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Wen M, Shcherbakov P, Xu Y, Li J, Hu Y, Zhou Q, Liang H, Yuan L, Zhang X. A temporal enhanced semi-supervised training framework for needle segmentation in 3D ultrasound images. Phys Med Biol 2024; 69:115023. [PMID: 38684166 DOI: 10.1088/1361-6560/ad450b] [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: 11/03/2023] [Accepted: 04/29/2024] [Indexed: 05/02/2024]
Abstract
Objective.Automated biopsy needle segmentation in 3D ultrasound images can be used for biopsy navigation, but it is quite challenging due to the low ultrasound image resolution and interference similar to the needle appearance. For 3D medical image segmentation, such deep learning networks as convolutional neural network and transformer have been investigated. However, these segmentation methods require numerous labeled data for training, have difficulty in meeting the real-time segmentation requirement and involve high memory consumption.Approach.In this paper, we have proposed the temporal information-based semi-supervised training framework for fast and accurate needle segmentation. Firstly, a novel circle transformer module based on the static and dynamic features has been designed after the encoders for extracting and fusing the temporal information. Then, the consistency constraints of the outputs before and after combining temporal information are proposed to provide the semi-supervision for the unlabeled volume. Finally, the model is trained using the loss function which combines the cross-entropy and Dice similarity coefficient (DSC) based segmentation loss with mean square error based consistency loss. The trained model with the single ultrasound volume input is applied to realize the needle segmentation in ultrasound volume.Main results.Experimental results on three needle ultrasound datasets acquired during the beagle biopsy show that our approach is superior to the most competitive mainstream temporal segmentation model and semi-supervised method by providing higher DSC (77.1% versus 76.5%), smaller needle tip position (1.28 mm versus 1.87 mm) and length (1.78 mm versus 2.19 mm) errors on the kidney dataset as well as DSC (78.5% versus 76.9%), needle tip position (0.86 mm versus 1.12 mm) and length (1.01 mm versus 1.26 mm) errors on the prostate dataset.Significance.The proposed method can significantly enhance needle segmentation accuracy by training with sequential images at no additional cost. This enhancement may further improve the effectiveness of biopsy navigation systems.
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Affiliation(s)
- Mingwei Wen
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, No 1037, Luoyu Road, Wuhan 430074, People's Republic of China
| | - Pavel Shcherbakov
- Institute for Control Science, Russian Academy of Sciences, 65, Profsoyuznaya str., Moscow 117997, Russia
| | - Yang Xu
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, No 1037, Luoyu Road, Wuhan 430074, People's Republic of China
- Hubei Medical Devices Quality Supervision and Test Institute, Wuhan, 430075, People's Republic of China
| | - Jing Li
- Hubei Medical Devices Quality Supervision and Test Institute, Wuhan, 430075, People's Republic of China
| | - Yi Hu
- Hubei Medical Devices Quality Supervision and Test Institute, Wuhan, 430075, People's Republic of China
| | - Quan Zhou
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, No 1037, Luoyu Road, Wuhan 430074, People's Republic of China
| | - Huageng Liang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 13, Hangkong Road, Wuhan 430022, People's Republic of China
| | - Li Yuan
- Department of Ultrasound imaging, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
| | - Xuming Zhang
- Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, No 1037, Luoyu Road, Wuhan 430074, People's Republic of China
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Ni L, Lin WK, Kasputis A, Postiff D, Siddiqui J, Allaway MJ, Davenport MS, Wei JT, Guo JL, Morgan TM, Udager AM, Wang X, Xu G. Assessment of prostate cancer progression using a translational needle photoacoustic sensing probe: Preliminary study with intact human prostates ex-vivo. PHOTOACOUSTICS 2022; 28:100418. [PMID: 36386297 PMCID: PMC9650056 DOI: 10.1016/j.pacs.2022.100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/17/2022] [Accepted: 10/23/2022] [Indexed: 06/14/2023]
Abstract
In our previous studies, we demonstrated the ability of an interstitial all-optical needle photoacoustic (PA) sensing probe and PA spectral analysis (PASA) to assess the aggressiveness of prostate cancer. In this clinical translation investigation, we integrated the optical components of the needle PA sensing probe into a 18G steel needle. The translational needle PA sensing probe was evaluated using intact human prostates in a simulated ultrasound-guided transperineal prostate biopsy. PA signals were acquired at 1220 nm, 1370 nm, 800 nm and 266 nm at each interstitial measurement location and quantified by PASA within the frequency range of 8-28 MHz. The measurement locations were stained for establishing spatial correlations between the quantitative measurements and the histological diagnosing. Most of the quantitative PA assessments reveal statistically significant differences between the benign and cancerous regions. Multivariate analysis combining the PASA quantifications shows an accuracy close to 90% in differentiating the benign and cancerous regions in the prostates.
