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Mac Curtain BM, Temperley HC, Kelly JAO, Ryan J, Qian W, O'Sullivan N, Breen KJ, Mc Carthy CJ, Brennan I, Davis NF. The role of urology and radiology in prostate biopsy: current trends and future perspectives. World J Urol 2024; 42:249. [PMID: 38649544 DOI: 10.1007/s00345-024-04967-6] [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: 02/20/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE Prostate biopsy is central to the accurate histological diagnosis of prostate cancer. In current practice, the biopsy procedure can be performed using a transrectal or transperineal route with different technologies available for targeting of lesions within the prostate. Historically, the biopsy procedure was performed solely by urologists, but with the advent of image-guided techniques, the involvement of radiologists in prostate biopsy has become more common. Herein, we discuss the pros, cons and future considerations regarding their ongoing role. METHODS A narrative review regarding the current evidence was completed. PubMed and Cochrane central register of controlled trials were search until January 2024. All study types were of consideration if published after 2000 and an English language translation was available. RESULTS There are no published studies that directly compare outcomes of prostate biopsy when performed by a urologist or radiologist. In all published studies regarding the learning curve for prostate biopsy, the procedure was performed by urologists. These studies suggest that the learning curve for prostate biopsy is between 10 and 50 cases to reach proficiency in terms of prostate cancer detection and complications. It is recognised that many urologists are poorly able to accurately interpret multi parametric (mp)-MRI of the prostate. Collaboration between the specialities is of importance with urology offering the advantage of being involved in prior and future care of the patient while radiology has the advantage of being able to expertly interpret preprocedure MRI. CONCLUSION There is no evidence to suggest that prostate biopsy should be solely performed by a specific specialty. The most important factor remains knowledge of the relevant anatomy and sufficient volume of cases to develop and maintain skills.
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Affiliation(s)
| | | | - John A O Kelly
- Department of Urology, St Vincent's University Hospital, Dublin, Ireland
| | - James Ryan
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Wanyang Qian
- Dept of Surgery, St John of God Midland Hospital, Midland, WA, USA
| | | | - Kieran J Breen
- Department of Urology, St Vincent's University Hospital, Dublin, Ireland
| | - Colin J Mc Carthy
- Department of Radiology, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| | - Ian Brennan
- Department of Radiology, St James Hospital, Dublin, Ireland
| | - Niall F Davis
- Department of Urology, Beaumont Hospital, Dublin, Ireland
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Biswas P, Dehghani H, Sikander S, Song SE. Kinematic and mechanical modelling of a novel 4-DOF robotic needle guide for MRI-guided prostate intervention. BIOMEDICAL ENGINEERING ADVANCES 2022; 4:100036. [PMID: 35968253 PMCID: PMC9365025 DOI: 10.1016/j.bea.2022.100036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Traditionally ultrasound-guided biopsy has been used to diagnose prostate cancer despite of its poor soft tissue contrast and frequent false negative results. Magnetic Resonance Imaging (MRI) has the advantage of excellent soft tissue contrast for guiding and monitoring prostate biopsy. However, its working area and access in the confined MRI bore space limit the use of interventional guide devices including robotic systems. To provide robotic precision, greater access, and compact design, we designed a novel robotic mechanism that can provide four degrees of freedom (DOF) manipulation in a compact form comparable to size of manual templates. To develop the mechanism, we established a mathematical model of inverse and forward kinematics and prototyped a proof-of-concept needle guide for MRI guided prostate biopsy. The mechanism was materialized using four discs that house small passive spherical joints that can be moved by rotating the discs consisting of grooved profile. With an initial needle insertion angle range of ±15°, we identified mathematical and kinematic parameters for the mechanism design and fabricated the first prototype that has dimension of 40 × 110 × 180 mm3. The prototype demonstrated that the unique robotic manipulation can physically be delivered and could provide precise needle guidance including angulated needle insertion with higher structural rigidity.
