS AND LIMITATIONS Overall, 1721 patients underwent a targeted biopsy resulting in a total of 5593 targeted cores. The median relative SVD was significantly lower in patients diagnosed with clinically significant prostate cancer than in those with ISUP 0-1: (6.7% [interquartile range {IQR} -2.7, 13.6] vs 8.0% [IQR 3.3, 16.4], p < 0.01). A multivariate regression analysis showed that a relative SVD of >10% of the MRI volume was associated with a lower detection rate of clinically significant prostate cancer (odds ratio = 0.74 [95% confidence interval: 0.55-0.98]; p = 0.038). CONCLUSIONS A relative SVD of >10% of the MRI segmented volume was associated with a lower detection rate of clinically significant prostate cancer on targeted biopsy cores. The relative SVD can be used as a per-procedure quality indicator of 3D-TRUS segmentation. PATIENT SUMMARY A discrepancy of ≥10% between segmented magnetic resonance imaging and transrectal ultrasound volume is associated with a reduced ability to detect significant prostate cancer on targeted biopsy cores.
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Affiliation(s)
- Louis Lenfant
- Urologie, GRC n 5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France; CNRS, INSERM, Grenoble INP, TIMC, Univ. Grenoble Alpes, Grenoble, France; CNRS UMR 7222, INSERM U1150, Institut des Systèmes Intelligents et Robotique (ISIR), Sorbonne Université, Paris, France.
| | - Clément Beitone
- CNRS, INSERM, Grenoble INP, TIMC, Univ. Grenoble Alpes, Grenoble, France
| | - Jocelyne Troccaz
- CNRS, INSERM, Grenoble INP, TIMC, Univ. Grenoble Alpes, Grenoble, France
| | - Aurélien Beaugerie
- Urologie, GRC n 5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Morgan Rouprêt
- Urologie, GRC n 5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Thomas Seisen
- Urologie, GRC n 5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Raphaele Renard-Penna
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Sandrine Voros
- CNRS, INSERM, Grenoble INP, TIMC, Univ. Grenoble Alpes, Grenoble, France
| | - Pierre C Mozer
- Urologie, GRC n 5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France; CNRS UMR 7222, INSERM U1150, Institut des Systèmes Intelligents et Robotique (ISIR), Sorbonne Université, Paris, France
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4
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Lang J, McClure TD, Margolis DJA. MRI-Ultrasound Fused Approach for Prostate Biopsy-How It Is Performed. Cancers (Basel) 2024; 16:1424. [PMID: 38611102 PMCID: PMC11010881 DOI: 10.3390/cancers16071424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
The use of MRI-ultrasound image fusion targeted biopsy of the prostate in the face of an elevated serum PSA is now recommended by multiple societies, and results in improved detection of clinically significant cancer and, potentially, decreased detection of indolent disease. This combines the excellent sensitivity of MRI for clinically significant prostate cancer and the real-time biopsy guidance and confirmation of ultrasound. Both transperineal and transrectal approaches can be implemented using cognitive fusion, mechanical fusion with an articulated arm and electromagnetic registration, or pure software registration. The performance has been shown comparable to in-bore MRI biopsy performance. However, a number of factors influence the performance of this technique, including the quality and interpretation of the MRI, the approach used for biopsy, and experience of the practitioner, with most studies showing comparable performance of MRI-ultrasound fusion to in-bore targeted biopsy. Future improvements including artificial intelligence promise to refine the performance of all approaches.
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Affiliation(s)
- Jacob Lang
- Department of Urology, Weill Cornell Medicine, New York, NY 10068, USA
| | - Timothy Dale McClure
- Department of Urology, Weill Cornell Medicine, New York, NY 10068, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY 10068, USA
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Costa DN, Recchimuzzi DZ, Schieda N. Targeted Prostate Biopsies-What the Radiologist Needs to Know. Radiol Clin North Am 2024; 62:109-120. [PMID: 37973237 DOI: 10.1016/j.rcl.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The emergence of multiparametric MR imaging has enabled a more reliable targeted approach to diagnosis of prostate cancer. Targeted biopsies are central to the MR imaging-dependent pathway to prostate cancer diagnosis and potentially improve the detection of clinically significant prostate cancers. In a targeted biopsy, tissue samples are obtained from suspicious regions identified on a prebiopsy diagnostic MR imaging. This article describes and compares principles, advantages, and disadvantages of the different strategies available for targeting an MR imaging-visible suspicious lesion.
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Affiliation(s)
- Daniel N Costa
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX 75390, USA; Department of Urology, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX 75390, USA.
| | - Debora Z Recchimuzzi
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX 75390, USA
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Room C159, Ottawa, Ontario K1Y 4E9, Canada
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Paesano N, Catalá V, Tcholakian L, Trilla E, Morote J. A Systematic Review of the Current Status of Magnetic Resonance-Ultrasound Images Fusion Software Platforms for Transperineal Prostate Biopsies. Cancers (Basel) 2023; 15:3329. [PMID: 37444439 DOI: 10.3390/cancers15133329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Given this new context, our objective is to recognize the suitability of the currently available software for image fusion and the reported series using the transperineal route, as well as to generate new evidence on the complementarity of the directed and systematic biopsies, which has been established through the transrectal approach. EVIDENCE ACQUISITION This systematic review, registered in Prospero (CRD42022375619), began with a bibliographic search that was carried out in PubMed, Cochrane, and Google Scholar databases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria and the studied eligibility based on the Participants, Intervention, Comparator, and Outcomes (PICO) strategy were followed. Warp analysis of selected studies was performed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. In addition, a Google search of all currently available fusion platforms was performed. Our Google search found 11 different commercially available robots to perform transperineal image fusion biopsies, of which 10 devices have published articles supporting their diagnostic effectiveness in transperineal prostate biopsies. RESULTS A total of 30 articles were selected and the characteristics and results of the biopsies of 11,313 patients were analyzed. The pooled mean age was 66.5 years (63-69). The mean pooled PSA level was 7.8 ng/mL (5.7-10.8). The mean pooled prostate volume was 45.4 cc. (34-56). The mean pooled PSA density was 0.17 (0.12-0.27). The overall cancer detection rate for all prostate cancers was 61.4%, while for csPCa it was 47.8%. PCa detection rate was more effective than that demonstrated in the systematic transrectal biopsy. However, the detection of csPCa in the systematic biopsy was only 9.5% in the reported series. To standardize our review, we grouped prostate cancer screening results according to the population studied and the software used. When the same populations were compared between elastic and rigid software, we found that rigid biopsies had a higher csPCa detection rate than biopsies with elastic fusion systems. CONCLUSION Platforms performing prostate biopsy using transperineal image fusion have better detection rates of csPCa than systematic transrectal biopsies. Rigid fusion systems have a better csPCa detection rate than elastic ones. We found no diagnostic differences between the different types of robotic systems currently available. The complementarity of systematic biopsy has also been demonstrated in transperineal imaging fusion biopsies.
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Affiliation(s)
| | | | | | - Enric Trilla
- Department of Urology, Vall d'Hebron Hospital, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Juan Morote
- Department of Urology, Vall d'Hebron Hospital, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Girometti R, Giannarini G, Peruzzi V, Amparore D, Pizzolitto S, Zuiani C. MRI-informed prostate biopsy: What the radiologist should know on quality in biopsy planning and biopsy acquisition. Eur J Radiol 2023; 164:110852. [PMID: 37167683 DOI: 10.1016/j.ejrad.2023.110852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
Quality is currently recognized as the pre-requisite for delivering the clinical benefits expected by magnetic resonance imaging (MRI)-informed prostate biopsy (MRI-i-PB) in patients with a suspicion for clinically significant prostate cancer (csPCa). The "quality chain" underlying MRI-i-PB is multidisciplinary in nature, and depends on several factors related to the patient, imaging technique, image interpretation and biopsy procedure. This review aims at making the radiologist aware of biopsy-related factors impacting on MRI-i-PB quality, both in terms of biopsy planning (threshold for biopsy decisions, association with systematic biopsy and number of targeted cores) and biopsy acquisition (biopsy route, targeting technique, and operator's experience). While there is still space for improvement and better standardization of several biopsy-related procedures, current evidence suggests that high-quality MRI-i-PB can be delivered by acquiring and increased the number of biopsy cores targeted to suspicious imaging findings and perilesional area ("focal saturation biopsy"). On the other hand, uncertainty still exists as to whether software-assisted fusion of MRI and transrectal ultrasound images can outperform cognitive fusion strategy. The role for operator's experience and quality assurance/quality control procedures are also discussed.
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Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Gianluca Giannarini
- Urology Unit, University Hospital Santa Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Valeria Peruzzi
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Daniele Amparore
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Torino, Italy.
| | - Stefano Pizzolitto
- Unit of Pathology, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, p.le S. Maria della Misericordia n. 15, 33100 Udine, Italy.
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Orlando N, Edirisinghe C, Gyacskov I, Vickress J, Sachdeva R, Gomez JA, D'Souza D, Velker V, Mendez LC, Bauman G, Fenster A, Hoover DA. Validation of a surface-based deformable MRI-3D ultrasound image registration algorithm toward clinical implementation for interstitial prostate brachytherapy. Brachytherapy 2023; 22:199-209. [PMID: 36641305 DOI: 10.1016/j.brachy.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/05/2022] [Accepted: 11/28/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to evaluate and clinically implement a deformable surface-based magnetic resonance imaging (MRI) to three-dimensional ultrasound (US) image registration algorithm for prostate brachytherapy (BT) with the aim to reduce operator dependence and facilitate dose escalation to an MRI-defined target. METHODS AND MATERIALS Our surface-based deformable image registration (DIR) algorithm first translates and scales to align the US- and MR-defined prostate surfaces, followed by deformation of the MR-defined prostate surface to match the US-defined prostate surface. The algorithm performance was assessed in a phantom using three deformation levels, followed by validation in three retrospective high-dose-rate BT clinical cases. For comparison, manual rigid registration and cognitive fusion by physician were also employed. Registration accuracy was assessed using the Dice similarity coefficient (DSC) and target registration error (TRE) for embedded spherical landmarks. The algorithm was then implemented intraoperatively in a prospective clinical case. RESULTS In the phantom, our DIR algorithm demonstrated a mean DSC and TRE of 0.74 ± 0.08 and 0.94 ± 0.49 mm, respectively, significantly improving the performance compared to manual rigid registration with 0.64 ± 0.16 and 1.88 ± 1.24 mm, respectively. Clinical results demonstrated reduced variability compared to the current standard of cognitive fusion by physicians. CONCLUSIONS We successfully validated a DIR algorithm allowing for translation of MR-defined target and organ-at-risk contours into the intraoperative environment. Prospective clinical implementation demonstrated the intraoperative feasibility of our algorithm, facilitating targeted biopsies and dose escalation to the MR-defined lesion. This method provides the potential to standardize the registration procedure between physicians, reducing operator dependence.