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Affiliation(s)
- Linyu Ni
- Department of Biomedical Engineering, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Wei-kuan Lin
- Department of Electrical Engineering and Computer Sciences, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Amy Kasputis
- Department of Urology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Deborah Postiff
- Department of Pathology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Javed Siddiqui
- Department of Pathology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | | | - Matthew S. Davenport
- Department of Urology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
- Department of Radiology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - John T. Wei
- Department of Urology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Jay L. Guo
- Department of Electrical Engineering and Computer Sciences, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Todd M. Morgan
- Department of Urology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Aaron M. Udager
- Michigan Center for Translational Pathology, Rogel Cancer Center, Department of Pathology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Xueding Wang
- Department of Biomedical Engineering, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
- Department of Radiology, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
| | - Guan Xu
- Department of Biomedical Engineering, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
- Department of Ophthalmology and Visual Sciences, University of Michigan, 500 S. State St., Ann Arbor, 48109, MI, USA
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Inherited risk assessment and its clinical utility for predicting prostate cancer from diagnostic prostate biopsies. Prostate Cancer Prostatic Dis 2022; 25:422-430. [PMID: 35347252 DOI: 10.1038/s41391-021-00458-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/25/2021] [Accepted: 09/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many studies on prostate cancer (PCa) germline variants have been published in the last 15 years. This review critically assesses their clinical validity and explores their utility in prediction of PCa detection rates from prostate biopsy. METHODS An integrative review was performed to (1) critically synthesize findings on PCa germline studies from published papers since 2016, including risk-associated single nucleotide polymorphisms (SNPs), polygenic risk score methods such as genetic risk score (GRS), and rare pathogenic mutations (RPMs); (2) exemplify the findings in a large population-based cohort from the UK Biobank (UKB); (3) identify gaps for implementing inherited risk assessment in clinic based on experience from a healthcare system; (4) evaluate available GRS data on their clinical utility in predicting PCa detection rates from prostate biopsies; and (5) describe a prospective germline-based biopsy trial to address existing gaps. RESULTS SNP-based GRS and RPMs in four genes (HOXB13, BRCA2, ATM, and CHEK2) were significantly and consistently associated with PCa risk in large well-designed studies. In the UKB, positive family history, RPMs in the four implicated genes, and a high GRS (>1.5) identified 8.12%, 1.61%, and 17.38% of men to be at elevated PCa risk, respectively, with hazard ratios of 1.84, 2.74, and 2.39, respectively. Additionally, the performance of GRS for predicting PCa detection rate on prostate biopsy was consistently supported in several retrospective analyses of transrectal ultrasound (TRUS)-biopsy cohorts. Prospective studies evaluating the performance of all three inherited measures in predicting PCa detection rate from contemporary multiparametric MRI (mpMRI)-based biopsy are lacking. A multicenter germline-based biopsy trial to address these gaps is warranted. CONCLUSIONS The complementary performance of three inherited risk measures in PCa risk stratification is consistently supported. Their clinical utility in predicting PCa detection rate, if confirmed in prospective clinical trials, may improve current decision-making for prostate biopsy.
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Biological and Medical Disturbances Due to Exposure to Fields Emitted by Electromagnetic Energy Devices—A Review. ENERGIES 2022. [DOI: 10.3390/en15124455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The use of electromagnetic systems in daily life is on the rise. The immediate environment, of these electromagnetic energy devices, is exposed to their emitted fields. Environmental disturbances from such exposure could be severe in many ways; one of the most important is health. This could be directly related to the human body or to healthcare sensing and interventional devices. The review of the biological effects and disturbances of medical instruments due to electromagnetic field exposure is the subject of this article. The analysis of the different types of exposure as well as their control to meet safety requirements are investigated involving energy devices covering wide ranges of power and frequency. Thus, biological effects of both wireless telecommunications tools and inductive charging systems are reviewed. Next, we survey electromagnetic disturbances in sensing and stimulation instruments joint to the human body as well as devices used in medical interventions. Means of evaluating and controlling the effects of electromagnetic fields, through electromagnetic compatibility analysis, experimentally and by numerical modeling are conferred and assessed.