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Affiliation(s)
- Pradipta Biswas
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, United States
| | | | - Sakura Sikander
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, United States
| | - Sang-Eun Song
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, United States
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Das CJ, Razik A, Sharma S, Verma S. Prostate biopsy: when and how to perform. Clin Radiol 2019; 74:853-864. [PMID: 31079953 DOI: 10.1016/j.crad.2019.03.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 03/15/2019] [Indexed: 12/24/2022]
Abstract
Prostate cancer, unlike other cancers, has been sampled in a non-targeted, systematic manner in the past three decades. On account of the low volume of prostate sampled despite the multiple cores acquired, systematic transrectal (TRUS) biopsy suffered from low sensitivity in picking up clinically significant prostate cancer. In addition, a significant number of cancers of the anterior, lateral peripheral zone, and the apex were missed as these areas were undersampled or missed during this biopsy protocol. Subsequently, the number of cores acquired was increased with special focus given to targeting the previously undersampled areas. These procedures led to an increase in the complication rates as well as detection of more clinically insignificant cancers. The advent of multiparametric magnetic resonance imaging (MRI) and its high intrinsic tissue contrast enabled better detection of prostate cancer. This led to the introduction of MRI-targeted biopsies with either MRI-TRUS fusion or under direct (in-gantry) guidance. MRI-targeted biopsies increased the percentage of positive cores and detection of clinically significant prostate cancers; however, these are expensive, time-intensive, require significant capital investment and operator expertise. This article describes the indications, workflow, complications, advantages, and disadvantages of TRUS-guided biopsy followed by MRI-guided biopsies.
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Affiliation(s)
- C J Das
- Department of Radiology, All India Institute of Medical Sciences (A.I.I.M.S), Ansari Nagar, New Delhi, 110029, India
| | - A Razik
- Department of Radiology, All India Institute of Medical Sciences (A.I.I.M.S), Ansari Nagar, New Delhi, 110029, India
| | - S Sharma
- Department of Radiology, All India Institute of Medical Sciences (A.I.I.M.S), Ansari Nagar, New Delhi, 110029, India
| | - S Verma
- Department of Radiology, The Veterans Administration Hospital Cincinnati, The University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45267, USA.
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Moreira P, Patel N, Wartenberg M, Li G, Tuncali K, Heffter T, Burdette EC, Iordachita I, Fischer GS, Hata N, Tempany CM, Tokuda J. Evaluation of robot-assisted MRI-guided prostate biopsy: needle path analysis during clinical trials. Phys Med Biol 2018; 63:20NT02. [PMID: 30226214 PMCID: PMC6198326 DOI: 10.1088/1361-6560/aae214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
While the interaction between a needle and the surrounding tissue is known to cause a significant targeting error in prostate biopsy leading to false-negative results, few studies have demonstrated how it impacts in the actual procedure. We performed a pilot study on robot-assisted MRI-guided prostate biopsy with an emphasis on the in-depth analysis of the needle-tissue interaction in vivo. The data were acquired during in-bore transperineal prostate biopsies in patients using a 4 degrees-of-freedom (DoF) MRI-compatible robot. The anatomical structures in the pelvic area and the needle path were reconstructed from MR images, and quantitatively analyzed. We analyzed each structure individually and also proposed a mathematical model to investigate the influence of those structures in the targeting error using the mixed-model regression. The median targeting error in 188 insertions (27 patients) was 6.3 mm. Both the individual anatomical structure analysis and the mixed-model analysis showed that the deviation resulted from the contact between the needle and the skin as the main source of error. On contrary, needle bending inside the tissue (expressed as needle curvature) did not vary among insertions with targeting errors above and below the average. The analysis indicated that insertions crossing the bulbospongiosus presented a targeting error lower than the average. The mixed-model analysis demonstrated that the distance between the needle guide and the patient skin, the deviation at the entry point, and the path length inside the pelvic diaphragm had a statistically significant contribution to the targeting error (p < 0.05). Our results indicate that the errors associated with the elastic contact between the needle and the skin were more prominent than the needle bending along the insertion. Our findings will help to improve the preoperative planning of transperineal prostate biopsies.