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Affiliation(s)
- Nathan Orlando
- Department of Medical Biophysics, Western University, London, Ontario, Canada; Robarts Research Institute, Western University, London, Ontario, Canada.
| | | | - Igor Gyacskov
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Jason Vickress
- Department of Oncology, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - Robin Sachdeva
- Lawson Health Research Institute, London, Ontario, Canada
| | - Jose A Gomez
- London Health Sciences Centre, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - David D'Souza
- Department of Oncology, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - Vikram Velker
- Department of Oncology, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - Lucas C Mendez
- Department of Oncology, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - Glenn Bauman
- Department of Oncology, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - Aaron Fenster
- Department of Medical Biophysics, Western University, London, Ontario, Canada; Robarts Research Institute, Western University, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada
| | - Douglas A Hoover
- Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
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Gravestock P, Somani BK, Tokas T, Rai BP. A Review of Modern Imaging Landscape for Prostate Cancer: A Comprehensive Clinical Guide. J Clin Med 2023; 12:jcm12031186. [PMID: 36769834 PMCID: PMC9918161 DOI: 10.3390/jcm12031186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
The development of prostate cancer imaging is rapidly evolving, with many changes to the way patients are diagnosed, staged, and monitored for recurrence following treatment. New developments, including the potential role of imaging in screening and the combined diagnostic and therapeutic applications in the field of theranostics, are underway. In this paper, we aim to outline the current landscape in prostate cancer imaging and look to the future at the potential modalities and applications to come.
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Affiliation(s)
- Paul Gravestock
- Department of Urology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall in Tirol, 6060 Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, 6060 Hall in Tirol, Austria
| | - Bhavan Prasad Rai
- Department of Urology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK
- Correspondence:
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10
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De Vulder N, Slots C, Geldof K, Ramboer K, Dekimpe P, Uvin P, Walgraeve MS, Van Holsbeeck A, Gieraerts K. Safety and efficacy of software-assisted MRI-TRUS fusion-guided transperineal prostate biopsy in an outpatient setting using local anaesthesia. Abdom Radiol (NY) 2023; 48:694-703. [PMID: 36399208 DOI: 10.1007/s00261-022-03745-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate diagnostic accuracy, safety, and efficiency of an MRI-TRUS fusion-guided transperineal prostate biopsy method in an outpatient setting under local anaesthesia. METHODS Patients undergoing transperineal prostate biopsy were included from March 2021 to May 2022. Biopsies were performed under local anaesthesia in an outpatient setting, using specialised fusion software. Primary outcome was (clinically significant) cancer detection rate. Secondary outcomes were procedure time, patient discomfort during the procedure and complication rate. RESULTS We included 203 male patients (69 years +-SD 8.2) with PI-RADS score > 2. In total 223 suspicious lesions were targeted. Overall cancer detection rate and clinically significant cancer detection rate were 73.5% and 60.1%, respectively. (Clinically significant) cancer detection rates in PI-RADS 3, 4 and 5 lesions were 46.4% (23.2%), 78.5% (66.1%) and 93.5% (89.1%), respectively. Mean duration of the procedure including fusion, targeted and systematic biopsies was 22.5 min. Patients rated injection of local anaesthesia on a numeric pain rating scale on average 3.7/10 (SD 2.09) and biopsy core sampling 1.6/10 (SD 1.65). No patient presented with acute urinary retention on follow-up consultation. Two (1%) patients presented with infectious complications. Four (2%) patients experienced a vasovagal reaction. CONCLUSION Transperineal targeted biopsy with MRI-TRUS fusion software has high overall and clinically significant cancer detection rates. The method is well tolerated under local anaesthesia and in an outpatient setting.
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Affiliation(s)
| | | | - Koen Geldof
- AZ Sint-Lucas Brugge-Sint-Lucaslaan 29, 8310, Brugge, Belgium
| | - Kristof Ramboer
- AZ Sint-Lucas Brugge-Sint-Lucaslaan 29, 8310, Brugge, Belgium
| | - Piet Dekimpe
- AZ Sint-Lucas Brugge-Sint-Lucaslaan 29, 8310, Brugge, Belgium
| | - Pieter Uvin
- AZ Sint-Jan Brugge-Ruddershove 10, 8000, Brugge, Belgium
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11
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Connor MJ, Gorin MA, Eldred-Evans D, Bass EJ, Desai A, Dudderidge T, Winkler M, Ahmed HU. Landmarks in the evolution of prostate biopsy. Nat Rev Urol 2023; 20:241-258. [PMID: 36653670 DOI: 10.1038/s41585-022-00684-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 01/19/2023]
Abstract
Approaches and techniques used for diagnostic prostate biopsy have undergone considerable evolution over the past few decades: from the original finger-guided techniques to the latest MRI-directed strategies, from aspiration cytology to tissue core sampling, and from transrectal to transperineal approaches. In particular, increased adoption of transperineal biopsy approaches have led to reduced infectious complications and improved antibiotic stewardship. Furthermore, as image fusion has become integral, these novel techniques could be incorporated into prostate biopsy methods in the future, enabling 3D-ultrasonography fusion reconstruction, molecular targeting based on PET imaging and autonomous robotic-assisted biopsy.
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Affiliation(s)
- Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK. .,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK.
| | - Michael A Gorin
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Eldred-Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Edward J Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Ankit Desai
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, W6 8RF, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
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Song X, Chao H, Xu X, Guo H, Xu S, Turkbey B, Wood BJ, Sanford T, Wang G, Yan P. Cross-modal attention for multi-modal image registration. Med Image Anal 2022; 82:102612. [PMID: 36126402 PMCID: PMC9588729 DOI: 10.1016/j.media.2022.102612] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/07/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022]
Abstract
In the past few years, convolutional neural networks (CNNs) have been proven powerful in extracting image features crucial for medical image registration. However, challenging applications and recent advances in computer vision suggest that CNNs are limited in their ability to understand the spatial correspondence between features, which is at the core of image registration. The issue is further exaggerated when it comes to multi-modal image registration, where the appearances of input images can differ significantly. This paper presents a novel cross-modal attention mechanism for correlating features extracted from the multi-modal input images and mapping such correlation to image registration transformation. To efficiently train the developed network, a contrastive learning-based pre-training method is also proposed to aid the network in extracting high-level features across the input modalities for the following cross-modal attention learning. We validated the proposed method on transrectal ultrasound (TRUS) to magnetic resonance (MR) registration, a clinically important procedure that benefits prostate cancer biopsy. Our experimental results demonstrate that for MR-TRUS registration, a deep neural network embedded with the cross-modal attention block outperforms other advanced CNN-based networks with ten times its size. We also incorporated visualization techniques to improve the interpretability of our network, which helps bring insights into the deep learning based image registration methods. The source code of our work is available at https://github.com/DIAL-RPI/Attention-Reg.
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Affiliation(s)
- Xinrui Song
- Department of Biomedical Engineering and Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Hanqing Chao
- Department of Biomedical Engineering and Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Xuanang Xu
- Department of Biomedical Engineering and Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Hengtao Guo
- Department of Biomedical Engineering and Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Sheng Xu
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health, Bethesda, MD 20892, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health, Bethesda, MD 20892, USA
| | - Thomas Sanford
- Department of Urology, The State University of New York Upstate Medical University, Syracuse, NY 13210, USA
| | - Ge Wang
- Department of Biomedical Engineering and Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Pingkun Yan
- Department of Biomedical Engineering and Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY 12180, USA.
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Corsi A, De Bernardi E, Bonaffini PA, Franco PN, Nicoletta D, Simonini R, Ippolito D, Perugini G, Occhipinti M, Da Pozzo LF, Roscigno M, Sironi S. Radiomics in PI-RADS 3 Multiparametric MRI for Prostate Cancer Identification: Literature Models Re-Implementation and Proposal of a Clinical-Radiological Model. J Clin Med 2022; 11:6304. [PMID: 36362530 PMCID: PMC9656103 DOI: 10.3390/jcm11216304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/18/2022] [Accepted: 10/22/2022] [Indexed: 10/29/2023] Open
Abstract
PI-RADS 3 prostate lesions clinical management is still debated, with high variability among different centers. Identifying clinically significant tumors among PI-RADS 3 is crucial. Radiomics applied to multiparametric MR (mpMR) seems promising. Nevertheless, reproducibility assessment by external validation is required. We retrospectively included all patients with at least one PI-RADS 3 lesion (PI-RADS v2.1) detected on a 3T prostate MRI scan at our Institution (June 2016-March 2021). An MRI-targeted biopsy was used as ground truth. We assessed reproducible mpMRI radiomic features found in the literature. Then, we proposed a new model combining PSA density and two radiomic features (texture regularity (T2) and size zone heterogeneity (ADC)). All models were trained/assessed through 100-repetitions 5-fold cross-validation. Eighty patients were included (26 with GS ≥ 7). In total, 9/20 T2 features (Hector's model) and 1 T2 feature (Jin's model) significantly correlated to biopsy on our dataset. PSA density alone predicted clinically significant tumors (sensitivity: 66%; specificity: 71%). Our model obtained a sensitivity of 80% and a specificity of 76%. Standard-compliant works with detailed methodologies achieve comparable radiomic feature sets. Therefore, efforts to facilitate reproducibility are needed, while complex models and imaging protocols seem not, since our model combining PSA density and two radiomic features from routinely performed sequences appeared to differentiate clinically significant cancers.