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Xie J, Jin C, Liu M, Sun K, Jin Z, Ding Z, Gong X. MRI/Transrectal Ultrasound Fusion-Guided Targeted Biopsy and Transrectal Ultrasound-Guided Systematic Biopsy for Diagnosis of Prostate Cancer: A Systematic Review and Meta-analysis. Front Oncol 2022; 12:880336. [PMID: 35677152 PMCID: PMC9169152 DOI: 10.3389/fonc.2022.880336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose For men suspected of having prostate cancer (PCa), the transrectal ultrasound (TRUS)-guided systematic biopsy (SB) was performed. MRI/TRUS fusion guided-targeted biopsy (MRI-TB) could enhance PCa detection, allowing sampling of sites at higher risk which were not obvious with TRUS alone. The aim of this systematic review and meta-analysis was to compare the detection rates of prostate cancer by MRI-TB or MRI-TB plus SB versus SB, mainly for diagnosis of high-risk PCa. Methods A literature Search was performed on PubMed, Cochrane Library, and Embase databases. We searched from inception of the databases up to January 2021. Results A total of 5831 patients from 26 studies were included in the present meta-analysis. Compared to traditional TRUS-guided biopsy, MRI-TB had a significantly higher detection rate of clinically significant PCa (RR=1.27; 95%CI 1.15-1.40; p<0.001) and high-risk PCa (RR=1.41; 95% CI 1.22-1.64; p<0.001), while the detection rate of clinically insignificant PCa was lower (RR=0.65; 95%CI 0.55-0.77; p<0.001). MRI-TB and SB did not significantly differ in the detection of overall prostate cancer (RR=1.04; 95%CI 0.95-1.12; p=0.41). Compared with SB alone, we found that MRI-TB plus SB diagnosed more cases of overall, clinically significant and high-risk PCa (p<0.001). Conclusion Compared with systematic protocols, MRI-TB detects more clinically significant and high-risk PCa cases, and fewer clinically insignificant PCa cases. MRI-TB combined with SB enhances PCa detection in contrast with either alone but did not reduce the diagnosis rate of clinically insignificant PCa. Systematic Review Registration https://www.crd.york.ac.uk/prospero/#searchadvanced, CRD42021218475.
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Affiliation(s)
- Jianfeng Xie
- Department of Ultrasound, Southern University of Science and Technology Hospital, Shenzhen, China
| | - Chunchun Jin
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Mengmeng Liu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
| | - Kun Sun
- Department of Ultrasound, Southern University of Science and Technology Hospital, Shenzhen, China
| | - Zhanqiang Jin
- Department of Ultrasound, Southern University of Science and Technology Hospital, Shenzhen, China
| | - Zhimin Ding
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, China
| | - Xuehao Gong
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
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Wilson DJ, Allen G, Bullock S, Denton J. Lumbar nerve root blocks using MRI - the effectiveness and safety of ultrasound/MRI fusion image guidance. Br J Radiol 2022; 95:20210599. [PMID: 34928177 PMCID: PMC9153711 DOI: 10.1259/bjr.20210599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To compare the outcome of nerve root injection guided by ultrasound/MRI fusion with radiofrequency needle tracking (eTRAX©) and the same procedure undertaken by fluoroscopic guidance. METHODS This is a retrospective audit of anonymised clinical records from before and after a change in the imaging technique used to perform nerve root blocks.We studied 181 consecutive patients who had undergone a nerve root block, the first 124 guided by fluoroscopic technique and the next 57 guided by ultrasound/MRI fusion with radiofrequency needle guidance.Using pain diaries, we reviewed the outcome scores at 24 h and 2 weeks. We recorded the use of analgesia, the patient's satisfaction, complications and the duration of the procedures. RESULTS Completed pain diaries were returned by 61% in the fluoroscopy group and 67% in the fusion imaging group.The visual analogue pain score was reduced at 24 h by 3.29 [standard deviation (SD) 2.35] for the fluoroscopy group and by 3.69 (SD 2.58) in the fusion group (p 0.399).At two weeks the pain reduction was 3.27 (SD 2.57) for the fluoroscopic group and 4.21 (SD 2.95) for the fusion group (p 0.083). There was no statistically significant difference between the groups.The patient's satisfaction scores were similar for both groups.The procedure by the two guidance methods took a similar time to perform.There were no serious complications in either group. One patient in the fusion-guided nerve root block group experienced paraesthesia in the nerve distribution for 2 h. CONCLUSION Ultrasound/MRI fusion imaging with needle tracking is an effective alternative to fluoroscopic image-guided injection. ADVANCES IN KNOWLEDGE Fusion imaging guidance provides the same outcome as fluoroscopic guidance.Fusion imaging guidance avoids the need for ionising radiation.