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Affiliation(s)
- Pedro Moreira
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Niravkumar Patel
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
| | - Marek Wartenberg
- Automation and Interventional Medicine Lab, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Gang Li
- Automation and Interventional Medicine Lab, Worcester Polytechnic Institute, Worcester, MA,USA
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA,USA
| | | | | | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
| | - Gregory S. Fischer
- Automation and Interventional Medicine Lab, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Nobuhiko Hata
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Clare M. Tempany
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA,USA
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The Learning Curve for Magnetic Resonance Imaging/Ultrasound Fusion-guided Prostate Biopsy. Eur Urol Oncol 2018; 2:135-140. [PMID: 31017088 DOI: 10.1016/j.euo.2018.07.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/28/2018] [Accepted: 07/16/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Magnetic resonance imaging/ultrasound-guided fusion biopsy (FBx) is more accurate at detecting clinically significant prostate cancer than conventional transrectal ultrasound-guided systematic biopsy. However, learning curves for attaining accuracy may limit the generalizability of published outcomes. OBJECTIVE To delineate and quantify the learning curve for FBx by assessing the targeted biopsy accuracy and pathological quality of systematic biopsy over time. DESIGN, SETTING, AND PARTICIPANTS We carried out a retrospective analysis of 173 consecutive men who underwent Artemis FBx with computer-template systematic sampling between July 2015 and May 2017. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The accuracy of targeted biopsy was determined by calculating the distance between planned and actual core trajectories stored on Artemis. Systematic sampling proficiency was assessed via pathological analysis of fibromuscular tissue in all cores and then comparing pathology elements from individual cores from men in the first and last tertiles. Polynomial linear regression models, change-point analysis, and piecewise linear regression were used to quantify the learning curve. RESULTS AND LIMITATION A significant improvement in targeted biopsy accuracy occurred up to 98 cases (p<0.01). There was a significant decrease in fibromuscular tissue in the systematic biopsy cores up to 84 cases (p<0.01) and an improvement in pathological quality when comparing systematic cores from the first and third tertiles. Use of a different fusion platform may limit the generalizability of our results. CONCLUSIONS There is a significant learning curve for targeted and systemic biopsy using the Artemis platform. Improvements in accuracy of targeted biopsy and better sampling for systematic biopsy can be achieved with greater experience. PATIENT SUMMARY We define the learning curve for magnetic resonance imaging/ultrasound-guided fusion biopsy (FBx) using targeted biopsy accuracy and systematic core sampling quality as measures. Our findings underscore the importance of overcoming learning curves inherent to FBx to minimize patient discomfort and biopsy risk and improve the quality of care for accurate risk stratification, active surveillance, and treatment selection.
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Bagheri MH, Ahlman MA, Lindenberg L, Turkbey B, Lin J, Cahid Civelek A, Malayeri AA, Agarwal PK, Choyke PL, Folio LR, Apolo AB. Advances in medical imaging for the diagnosis and management of common genitourinary cancers. Urol Oncol 2017; 35:473-491. [PMID: 28506596 PMCID: PMC5931389 DOI: 10.1016/j.urolonc.2017.04.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/05/2017] [Accepted: 04/15/2017] [Indexed: 01/01/2023]
Abstract
Medical imaging of the 3 most common genitourinary (GU) cancers-prostate adenocarcinoma, renal cell carcinoma, and urothelial carcinoma of the bladder-has evolved significantly during the last decades. The most commonly used imaging modalities for the diagnosis, staging, and follow-up of GU cancers are computed tomography, magnetic resonance imaging (MRI), and positron emission tomography (PET). Multiplanar multidetector computed tomography and multiparametric MRI with diffusion-weighted imaging are the main imaging modalities for renal cell carcinoma and urothelial carcinoma, and although multiparametric MRI is rapidly becoming the main imaging tool in the evaluation of prostate adenocarcinoma, biopsy is still required for diagnosis. Functional and molecular imaging using 18-fluorodeoxyglucose-PET and sodium fluoride-PET are essential for the diagnosis, and especially follow-up, of metastatic GU tumors. This review provides an overview of the latest advances in the imaging of these 3 major GU cancers.
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Affiliation(s)
- Mohammad H Bagheri
- Clinical Image Processing Service, Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Mark A Ahlman
- Nuclear Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD; Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Liza Lindenberg
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jeffrey Lin
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Ali Cahid Civelek
- Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Ashkan A Malayeri
- Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Piyush K Agarwal
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Les R Folio
- Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Andrea B Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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Brown AM, Elbuluk O, Mertan F, Sankineni S, Margolis DJ, Wood BJ, Pinto PA, Choyke PL, Turkbey B. Recent advances in image-guided targeted prostate biopsy. ACTA ACUST UNITED AC 2016; 40:1788-99. [PMID: 25596716 DOI: 10.1007/s00261-015-0353-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Prostate cancer is a common malignancy in the United States that results in over 30,000 deaths per year. The current state of prostate cancer diagnosis, based on PSA screening and sextant biopsy, has been criticized for both overdiagnosis of low-grade tumors and underdiagnosis of clinically significant prostate cancers (Gleason score ≥7). Recently, image guidance has been added to perform targeted biopsies of lesions detected on multi-parametric magnetic resonance imaging (mpMRI) scans. These methods have improved the ability to detect clinically significant cancer, while reducing the diagnosis of low-grade tumors. Several approaches have been explored to improve the accuracy of image-guided targeted prostate biopsy, including in-bore MRI-guided, cognitive fusion, and MRI/transrectal ultrasound fusion-guided biopsy. This review will examine recent advances in these image-guided targeted prostate biopsy techniques.