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Affiliation(s)
- Andrea Corsi
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
| | - Elisabetta De Bernardi
- Medicine and Surgery Department, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
- Interdepartmental Research Centre Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, University of Milano-Bicocca, Via Follereau 3, 20854 Vedano al Lambro, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
| | - Paolo Niccolò Franco
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
| | - Dario Nicoletta
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
| | - Roberto Simonini
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
| | - Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
- Department of Radiology, San Gerardo Hospital, Via G. B. Pergolesi 33, 20900 Monza, Italy
| | - Giovanna Perugini
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | | | - Luigi Filippo Da Pozzo
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
- Department of Urology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Marco Roscigno
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
- Department of Urology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
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14
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Sigle A, Michaelis J, Schöb D, Benndorf M, Schimmöller L, Becker B, Pallauf M, Gross AJ, Herrmann TRW, Klein JT, Lusuardi L, Netsch C, Häcker A, Westphal J, Jilg C, Gratzke C, Miernik A. [Image-guided biopsy of the prostate gland]. UROLOGIE (HEIDELBERG, GERMANY) 2022; 61:1137-1148. [PMID: 36040512 DOI: 10.1007/s00120-022-01929-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
The recommendations on carrying out a multiparametric magnetic resonance imaging (mpMRI) for the primary diagnostics and during active surveillance of prostate cancer, include as a consequence an image-guided sampling from conspicuous areas. In doing so, the information on the localization provided by mpMRI is used for a targeted biopsy of the area suspected of being a tumor. The targeted sampling is mainly performed under sonographic control and after fusion of MRI and ultrasound but can also be (mostly in special cases) carried out directly in the MRI scanner. In an ultrasound-guided biopsy, it is vital to coregister the MR images with the ultrasound images (segmentation of the contour of the prostate and registration of suspect findings). This coregistration can either be carried out cognitively (transfer by the person performing the biopsy alone) or software based. Each method shows specific advantages and disadvantages in the prioritization between diagnostic accuracy and resource expenditure.
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Affiliation(s)
- August Sigle
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland.
- Berta-Ottenstein-Programm, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland.
| | - Jakob Michaelis
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - Dominik Schöb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - Matthias Benndorf
- Medizinische Fakultät, Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Lars Schimmöller
- Medizinische Fakultät, Institut für Diagnostische und Interventionelle Radiologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Benedikt Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - Maximilian Pallauf
- Johns Hopkins University, Baltimore, USA
- Department für Urologie und Onkologie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
- Department für Urologie, Uniklinikum Salzburg, Salzburg, Österreich
| | - Andreas J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - Thomas R W Herrmann
- Urologie, Spital Thurgau AG, Frauenfeld, Schweiz
- Medizinische Hochschule Hannover, Hannover, Deutschland
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, Südafrika
| | - Jan-Thorsten Klein
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Lukas Lusuardi
- Paracelsus Medizinische Universitätsklinik für Urologie, Salzburger Landeskliniken, Salzburg, Österreich
| | | | - Axel Häcker
- Klinik für Urologie, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | - Jens Westphal
- Klinik für Urologie, Kinderurologie und Urogynäkologie, Krankenhaus Maria-Hilf, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf, Krefeld, Deutschland
| | - Cordula Jilg
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - Christian Gratzke
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - Arkadiusz Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
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15
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16
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Jager A, Vilanova JC, Michi M, Wijkstra H, Oddens JR. The challenge of prostate biopsy guidance in the era of mpMRI detected lesion: ultrasound-guided versus in-bore biopsy. Br J Radiol 2022; 95:20210363. [PMID: 34324383 PMCID: PMC8978231 DOI: 10.1259/bjr.20210363] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The current recommendation in patients with a clinical suspicion for prostate cancer is to perform systematic biopsies extended with targeted biopsies, depending on mpMRI results. Following a positive mpMRI [i.e. Prostate Imaging Reporting and Data System (PI-RADS) ≥3], three targeted biopsy approaches can be performed: visual registration of the MRI images with real-time ultrasound imaging; software-assisted fusion of the MRI images and real-time ultrasound images, and in-bore biopsy within the MR scanner. This collaborative review discusses the advantages and disadvantages of each targeting approach and elaborates on future developments. Cancer detection rates seem to mostly depend on practitioner experience and selection criteria (biopsy naïve, previous negative biopsy, prostate-specific antigen (PSA) selection criteria, presence of a lesion on MRI), and to a lesser extent dependent on biopsy technique. There is no clear consensus on the optimal targeting approach. The choice of technique depends on local experience and availability of equipment, individual patient characteristics, and onsite cost-benefit analysis. Innovations in imaging techniques and software-based algorithms may lead to further improvements in this field.
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Affiliation(s)
- Auke Jager
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Joan C Vilanova
- Department of Radiology, Clinica Girona, Diagnostic Imaging Institute (IDI), University of Girona, Girona, Spain
| | - Massimo Michi
- Lab of Biomedical Diagnostics, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Görtz M, Nyarangi-Dix JN, Pursche L, Schütz V, Reimold P, Schwab C, Stenzinger A, Sültmann H, Duensing S, Schlemmer HP, Bonekamp D, Hohenfellner M, Radtke JP. Impact of Surgeon's Experience in Rigid versus Elastic MRI/TRUS-Fusion Biopsy to Detect Significant Prostate Cancer Using Targeted and Systematic Cores. Cancers (Basel) 2022; 14:cancers14040886. [PMID: 35205634 PMCID: PMC8870088 DOI: 10.3390/cancers14040886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary For the transfer of suspicious lesions in magnetic resonance imaging (MRI) to ultrasound in prostate fusion biopsy, biopsy platforms can be distinguished by rigid or elastic image registration. This study evaluates the detection rate of these different platforms for transperineal fusion-guided prostate biopsy to detect clinically significant prostate cancer under consideration of the surgeon’s learning curve. In our cohort, rigid and elastic registration systems showed a similar prostate cancer detection rate in experienced surgeons, whereas novices seem to benefit from rigid fusion. In the total cohort, targeted fusion biopsy with a rigid registration system outperformed elastic registration target biopsy with a superior significant prostate cancer detection rate, each compared to systematic saturation biopsy. Thus, rigid target biopsy aided in reducing targeting errors that result in missing MRI-visualized significant prostate cancer. These results can provide valuable decision support in selecting a biopsy fusion platform to increase the detection rate and risk stratification of prostate cancer, especially at the beginning of the surgeon’s learning curve. Abstract Multiparametric magnetic resonance imaging (mpMRI) and MRI/ultrasound fusion-targeted prostate biopsy (FB) have excellent sensitivity in detecting significant prostate cancer (sPC). FB platforms can be distinguished by rigid (RTB) or elastic image registration (ETB). We compared RTB and ETB by analyzing sPC detection rates of both RTB and ETB at different stages of the surgeons’ learning curve. Patients undergoing RTB between 2015–2017 (n = 502) were compared to patients undergoing ETB from 2017–2019 (n = 437). SPC detection rates were compared by Chi-square-test on patient-basis. Combination of transperineal systematic biopsy and each TB served as reference and sub-analyses were performed for different grades of surgeon’s experience. In the RTB subgroup, 233 men (46%) had sPC, compared to 201 (46%) in the ETB subgroup. RTB alone detected 94% of men with sPC and ETB 87% (p = 0.02). However, for at least intermediate-experienced surgeons (>100 FB), no differences occurred between RTB and ETB. In the total cohort, at least intermediate-experienced surgeons detected significantly more sPC (10%, p = 0.008) than novices. Thus, targeted transperineal MRI/TRUS-FB with a RTB registration system showed a similar sPC detection rate to ETB in experienced surgeons but a superior sPC detection rate to ETB in the total cohort. Low-experienced surgeons seem to benefit from RTB.
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Affiliation(s)
- Magdalena Görtz
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
- Helmholtz Young Investigator Group ‘Multiparametric Methods for Early Detection of Prostate Carcinoma’, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Correspondence: or ; Tel.: +49-62-2156-8820
| | - Joanne Nyaboe Nyarangi-Dix
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Lars Pursche
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Philipp Reimold
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Constantin Schwab
- Institute of Pathology, University Heidelberg, 69120 Heidelberg, Germany; (C.S.); (A.S.)
| | - Albrecht Stenzinger
- Institute of Pathology, University Heidelberg, 69120 Heidelberg, Germany; (C.S.); (A.S.)
| | - Holger Sültmann
- Division of Cancer Genome Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany;
| | - Stefan Duensing
- Section of Molecular Urooncology, Department of Urology, University of Heidelberg School of Medicine, 69120 Heidelberg, Germany;
| | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.-P.S.); (D.B.)
| | - David Bonekamp
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.-P.S.); (D.B.)
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (J.N.N.-D.); (L.P.); (V.S.); (P.R.); (M.H.); (J.P.R.)
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (H.-P.S.); (D.B.)
- Department of Urology, University Hospital Düsseldorf, 40225 Düsseldorf, Germany
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18
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Diagnostic performance of fusion (US/MRI guided) prostate biopsy: propensity score matched comparison of elastic versus rigid fusion system. World J Urol 2022; 40:991-996. [PMID: 35037076 DOI: 10.1007/s00345-021-03921-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Many software for US/MRI guided fusion prostate biopsy (FPB), have been developed in the last years. However, there are few data comparing diagnostic accuracy of different fusion systems. We assessed diagnostic performance of elastic (EF) versus rigid fusion (RF) PB in a propensity score matched (PSM) analysis. METHODS A total of 314 FPB were prospectively collected from two different centers. All patients were biopsy naïve and all mpMRI reported a single suspicious area. Overall, 211 PB were performed using a RF system and 103 using an EF software. The two groups were compared for the main clinical features. A 1:1 PSM analysis was employed to reduce covariate imbalance to < 10%. Detection rate (DR) for any prostate cancer (PCa) and clinically significant (cs) PCa were compared and stratified for PI-RADS Score. A per target univariable and multivariable regression analyses were applied to identity predictors of anyPCa and csPCa. RESULTS After applying the PSM, two cohorts of 83 cases were selected. DR of any PCa cancer and csPCa were comparable between the two cohorts (all p > 0.077) as well as DR of csPCa for every PIRADS score. At univariable regression analysis lesion size, PI-RADS Score, PSA Density and EF system were predictors of any PCa (all p < 0.001); however, at multivariable analysis only PI-RADS Score was independent predictor of any PCa (p = 0.027). At multivariable analysis only PI-RADS score was independent predictor of csPCa. CONCLUSIONS Fusion PB guarantees high diagnostic accuracy for csPCa, regardless of the fusion technology. Prospective randomized study is needed to confirm these data.
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Kaneko M, Lenon MSL, Storino Ramacciotti L, Medina LG, Sayegh AS, La Riva A, Perez LC, Ghoreifi A, Lizana M, Jadvar DS, Lebastchi AH, Cacciamani GE, Abreu AL. Multiparametric ultrasound of prostate: role in prostate cancer diagnosis. Ther Adv Urol 2022; 14:17562872221145625. [PMID: 36601020 PMCID: PMC9806443 DOI: 10.1177/17562872221145625] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 11/25/2022] [Indexed: 12/28/2022] Open
Abstract
Recent advances in ultrasonography (US) technology established modalities, such as Doppler-US, HistoScanning, contrast-enhanced ultrasonography (CEUS), elastography, and micro-ultrasound. The early results of these US modalities have been promising, although there are limitations including the need for specialized equipment, inconsistent results, lack of standardizations, and external validation. In this review, we identified studies evaluating multiparametric ultrasonography (mpUS), the combination of multiple US modalities, for prostate cancer (PCa) diagnosis. In the past 5 years, a growing number of studies have shown that use of mpUS resulted in high PCa and clinically significant prostate cancer (CSPCa) detection performance using radical prostatectomy histology as the reference standard. Recent studies have demonstrated the role mpUS in improving detection of CSPCa and guidance for prostate biopsy and therapy. Furthermore, some aspects including lower costs, real-time imaging, applicability for some patients who have contraindication for magnetic resonance imaging (MRI) and availability in the office setting are clear advantages of mpUS. Interobserver agreement of mpUS was overall low; however, this limitation can be improved using standardized and objective evaluation systems such as the machine learning model. Whether mpUS outperforms MRI is unclear. Multicenter randomized controlled trials directly comparing mpUS and multiparametric MRI are warranted.
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Affiliation(s)
- Masatomo Kaneko
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Maria Sarah L. Lenon
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lorenzo Storino Ramacciotti
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Luis G. Medina
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Aref S. Sayegh
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anibal La Riva
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Laura C. Perez
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alireza Ghoreifi
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Maria Lizana
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Donya S. Jadvar
- Dornsife School of Letters and Science, University of Southern California, Los Angeles, CA, USA
| | - Amir H. Lebastchi
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E. Cacciamani
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andre Luis Abreu
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology and Catherine & Joseph Aresty
- Department of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA 90089, USADepartment of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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20
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High-Intensity Focused Ultrasound (HIFU) Focal Therapy for Localized Prostate Cancer with MRI-US Fusion Platform. Adv Urol 2021; 2021:7157973. [PMID: 34950204 PMCID: PMC8692047 DOI: 10.1155/2021/7157973] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022] Open
Abstract
Objective The study aimed at investigating the outcome of prostate HIFU focal therapy using the MRI-US fusion platform for treatment localization and delivery. Methods It is a prospectively designed case series of HIFU focal therapy for localized prostate cancer. The inclusion criteria include clinical tumor stage ≤T2, visible index lesion on multiparametric MRI less than 20 mm in diameter, absence of Gleason 5 pattern on prostate biopsy, and PSA ≤ 20 ng/ml. HIFU focal therapy was performed in the conventional manner in the beginning 50% of the series, whereas the subsequent cases were performed with MRI-US fusion platform. The primary outcome was treatment failure rate which is defined by the need of salvage therapy. Secondary outcomes included tumor recurrence in follow-up biopsy, PSA change, perioperative complications, and postoperative functional outcomes. Results Twenty patients underwent HIFU focal ablation. HIFU on an MRI-US fusion platform had a trend of a longer total operative time than the conventional counterpart (124.2 min vs. 107.1 min, p=0.066). There was no difference in the mean ablation volume to lesion volume ratio between the two. The mean PSA percentage change from baseline to 6-month is more significant in the conventional group (63.3% vs. 44.6%, p=0.035). No suspicious lesion was seen at 6-month mpMRI in all 20 patients. Two patients, one from each group, eventually underwent radical treatment because of the presence of clinically significant prostate cancer in the form of out-of-field recurrences during follow-up biopsy. No significant difference was observed before and after HIFU concerning uroflowmetry, SF-12 score, and EPIC-26 score. It was observed that energy used per volume was positively correlated with PSA density of the patient (r = 0.6364, p=0.014). Conclusion In conclusion, HIFU with conventional or MRI-US fusion platform provided similar oncological and functional outcomes.
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Abstract
Prostate cancer is the second most common cancer in the United States. Screening for prostate cancer has increased through the usage of prostate specific antigen and biopsies. Traditionally, prostate biopsies are done using transrectal ultrasound with 10-12 cores obtained in a sextant pattern. Advances in prostate imaging with multiparametric magnetic resonance imaging has led to image guided targeted prostate biopsies. This can be done with cognitive fusion, MRI-fusion, and in-bore MRI. This article will review the indications, techniques, and outcomes for targeted image guided prostate biopsies using in-bore MRI and MRI fusion.
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Abashidze N, Stecher C, Rosenkrantz AB, Duszak R, Hughes DR. Racial and Ethnic Disparities in the Use of Prostate Magnetic Resonance Imaging Following an Elevated Prostate-Specific Antigen Test. JAMA Netw Open 2021; 4:e2132388. [PMID: 34748010 PMCID: PMC8576586 DOI: 10.1001/jamanetworkopen.2021.32388] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Prostate cancer screening and diagnosis exhibit known racial and ethnic disparities. Whether these disparities persist in prostate magnetic resonance imaging (MRI) utilization after elevated prostate-specific antigen (PSA) results is poorly understood. OBJECTIVE To assess potential racial and ethnic disparities in prostate MRI utilization following elevated PSA results. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 794 809 insured US men was drawn from deidentified medical claims between January 2011 and December 2017 obtained from a commercial claims database. Eligible participants were aged 40 years and older and received a single PSA result and no prior PSA screening or prostate MRI claims. Analysis was performed in January 2021. MAIN OUTCOMES AND MEASURES Multivariable logistic regression was used to examine associations between elevated PSA results and follow-up prostate MRI. For patients receiving prostate MRI, multivariable regressions were estimated for the time between PSA and subsequent prostate MRI. PSA thresholds explored included PSA levels above 2.5 ng/mL, 4 ng/mL, and 10 ng/mL. Analyses were stratified by race, ethnicity, and age. RESULTS Of 794 809 participants, 51 500 (6.5%) had PSA levels above 4 ng/mL; of these, 1524 (3.0%) underwent prostate MRI within 180 days. In this sample, mean (SD) age was 59.8 (11.3) years (range 40-89 years); 31 350 (3.9%) were Asian, 75 935 (9.6%) were Black, 107 956 (13.6%) were Hispanic, and 455 214 (57.3%) were White. Compared with White patients, Black patients with PSA levels above 4 ng/mL and 10 ng/mL were 24.1% (odds ratio [OR], 0.78; 95% CI, 0.65-0.89) and 35.0% (OR, 0.65; 95% CI, 0.50-0.85) less likely to undergo subsequent prostate MRI, respectively. Asian patients with PSA levels higher than 4 ng/mL (OR, 0.76; 95% CI, 0.58-0.99) and Hispanic patients with PSA levels above 10 ng/mL (OR, 0.77; 95% CI, 0.59-0.99) were also less likely to undergo subsequent prostate MRI compared with White patients. Black patients between ages 65 and 74 years with PSA above 4 ng/mL and 10 ng/mL were 23.6% (OR, 0.76; 95% CI, 0.64-0.91) and 43.9% (OR, 0.56; 95% CI, 0.35-0.91) less likely to undergo MRI, respectively. Race and ethnicity were not significantly associated with mean time between PSA and MRI. CONCLUSIONS AND RELEVANCE Among men with elevated PSA results, racial and ethnic disparities were evident in subsequent prostate MRI utilization and were more pronounced at higher PSA thresholds. Further research is needed to better understand and mitigate physician decision-making biases and other potential sources of disparities in prostate cancer diagnosis and management.
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Affiliation(s)
- Nino Abashidze
- Haub School of Environment and Natural Resources, University of Wyoming, Laramie
| | - Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix
| | | | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Danny R. Hughes
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
- School of Economics, Georgia Institute of Technology, Atlanta
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Magnier A, Nedelcu C, Chelly S, Rousselet-Chapeau MC, Azzouzi AR, Lebdai S. Prostate cancer detection by targeted prostate biopsy using the 3D Navigo system: a prospective study. Abdom Radiol (NY) 2021; 46:4381-4387. [PMID: 33856508 DOI: 10.1007/s00261-021-03078-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The 3D Navigo™ system is a magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion device for prostate targeted biopsies (TB). Our aim was to evaluate the clinically significant prostate cancer (CSC) detection rate of TB using the 3D Navigo™ system. METHODS Patients who underwent TB with the 3D Navigo™ system in our center between June 2014 and May 2018 were prospectively included, excluding those who have previously received treatment for prostate cancer. A 3-Tesla MRI imaging was performed before biopsies; findings were reported according to the Prostate Imaging Reporting and Data System version 2 (PIRADS). CSC was defined by an ISUP score ≥ 2. RESULTS 304 patients underwent TB. Median age was 66 years (51-84). Median PSA was 7.75 ng/ml (0.6-70.0). Median prostate volume was 45.0 ml (15.9-221.7). PCa and CSC were found in 70.4% (214/304) and 47.7% (145/304) of the patients, respectively. The proportion of patients diagnosed with CSC among those with PCa was 67.8% (145/214). There was a significant risk of having a CSC in case of PIRADS score ≥ 4 and 5 (OR 5.0, 95% CI [2.7-9.2], P < 0.001; OR 3.2, 95% CI [1.8-5.5], P < 0.001). PIRADS score was an independent risk factor of having a CSC (OR 4.19, 95% CI [2.49-7.05], P < 0.001). There was no significant difference between pathological outcomes of TB and RP in paired analysis (P = 0.892). There was a correlation between TB and RP specimens for PCa detection (r = 0.60, P < 0.001). CONCLUSION Detecting CSC with MRI-TRUS fusion targeted biopsies using the 3D Navigo™ system is feasible and safe. We found a positive correlation between TB and RP for ISUP scores.