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Affiliation(s)
- Anna M Brown
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
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Mertan FV, Berman R, Szajek K, Pinto PA, Choyke PL, Turkbey B. Evaluating the Role of mpMRI in Prostate Cancer Assessment. Expert Rev Med Devices 2016; 13:129-41. [PMID: 26690507 DOI: 10.1586/17434440.2016.1134311] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Prostate cancer is the most common malignancy among American men. The role of multi-parametric MRI has recently gained more importance in detection of prostate cancer, its targeted biopsy, and focal therapy guidance. In this review, uses of multi-parametric MRI in prostate cancer assessment and treatment are discussed.
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Affiliation(s)
| | - Rose Berman
- a Molecular Imaging Program , NCI, NIH , Bethesda , MD , USA
| | - Kathryn Szajek
- a Molecular Imaging Program , NCI, NIH , Bethesda , MD , USA.,b Department of Science , Mount St. Mary's University , Emmitsburg , MD , USA
| | - Peter A Pinto
- c Urologic Oncology Branch , NCI, NIH , Bethesda , MD , USA
| | - Peter L Choyke
- a Molecular Imaging Program , NCI, NIH , Bethesda , MD , USA
| | - Baris Turkbey
- a Molecular Imaging Program , NCI, NIH , Bethesda , MD , USA
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Hong CW, Rais-Bahrami S, Walton-Diaz A, Shakir N, Su D, George AK, Merino MJ, Turkbey B, Choyke PL, Wood BJ, Pinto PA. Comparison of magnetic resonance imaging and ultrasound (MRI-US) fusion-guided prostate biopsies obtained from axial and sagittal approaches. BJU Int 2014; 115:772-9. [PMID: 25045781 DOI: 10.1111/bju.12871] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare cancer detection rates and concordance between magnetic resonance imaging and ultrasound (MRI-US) fusion-guided prostate biopsy cores obtained from axial and sagittal approaches. PATIENTS AND METHODS Institutional records of MRI-US fusion-guided biopsy were reviewed. Detection rates for all cancers, Gleason ≥3 + 4 cancers, and Gleason ≥4 + 3 cancers were computed. Agreement between axial and sagittal cores for cancer detection, and frequency where one was upgraded the other was computed on a per-target and per-patient basis. RESULTS In all, 893 encounters from 791 patients that underwent MRI-US fusion-guided biopsy in 2007-2013 were reviewed, yielding 4688 biopsy cores from 2344 targets for analysis. The mean age and PSA level at each encounter was 61.8 years and 9.7 ng/mL (median 6.45 ng/mL). Detection rates for all cancers, ≥3 + 4 cancers, and ≥4 + 3 cancers were 25.9%, 17.2%, and 8.1% for axial cores, and 26.1%, 17.6%, and 8.6% for sagittal cores. Per-target agreement was 88.6%, 93.0%, and 96.5%, respectively. On a per-target basis, the rates at which one core upgraded or detected a cancer missed on the other were 8.3% and 8.6% for axial and sagittal cores, respectively. Even with the inclusion of systematic biopsies, omission of axial or sagittal cores would have resulted in missed detection or under-characterisation of cancer in 4.7% or 5.2% of patients, respectively. CONCLUSION Cancer detection rates, Gleason scores, and core involvement from axial and sagittal cores are similar, but significant cancer may be missed if only one core is obtained for each target. Discordance between axial and sagittal cores is greatest in intermediate-risk scenarios, where obtaining multiple cores may improve tissue characterisation.
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Affiliation(s)
- Cheng W Hong
- Center for Interventional Oncology, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, USA
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