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Affiliation(s)
- Alexandre Magnier
- Urology Department, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France.
| | - Cosmina Nedelcu
- Radiology Department, University Hospital of Angers, Angers, France
| | - Samuel Chelly
- Urology Department, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
| | | | - Abdel Rahmene Azzouzi
- Urology Department, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - Souhil Lebdai
- Urology Department, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
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Comparison of Accuracies between Real-Time Nonrigid and Rigid Registration in the MRI-US Fusion Biopsy of the Prostate. Diagnostics (Basel) 2021; 11:diagnostics11081481. [PMID: 34441415 PMCID: PMC8392836 DOI: 10.3390/diagnostics11081481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/17/2022] Open
Abstract
Magnetic resonance imaging (MRI) is increasingly important in the detection and localization of prostate cancer. Regarding suspicious lesions on MRI, a targeted biopsy using MRI fused with ultrasound (US) is widely used. To achieve a successful targeted biopsy, a precise registration between MRI and US is essential. The purpose of our study was to show any decrease in errors using a real-time nonrigid registration technique for prostate biopsy. Nineteen patients with suspected prostate cancer were prospectively enrolled in this study. Registration accuracy was calculated by the measuring distance of corresponding points by rigid and nonrigid registration between MRI and US, and compared for rigid and nonrigid registration methods. Overall cancer detection rates were also evaluated by patient and by core. Prostate volume was measured automatically from MRI and manually from US, and compared to each other. Mean distances between the corresponding points in MRI and US were 5.32 ± 2.61 mm for rigid registration and 2.11 ± 1.37 mm for nonrigid registration (p < 0.05). Cancer was diagnosed in 11 of 19 patients (57.9%), and in 67 of 266 biopsy cores (25.2%). There was no significant difference in prostate-volume measurement between the automatic and manual methods (p = 0.89). In conclusion, nonrigid registration reduces targeting errors.
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Wang HK. Magnetic Resonance Imaging Fusion Transrectal Ultrasound-guided Biopsy for Diagnosis of Prostate Cancer. J Med Ultrasound 2021; 29:75-76. [PMID: 34377635 PMCID: PMC8330678 DOI: 10.4103/jmu.jmu_96_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Hsin-Kai Wang
- Division of Ultrasound and Breast Imaging, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Yangming Campus, Taipei, Taiwan
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McGeachy P, Watt E, Husain S, Martell K, Martinez P, Sawhney S, Thind K. MRI-TRUS registration methodology for TRUS-guided HDR prostate brachytherapy. J Appl Clin Med Phys 2021; 22:284-294. [PMID: 34318581 PMCID: PMC8364261 DOI: 10.1002/acm2.13292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose High‐dose‐rate (HDR) prostate brachytherapy is an established technique for whole‐gland treatment. For transrectal ultrasound (TRUS)‐guided HDR prostate brachytherapy, image fusion with a magnetic resonance image (MRI) can be performed to make use of its soft‐tissue contrast. The MIM treatment planning system has recently introduced image registration specifically for HDR prostate brachytherapy and has incorporated a Predictive Fusion workflow, which allows clinicians to attempt to compensate for differences in patient positioning between imaging modalities. In this study, we investigate the accuracy of the MIM algorithms for MRI‐TRUS fusion, including the Predictive Fusion workflow. Materials and Methods A radiation oncologist contoured the prostate gland on both TRUS and MRI. Four registration methodologies to fuse the MRI and the TRUS images were considered: rigid registration (RR), contour‐based (CB) deformable registration, Predictive Fusion followed by RR (pfRR), and Predictive Fusion followed by CB deformable registration (pfCB). Registrations were compared using the mean distance to agreement and the Dice similarity coefficient for the prostate as contoured on TRUS and the registered MRI prostate contour. Results Twenty patients treated with HDR prostate brachytherapy at our center were included in this retrospective evaluation. For the cohort, mean distance to agreement was 2.1 ± 0.8 mm, 0.60 ± 0.08 mm, 2.0 ± 0.5 mm, and 0.59 ± 0.06 mm for RR, CB, pfRR, and pfCB, respectively. Dice similarity coefficients were 0.80 ± 0.05, 0.93 ± 0.02, 0.81 ± 0.03, and 0.93 ± 0.01 for RR, CB, pfRR, and pfCB, respectively. The inclusion of the Predictive Fusion workflow did not significantly improve the quality of the registration. Conclusions The CB deformable registration algorithm in the MIM treatment planning system yielded the best geometric registration indices. MIM offers a commercial platform allowing for easier access and integration into clinical departments with the potential to play an integral role in future focal therapy applications for prostate cancer.
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Affiliation(s)
- Philip McGeachy
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada
| | - Elizabeth Watt
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Siraj Husain
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Kevin Martell
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Pedro Martinez
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada
| | - Summit Sawhney
- Department of Radiology and Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
| | - Kundan Thind
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada
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MRI-Targeted Prostate Biopsy Techniques: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 217:1263-1281. [PMID: 34259038 DOI: 10.2214/ajr.21.26154] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Prostate cancer is the second most common malignancy in men worldwide. Systematic transrectal prostate biopsy is commonly used to obtain tissue to establish the diagnosis. However, in recent years, MRI-targeted biopsy (based on an MRI examination performed prior to consideration of biopsy) has been shown to detect more clinically significant cancer and less clinically insignificant cancer compared to systematic biopsy. This approach of performing MRI prior to biopsy has become, or is becoming, a standard of practice in centers throughout the world. This growing use of an MRI-directed pathway is leading to performance of a larger volume of MRI-targeted prostate biopsies. The three common MRI-targeted biopsy techniques are cognitive biopsy, MRI-ultrasound software fusion biopsy, and MRI in-bore guided biopsy. These techniques for using MRI information at the time of biopsy can be performed via a transrectal or transperineal approach. This narrative review presents the three MRI-targeted biopsy techniques along with their advantages and shortcomings. Comparisons among the techniques are summarized based on the available evidence. Studies to date have provided heterogeneous results, and the preferred technique remains debated.
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Sokolakis I, Pyrgidis N, Koneval L, Krebs M, Thurner A, Kübler H, Hatzichristodoulou G. Usability and diagnostic accuracy of different MRI/ultrasound-guided fusion biopsy systems for the detection of clinically significant and insignificant prostate cancer: a prospective cohort study. World J Urol 2021; 39:4101-4108. [PMID: 34142231 DOI: 10.1007/s00345-021-03761-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/10/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To explore the usability and diagnostic accuracy for prostate cancer of three multiparametric magnetic resonance imaging (mpMRI)/transrectal ultrasound (TRUS)-guided fusion biopsy systems operated by the same urologists. METHODS We performed a prospective, observational study including patients that underwent prostate biopsy due to a visible lesion in mpMRI (PI-RADS ≥ 3). We consecutively assessed two platforms with a rigid image registration (BioJet, D&K Technologies and UroNav, Invivo Corporation) and one with an elastic registration (Trinity, KOELIS). Four urologists evaluated each fusion system in terms of usability based on the System Usability Scale and diagnostic accuracy based on the detection of prostate cancer. RESULTS We enrolled 60 consecutive patients that received mpMRI/TRUS-guided prostate biopsy with the BioJet (n = 20), UroNav (n = 20) or Trinity (n = 20) fusion system. Comparing the rigid with the elastic registration systems, the rigid registration systems were more user-friendly compared to the elastic registration systems (p = 0.012). Similarly, the prostate biopsy with the rigid registration systems had a shorter duration compared to the elastic registration system (p < 0.001). Overall, 40 cases of prostate cancer were detected. Of them, both the BioJet and UroNav fusion systems detected 13 prostate cancer cases, while the Trinity detected 14. No significant differences were demonstrated among the three fusion biopsy systems in terms of highest ISUP Grade Group (p > 0.99). CONCLUSIONS Rigid fusion biopsy systems are easier to use and provide shorter operative time compared to elastic systems, while both types of platforms display similar detection rates for prostate cancer. Still, further high-quality, long-term results are mandatory.
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Affiliation(s)
- Ioannis Sokolakis
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany. .,Department of Urology, Martha-Maria Hospital Nuremberg, Stadenstraße 58, 90491, Nuremberg, Germany.
| | - Nikolaos Pyrgidis
- Department of Urology, Martha-Maria Hospital Nuremberg, Stadenstraße 58, 90491, Nuremberg, Germany
| | - Lukas Koneval
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Markus Krebs
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Annette Thurner
- Department of Diagnostic and Interventional Radiology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Hubert Kübler
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Georgios Hatzichristodoulou
- Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany.,Department of Urology, Martha-Maria Hospital Nuremberg, Stadenstraße 58, 90491, Nuremberg, Germany
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Cata ED, Van Praet C, Andras I, Kadula P, Ognean R, Buzoianu M, Leucuta D, Caraiani C, Tamas-Szora A, Decaestecker K, Coman I, Crisan N. Analyzing the learning curves of a novice and an experienced urologist for transrectal magnetic resonance imaging-ultrasound fusion prostate biopsy. Transl Androl Urol 2021; 10:1956-1965. [PMID: 34159076 PMCID: PMC8185669 DOI: 10.21037/tau-21-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The aim of the current study was to evaluate and compare the learning curves of transrectal magnetic resonance imaging-ultrasound fusion biopsy for two urologists with different backgrounds (Operator 1: experienced, self-trained and Operator 2: novice, trained by a mentor/MRI reading courses). Methods A cohort of 400 patients who underwent fusion prostate biopsy in our department was analyzed. The learning curves were assessed in terms of overall and clinically significant prostate cancer (PCa) detection rates, percentage of positive biopsy cores/targeted and the percentage of PCa tissue on positive targeted cores. Results Increasing trends were observed for both urologists in terms of all biopsy outcomes during the study time. For the novice urologist, a significant increase was observed for overall PCa detection rate, but not for clinically significant disease (25.44%, P=0.04/15%, P=0.145). Operator 1 showed an increasing diagnosis yield of clinically significant disease up to 104 cases. Similar cancer detection rates were observed when comparing the first and last biopsies performed by both operators. Multivariate analysis adjusted for age, PSA, prostate volume, lesion diameter and PIRADS score showed an increase of PCa detection with 51% for every 52 biopsies performed (P=0.022). Conclusions When starting with magnetic resonance imaging-ultrasound fusion prostate biopsy, mentoring and prostate magnetic resonance imaging reading training allow a novice urologist to demonstrate a good initial PCa detection rate. After about 52 cases, he reached a stable PCa and clinically significant PCa detection rate, that was similar to that of an experienced urologist.
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Affiliation(s)
- Emanuel Darius Cata
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Municipal Hospital, Cluj-Napoca, Romania
| | | | - Iulia Andras
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Municipal Hospital, Cluj-Napoca, Romania
| | - Pierre Kadula
- Urology Department, Municipal Hospital, Cluj-Napoca, Romania
| | - Razvan Ognean
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maximilian Buzoianu
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniel Leucuta
- Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Cosmin Caraiani
- Medical Imaging Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | | | | | - Ioan Coman
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Municipal Hospital, Cluj-Napoca, Romania
| | - Nicolae Crisan
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Urology Department, Municipal Hospital, Cluj-Napoca, Romania
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Cata ED, Andras I, Telecan T, Tamas-Szora A, Coman RT, Stanca DV, Coman I, Crisan N. MRI-targeted prostate biopsy: the next step forward! Med Pharm Rep 2021; 94:145-157. [PMID: 34013185 PMCID: PMC8118209 DOI: 10.15386/mpr-1784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/13/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022] Open
Abstract
Aim For decades, the gold standard technique for diagnosing prostate cancer was the 10 to 12 core systematic transrectal or transperineal biopsy, under ultrasound guidance. Over the past years, an increased rate of false negative results and detection of clinically insignificant prostate cancer has been noted, resulting into overdiagnosis and overtreatment. The purpose of the current study was to evaluate the changes in diagnosis and management of prostate cancer brought by MRI-targeted prostate biopsy. Methods A critical review of literature was carried out using the Medline database through a PubMed search, 37 studies meeting the inclusion criteria: prospective studies published in the past 8 years with at least 100 patients per study, which used multiparametric magnetic resonance imaging as guidance for targeted biopsies. Results In-Bore MRI targeted biopsy and Fusion targeted biopsy outperform standard systematic biopsy both in terms of overall and clinically significant prostate cancer detection, and ensure a lower detection rate of insignificant prostate cancer, with fewer cores needed. In-Bore MRI targeted biopsy performs better than Fusion biopsy especially in cases of apical lesions. Conclusion Targeted biopsy is an emerging and developing technique which offers the needed improvements in diagnosing clinically significant prostate cancer and lowers the incidence of insignificant ones, providing a more accurate selection of the patients for active surveillance and focal therapies.
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Affiliation(s)
- Emanuel Darius Cata
- Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania.,Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Iulia Andras
- Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania.,Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Teodora Telecan
- Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Radu-Tudor Coman
- Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan-Vasile Stanca
- Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania.,Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Coman
- Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania.,Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nicolae Crisan
- Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania.,Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Abstract
PURPOSE OF REVIEW The goal of this study is to review recent findings and evaluate the utility of MRI transrectal ultrasound fusion biopsy (FBx) techniques and discuss future directions. RECENT FINDINGS FBx detects significantly higher rates of clinically significant prostate cancer (csPCa) than ultrasound-guided systematic prostate biopsy (SBx), particularly in repeat biopsy settings. FBx has also been shown to detect significantly lower rates of clinically insignificant prostate cancer. In addition, a dedicated prostate MRI can assist in more accurately predicting the Gleason score and provide further information regarding the index cancer location, prostate volume, and clinical stage. The ability to accurately evaluate specific lesions is vital to both focal therapy and active surveillance, for treatment selection, planning, and adequate follow-up. FBx has been demonstrated in multiple high-quality studies to have improved performance in diagnosis of csPCa compared to SBx. The combination of FBx with novel technologies including radiomics, prostate-specific membrane antigen positron emission tomography (PSMA PET), and high-resolution micro-ultrasound may have the potential to further enhance this performance.
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Thomson A, Li M, Grummet J, Sengupta S. Transperineal prostate biopsy: a review of technique. Transl Androl Urol 2020; 9:3009-3017. [PMID: 33457274 PMCID: PMC7807331 DOI: 10.21037/tau.2019.12.40] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
As the second most diagnosed cancer worldwide, prostate cancer is confirmed via tissue biopsy. Given the large number of prostate biopsies performed each year, the technique should be as accurate and safe as possible for the patient’s well-being. Transrectal ultrasound guided prostate biopsy (TRUS-biopsy) is most offered worldwide. Transperineal biopsy (TPP-biopsy), on the other hand, has been gaining popularity due to its superior sensitivity and lower rate of sepsis. This article offers a review of the brachytherapy grid technique used to perform a TPP-biopsy, as well as a discussion of possible variations in the procedure. TPP-biopsy is typically performed under general anaesthesia with patient in lithotomy. Through the perineum, cores of tissue are taken systematically, with or without targeting, under US guidance. Different fusion techniques (cognition, MRI-US fusion software, MRI in-bore) can be used to target pre-identified lesions on MRI. The sampling can be done either by free hand or using a brachytherapy grid. Robotic assisted prostate biopsy is also available on the market as an alternative. In recent years, there has been accumulating evidence showing that it is safe and feasible to perform TPPB under local anaesthesia. This may improve the uptake of TPPB as the preferred biopsy technique for prostate cancer.
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Affiliation(s)
- Alice Thomson
- Urology Department, Eastern Health, Box Hill, Victoria, Australia
| | - Mo Li
- Urology Department, Eastern Health, Box Hill, Victoria, Australia.,Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Jeremy Grummet
- Urology Department, Alfred Hospital, Prahran, Victoria, Australia.,Central Clinical School, Monash University, Prahran, Victoria, Australia
| | - Shomik Sengupta
- Urology Department, Eastern Health, Box Hill, Victoria, Australia.,Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.,Department of Surgery, University of Melbourne, Heidelberg, Victoria, Australia
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34
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Hale GR, Pesapane F, Xu S, Bakhutashvili I, Glossop N, Turkbey B, Pinto PA, Wood BJ. Tracked Foley catheter for motion compensation during fusion image-guided prostate procedures: a phantom study. Eur Radiol Exp 2020; 4:24. [PMID: 32300896 PMCID: PMC7163002 DOI: 10.1186/s41747-020-00147-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uncorrected patient or prostate motion may impair targeting prostate areas during fusion image-guided procedures. We evaluated if a prototype "tracked Foley catheter" (TFC) could maintain fusion image alignment after simulated organ motion. METHODS A pelvic phantom model underwent magnetic resonance imaging (MRI), and the prostate was segmented. The TFC was placed in the phantom. MRI/ultrasound (US) fusion was performed. Four trials were performed varying motion and TFC presence/absence: (1) TFC/no-motion, (2) TFC/motion, (3) no-TFC/no-motion, and (4) no-TFC/motion. To quantify image alignment, screen captures generated Dice similarity coefficient (DSC) and offset distances (ODs) (maximal US-to-MRI distance between edges on fusion images). Three anatomical targets were identified for placement of a needle under fusion guidance. A computed tomography scan was used to measure system error (SE), i.e., the distance from needle tip to intended target. RESULTS The TFC presence improved MRI/US alignment by DSC 0.88, 0.88, 0.74, and 0.61 in trials 1, 2, 3, and 4, respectively. Both OD (trial 2 versus trial 4, 4.85 ± 1.60 versus 25.29 ± 6.50 mm, p < 0.001) and SE (trial 2 versus trial 4, 6.35 ± 1.31 versus 32.16 ± 6.50 mm, p < 0.005) were significantly lower when the TFC was present after artificial motion, and significantly smaller OD when static (trial 1 versus trial 3, 4.29 ± 1.24 versus 6.42 ± 2.29 mm, p < 0.001). CONCLUSION TFC provided better image alignment with or without simulated motion. This may overcome system limitations, allowing for more accurate fusion image alignment during fusion-guided biopsy, ablation, or robotic prostatectomy.
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Affiliation(s)
- Graham R Hale
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Filippo Pesapane
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. .,Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy.
| | - Sheng Xu
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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35
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Venderink W, Bomers JG, Overduin CG, Padhani AR, de Lauw GR, Sedelaar MJ, Barentsz JO. Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know. Part 3: Targeted Biopsy. Eur Urol 2020; 77:481-490. [DOI: 10.1016/j.eururo.2019.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/18/2019] [Indexed: 02/02/2023]
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36
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Ghabili K, Swallow M, Sherrer RL, Syed JS, Khajir G, Gordetsky JB, Leapman MS, Rais-Bahrami S, Sprenkle PC. Association Between Tumor Multifocality on Multi-parametric MRI and Detection of Clinically-Significant Prostate Cancer in Lesions with Prostate Imaging Reporting and Data System (PI-RADS) Score 4. Urology 2019; 134:173-180. [PMID: 31419433 DOI: 10.1016/j.urology.2019.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate whether presence of multifocality on multi-parametric magnetic resonance imaging would increase the likelihood of detecting clinically-significant prostate cancer in a PI-RADS 4 lesion. METHODS We identified patients with at least 1 PI-RADS 4 lesion who underwent multi-parametric magnetic resonance imaging-ultrasound fusion prostate biopsy. Patients were grouped into 1 of 4 cohorts-cohort 1 (a PI-RADS 4 index lesion and an additional PI-RADS 2 or 3 lesion), cohort 2 (single lesion with PI-RADS 4), cohort 3 (2 or more PI-RADS 4 lesions), or cohort 4 (a PI-RADS 4 lesion and an index lesion with PI-RADS 5). We compared the rate of grade group (GG) ≥ 2 pathology on targeted biopsy of PI-RADS 4 lesions between cohorts and evaluated clinical and radiological factors associated with cancer detection. RESULTS The overall rate of GG ≥ 2 pathology in the PI-RADS 4 lesions was 35.2%. The rate of GG ≥ 2 pathology in the cohorts 1, 2, 3, and 4 was 21.7%, 36.3%, 49.1%, and 42.7%, respectively (P< .001). On multivariable analysis, age (OR1.06, P < .001), clinical stage T2 (OR1.59, P= .03), prostate-specific antigen density (OR1.43, P < .001), peripheral zone lesion (OR1.62, P = .04), and study cohort (cohort 2 vs 1, OR1.93, P = .006; and cohort 3 vs 1, OR3.28, P < .001) were significantly associated with the risk of GG ≥ 2 in the PI-RADS 4 lesion. CONCLUSION On targeted biopsy of the PI-RADS 4 lesions, the proportion of GG ≥ 2 pathology is approximately 35%. Rate of GG ≥ 2 detection in PI-RADS 4 lesions might differ based on their location, multifocality, and PI-RADS classifications of other lesions identified.
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Affiliation(s)
- Kamyar Ghabili
- Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Matthew Swallow
- Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Rachael L Sherrer
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - Jamil S Syed
- Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Ghazal Khajir
- Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - Michael S Leapman
- Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Preston C Sprenkle
- Department of Urology, Yale University School of Medicine, New Haven, CT.
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37
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[Importance of magnetic resonance imaging/ultrasound-guided fusion biopsy for the detection and monitoring of prostate cancer]. Urologe A 2019; 58:1499-1510. [PMID: 31741003 DOI: 10.1007/s00120-019-01069-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The use of multiparametric magnetic resonance imaging (mpMRI) is becoming increasingly more important for the primary diagnostics of prostate cancer (PCa) and for monitoring under active surveillance. Current studies confirmed that the use of mpMRI can increase the detection of clinically significant PCa and reduce the detection rate of insignificant PCa as well as the rate of unnecessary biopsies. The information from mpMRI can be cognitively used for in-bore biopsy and using fusion biopsy systems. There are no clear recommendations on the access approach for fusion biopsy (e. g. transrectal or perineal), whereby higher rates of rectal bleeding and infections have been described for transrectal access compared to perineal access. The increasing rate of antibiotic resistance as well as restricted indications for the use of quinolones are a major challenge for transrectal biopsy.
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38
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van Luijtelaar A, Bomers J, Fütterer J. A comparison of magnetic resonance imaging techniques used to secure biopsies in prostate cancer patients. Expert Rev Anticancer Ther 2019; 19:705-716. [PMID: 31277551 DOI: 10.1080/14737140.2019.1641086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Prostate cancer (PCa) is the most common diagnosed malignancy among the male population in the United States. The incidence is increasing with an estimated amount of 175.000 cases in 2019. Areas covered: Primarily, PCa is generally detected by an elevated or rising serum prostate-specific antigen (PSA) and digital rectal examination (DRE) followed by pathological examination. Histopathology ultimately confirms the presence of PCa and determines a Gleason score. However, PSA and DRE have low specificity and sensitivity, respectively. Subsequently, accurate assessment of the aggressiveness of PCa is essential to prevent overdiagnosis and thus overtreatment of low-risk or indolent cancers. By visualizing PCa suspicious lesions and sampling them during the targeted biopsy, it is likely that the diagnostic accuracy of significant PCa improves. This article reviews the current imaging techniques used to secure biopsies in patients with a suspicion of PCa. The advantages and limitations of each technique are described. Expert opinion: Multiparametric magnetic resonance imaging (mpMRI) and subsequent-targeted biopsy have improved the diagnostic accuracy of PCa detection in men with an elevated or rising serum PSA. Prostate lesions visible on mpMRI are easily targeted during either in-bore MRI-guided biopsy, cognitive fusion biopsy or MRI-TRUS fusion biopsy.
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Affiliation(s)
- Annemarijke van Luijtelaar
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Joyce Bomers
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Jurgen Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center , Nijmegen , The Netherlands
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39
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Boesen L. Magnetic resonance imaging-transrectal ultrasound image fusion guidance of prostate biopsies: current status, challenges and future perspectives. Scand J Urol 2019; 53:89-96. [PMID: 31006323 DOI: 10.1080/21681805.2019.1600581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The use of multiparametric magnetic resonance imaging (mpMRI) in prostate cancer (PCa) diagnosis is rapidly evolving to try to overcome the limitations of the current diagnostic pathway using systematic transrectal ultrasound-guided biopsies (TRUSbx) for all men with clinical suspicion of PCa. Prostate mpMRI allows for high quality lesion detection and characterization and has been shown to improve detection of significant PCa with a more accurate Gleason score grading. Suspicious lesions can be stratified by suspicion and sampled by selective MRI-guided targeted biopsies (TBx) for improved diagnostic accuracy. Several TBx methods have been established and include MRI/TRUS image fusion biopsies (cognitive or software-assisted) and in-bore biopsies, but none have yet proven superior in clinical practice. However, while MRI in-bore biopsy is not routinely used due to its costs and limited availability, MRI/TRUS image fusion is rapidly embraced as it allows skilled urologists to perform TBx in an outpatient clinic. Furthermore, it gives the operator the advantage of adding TBx to the systematic standard biopsy scheme, which is the currently recommended approach. With the anticipated increased future use of prebiopsy mpMRI, a more widespread implementation of MRI/TRUS image fusion platforms is concurrently expected in clinical practice. Therefore, the objective of this review is to assess the current status, challenges and future perspectives of prostate MRI/TRUS image fusion biopsies.
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Affiliation(s)
- Lars Boesen
- a Department of Urology and Urological Research , Herlev Gentofte University Hospital , Herlev , Denmark
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40
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Püllen L, Hadaschik B, Eberli D, Kuru TH. [Fusion biopsies for primary diagnosis of prostate cancer : Implementation, benefits, and clinical aspects]. Urologe A 2019; 58:504-510. [PMID: 30838429 DOI: 10.1007/s00120-019-0889-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Prostate carcinoma is one of the most common tumors worldwide. Histological confirmation by biopsy is an obligatory part of the diagnostic approach. The main problem of the 10-12-fold transrectal ultrasound-guided (TRUS) biopsy, which has so far been regarded as the gold standard, is the underdiagnosis of clinically significant cancer. MRI-based procedures, so-called fusion biopsies, have shown superior results when compared to conventional biopsies. There are three different approaches (cognitive and software-based MRI/TRUS fusion and in-bore biopsy) with comparable detection rates but differences in the technical aspects and time involvement. In order to reduce fusion errors, targeted biopsies should consist of multiple cores. There is currently no clear preference for the access pathway (transrectal or transperineal), but clinical parameters such as infection risk or location of the tumor can influence the decision. While the German S3 guideline considers MRI prior to primary biopsy to be optional, the 2019 European Association of Urology guidelines already recommend MRI prior to biopsy for all patients. The combination of MRI-targeted and systematic biopsy offers the highest detection rates with the disadvantage that more low-risk tumors are diagnosed. Both the patient and the urologist benefit from an improved informative value of the biopsy when deciding on active surveillance as well as when planning invasive therapies.
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Affiliation(s)
- L Püllen
- Klinik für Urologie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
| | - B Hadaschik
- Klinik für Urologie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - D Eberli
- Klinik für Urologie, Universitätsspital Zürich, Zürich, Schweiz
| | - T H Kuru
- Klinik für Urologie, Universitätsklinikum Köln, Köln, Deutschland.,Urologie am Ebertplatz, Köln, Deutschland
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41
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Clinical evaluation of an MRI-to-ultrasound deformable image registration algorithm for prostate brachytherapy. Brachytherapy 2019; 18:95-102. [DOI: 10.1016/j.brachy.2018.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/16/2018] [Accepted: 08/08/2018] [Indexed: 11/21/2022]
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42
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Shoji S. Magnetic resonance imaging-transrectal ultrasound fusion image-guided prostate biopsy: Current status of the cancer detection and the prospects of tailor-made medicine of the prostate cancer. Investig Clin Urol 2018; 60:4-13. [PMID: 30637355 PMCID: PMC6318202 DOI: 10.4111/icu.2019.60.1.4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/12/2018] [Indexed: 12/11/2022] Open
Abstract
Multi-parametric magnetic resonance imaging (mpMRI) has been increasingly used to diagnose clinically significant prostate cancer (csPCa) because of its growing availability and its ability to combine anatomical and functional data. Magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) fusion imaging provides MRI information with TRUS images for prostate biopsies. This technique combines the superior sensitivity of MRI for targeting suspicious lesions with the practicality and familiarity of TRUS. MRI-TRUS fusion image-guided prostate biopsy is performed with different types of image registration (rigid vs. elastic) and needle tracking methods (electromagnetic tracking vs. mechanical position encoders vs. image-based software tracking). A systematic review and meta-analysis showed that MRI-targeted biopsy detected csPCa at a significantly higher rate than did TRUS-guided biopsy, while it detected significantly fewer cases of insignificant PCas. In addition to the high accuracy of MRI-targeted biopsy for csPCa, localization of csPCa is accurate. The ability to choose the route of biopsy (transperineal vs. transrectal) is required, depending on the patients' risk and the location and size of suspicious lesions on mpMRI. Fusion image-guided prostate biopsy has the potential to allow precise management of prostate cancer, including active surveillance, radical treatment, and focal therapy.
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Affiliation(s)
- Sunao Shoji
- Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
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43
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Ploussard G, Borgmann H, Briganti A, de Visschere P, Fütterer JJ, Gandaglia G, Heidegger I, Kretschmer A, Mathieu R, Ost P, Sooriakumaran P, Surcel C, Tilki D, Tsaur I, Valerio M, van den Bergh R. Positive pre-biopsy MRI: are systematic biopsies still useful in addition to targeted biopsies? World J Urol 2018; 37:243-251. [PMID: 29967944 DOI: 10.1007/s00345-018-2399-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/28/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The diagnostic strategy implementing multiparametric magnet resonance tomography (mpMRI) and targeted biopsies (TB) improves the detection and characterization of significant prostate cancer (PCa). We aimed to assess the clinical usefulness of systematic biopsies (SB) in the setting of patients having a pre-biopsy positive MRI. METHODS A review of the literature was performed in March 2018. All studies investigating the performance of SB in addition to TB (all techniques) were assessed, both in the biopsy-naïve and repeat biopsy setting. RESULTS Evidence demonstrates that TB improves the detection of index-significant PCa compared with SB alone, in both initial and repeat biopsy settings. However, the combination of both TB and SB improved the overall (around 30%) and significant (around 10%) PCa detection rates as compared with TB alone. Significant differences between both biopsy approaches exist regarding cancer location favoring SB for the far lateral sampling, and TB for the anterior zone. Main current pitfalls of pure TB strategy are the learning curve and experience required for mpMRI reading and biopsy targeting, as well as the precision assessment in TB techniques. CONCLUSION A pure TB strategy omitting SB leads to the risk of missing up to 15% of significant cancer, due to limitations of mpMRI performance/reading and of precision during lesion targeting. SB remain necessary, in addition to the TB, to obtain the most accurate assessment of the entire prostate gland in this sub-group of patients at risk of significant disease.
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Affiliation(s)
- Guillaume Ploussard
- Department of Urology, Saint Jean Languedoc/La Croix du Sud Hospital, 20, route de Revel, 31400, Toulouse, France. .,IUCT-O, Avenue Joliot-Curie, 31000, Toulouse, France.
| | - Hendrik Borgmann
- Department of Urology, University Hospital of Mainz, Mainz, Germany
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Vita-Salute University and San Raffaele Hospital, Milan, Italy
| | | | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Giorgio Gandaglia
- Department of Urology, Urological Research Institute, Vita-Salute University and San Raffaele Hospital, Milan, Italy
| | - Isabel Heidegger
- Department of Urology, University Hospital of Innsbrück, Innsbrück, Austria
| | | | | | - Piet Ost
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | | | - Cristian Surcel
- Department of Urology, Fundeni Clinical Institute, Bucharest, Romania
| | - Derya Tilki
- Department of Urology, Martini Klinik, Hamburg, Germany
| | - Igor Tsaur
- Department of Urology, University Hospital of Mainz, Mainz, Germany
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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44
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Rosenkrantz AB, Hemingway J, Hughes DR, Duszak R, Allen B, Weinreb JC. Evolving Use of Prebiopsy Prostate Magnetic Resonance Imaging in the Medicare Population. J Urol 2018; 200:89-94. [DOI: 10.1016/j.juro.2018.01.071] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Andrew B. Rosenkrantz
- Department of Radiology, New York University Langone Medical Center, New York, New York
| | | | - Danny R. Hughes
- Harvey L. Neiman Health Policy Institute, Reston, Virginia
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Bibb Allen
- Department of Radiology, Grandview Medical Center, Birmingham, Alabama
| | - Jeffrey C. Weinreb
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
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45
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Hale GR, Czarniecki M, Cheng A, Bloom JB, Seifabadi R, Gold SA, Rayn KN, Sabarwal VK, Mehralivand S, Choyke PL, Turkbey B, Wood B, Pinto PA. Comparison of Elastic and Rigid Registration during Magnetic Resonance Imaging/Ultrasound Fusion-Guided Prostate Biopsy: A Multi-Operator Phantom Study. J Urol 2018; 200:1114-1121. [PMID: 29940248 DOI: 10.1016/j.juro.2018.06.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The relative value of rigid or elastic registration during magnetic resonance imaging/ultrasound fusion guided prostate biopsy has been poorly studied. We compared registration errors (the distance between a region of interest and fiducial markers) between rigid and elastic registration during fusion guided prostate biopsy using a prostate phantom model. MATERIALS AND METHODS Four gold fiducial markers visible on magnetic resonance imaging and ultrasound were placed throughout 1 phantom prostate model. The phantom underwent magnetic resonance imaging and the fiducial markers were labeled as regions of interest. An experienced user and a novice user of fusion guided prostate biopsy targeted regions of interest and then the corresponding fiducial markers on ultrasound after rigid and then elastic registration. Registration errors were compared. RESULTS A total of 224 registration error measurements were recorded. Overall elastic registration did not provide significantly improved registration error over rigid registration (mean ± SD 4.87 ± 3.50 vs 4.11 ± 2.09 mm, p = 0.05). However, lesions near the edge of the phantom showed increased registration errors when using elastic registration (5.70 ± 3.43 vs 3.23 ± 1.68 mm, p = 0.03). Compared to the novice user the experienced user reported decreased registration error with rigid registration (3.25 ± 1.49 vs 4.98 ± 2.10 mm, p <0.01) and elastic registration (3.94 ± 2.61 vs 6.07 ± 4.16 mm, p <0.01). CONCLUSIONS We found no difference in registration errors between rigid and elastic registration overall but rigid registration decreased the registration error of targets near the prostate edge. Additionally, operator experience reduced registration errors regardless of the registration method. Therefore, elastic registration algorithms cannot serve as a replacement for attention to detail during the registration process and anatomical landmarks indicating accurate registration when beginning the procedure and before targeting each region of interest.
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Affiliation(s)
- Graham R Hale
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Marcin Czarniecki
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Alexis Cheng
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Reza Seifabadi
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Samuel A Gold
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Kareem N Rayn
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Vikram K Sabarwal
- Department of Urology, George Washington University, Washington, D. C
| | - Sherif Mehralivand
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Department of Urology and Pediatric Urology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Germany
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Brad Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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46
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Gillies DJ, Gardi L, De Silva T, Zhao SR, Fenster A. Real-time registration of 3D to 2D ultrasound images for image-guided prostate biopsy. Med Phys 2017; 44:4708-4723. [PMID: 28666058 DOI: 10.1002/mp.12441] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/29/2017] [Accepted: 06/16/2017] [Indexed: 12/13/2022] Open
Abstract
PURPOSE During image-guided prostate biopsy, needles are targeted at tissues that are suspicious of cancer to obtain specimen for histological examination. Unfortunately, patient motion causes targeting errors when using an MR-transrectal ultrasound (TRUS) fusion approach to augment the conventional biopsy procedure. This study aims to develop an automatic motion correction algorithm approaching the frame rate of an ultrasound system to be used in fusion-based prostate biopsy systems. Two modes of operation have been investigated for the clinical implementation of the algorithm: motion compensation using a single user initiated correction performed prior to biopsy, and real-time continuous motion compensation performed automatically as a background process. METHODS Retrospective 2D and 3D TRUS patient images acquired prior to biopsy gun firing were registered using an intensity-based algorithm utilizing normalized cross-correlation and Powell's method for optimization. 2D and 3D images were downsampled and cropped to estimate the optimal amount of image information that would perform registrations quickly and accurately. The optimal search order during optimization was also analyzed to avoid local optima in the search space. Error in the algorithm was computed using target registration errors (TREs) from manually identified homologous fiducials in a clinical patient dataset. The algorithm was evaluated for real-time performance using the two different modes of clinical implementations by way of user initiated and continuous motion compensation methods on a tissue mimicking prostate phantom. RESULTS After implementation in a TRUS-guided system with an image downsampling factor of 4, the proposed approach resulted in a mean ± std TRE and computation time of 1.6 ± 0.6 mm and 57 ± 20 ms respectively. The user initiated mode performed registrations with in-plane, out-of-plane, and roll motions computation times of 108 ± 38 ms, 60 ± 23 ms, and 89 ± 27 ms, respectively, and corresponding registration errors of 0.4 ± 0.3 mm, 0.2 ± 0.4 mm, and 0.8 ± 0.5°. The continuous method performed registration significantly faster (P < 0.05) than the user initiated method, with observed computation times of 35 ± 8 ms, 43 ± 16 ms, and 27 ± 5 ms for in-plane, out-of-plane, and roll motions, respectively, and corresponding registration errors of 0.2 ± 0.3 mm, 0.7 ± 0.4 mm, and 0.8 ± 1.0°. CONCLUSIONS The presented method encourages real-time implementation of motion compensation algorithms in prostate biopsy with clinically acceptable registration errors. Continuous motion compensation demonstrated registration accuracy with submillimeter and subdegree error, while performing < 50 ms computation times. Image registration technique approaching the frame rate of an ultrasound system offers a key advantage to be smoothly integrated to the clinical workflow. In addition, this technique could be used further for a variety of image-guided interventional procedures to treat and diagnose patients by improving targeting accuracy.
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Affiliation(s)
- Derek J Gillies
- Department of Medical Biophysics, Western University, London, Ontario, N6A 3K7, Canada.,Robarts Research Institute, Western University, London, Ontario, N6A 5B7, Canada
| | - Lori Gardi
- Department of Medical Biophysics, Western University, London, Ontario, N6A 3K7, Canada.,Robarts Research Institute, Western University, London, Ontario, N6A 5B7, Canada
| | - Tharindu De Silva
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Shuang-Ren Zhao
- Centre for Imaging Technology Commercialization, London, Ontario, N6G 4X8, Canada
| | - Aaron Fenster
- Department of Medical Biophysics, Western University, London, Ontario, N6A 3K7, Canada.,Robarts Research Institute, Western University, London, Ontario, N6A 5B7, Canada.,Centre for Imaging Technology Commercialization, London, Ontario, N6G 4X8, Canada
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