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Affiliation(s)
| | | | | | - Jon Denton
- Manor Hospital, Beach Road, Headington, Oxford, United Kingdom
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7
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Wu S, Liu Y, Chen Y, Xu C, Chen P, Zhang M, Ye W, Wu D, Huang S, Cheng Q. Quick identification of prostate cancer by wavelet transform-based photoacoustic power spectrum analysis. PHOTOACOUSTICS 2022; 25:100327. [PMID: 34987958 PMCID: PMC8695359 DOI: 10.1016/j.pacs.2021.100327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
Pathology is currently the gold standard for grading prostate cancer (PCa). However, pathology takes considerable time to provide a final result and is significantly dependent on subjective judgment. In this study, wavelet transform-based photoacoustic power spectrum analysis (WT-PASA) was used for grading PCa with different Gleason scores (GSs). The tumor region was accurately identified via wavelet transform time-frequency analysis. Then, a linear fitting was conducted on the photoacoustic power spectrum curve of the tumor region to obtain the quantified spectral parameter slope. The results showed that high GSs have small glandular cavity structures and higher heterogeneity, and consequently, the slopes at both 1210 nm and 1310 nm were high (p < 0.01). The classification accuracy of the PA time frequency spectrum (PA-TFS) of tumor region using ResNet-18 was 89% at 1210 nm and 92.7% at 1310 nm. Further, the testing time was less than 7 mins. The results demonstrated that identification of PCa can be rapidly and objectively realized using WT-PASA.
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Affiliation(s)
- Shiying Wu
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai, PR China
| | - Ying Liu
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Yingna Chen
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai, PR China
- Shanghai Research Institute for Intelligent Autonomous Systems, Tongji University, Shanghai, PR China
| | - Chengdang Xu
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Panpan Chen
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai, PR China
| | - Mengjiao Zhang
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai, PR China
| | - Wanli Ye
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai, PR China
| | - Denglong Wu
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Shengsong Huang
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Qian Cheng
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai, PR China
- Shanghai Research Institute for Intelligent Autonomous Systems, Tongji University, Shanghai, PR China
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8
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Bass EJ, Pantovic A, Connor MJ, Loeb S, Rastinehad AR, Winkler M, Gabe R, Ahmed HU. Diagnostic accuracy of magnetic resonance imaging targeted biopsy techniques compared to transrectal ultrasound guided biopsy of the prostate: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2021; 25:174-179. [PMID: 34548624 PMCID: PMC9184263 DOI: 10.1038/s41391-021-00449-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 11/15/2022]
Abstract
Background Multiparametric MRI localizes cancer in the prostate, allowing for MRI guided biopsy (MRI-GB) 43 alongside transrectal ultrasound-guided systematic biopsy (TRUS-GB). Three MRI-GB approaches exist; visual estimation (COG-TB); fusion software-assisted (FUS-TB) and MRI ‘in-bore’ biopsy (IB-TB). It is unknown whether any of these are superior. We conducted a systematic review and meta-analysis to address three questions. First, whether MRI-GB is superior to TRUS-GB at detecting clinically significant PCa (csPCa). Second, whether MRI-GB is superior to TRUS-GB at avoiding detection of insignificant PCa. Third, whether any MRI-GB strategy is superior at detecting csPCa. Methods A systematic literature review from 2015 to 2019 was performed in accordance with the START recommendations. Studies reporting PCa detection rates, employing MRI-GB and TRUS-GB were included and evaluated using the QUADAS-2 checklist. 1553 studies were found, of which 43 were included in the meta-analysis. Results For csPCa, MRI-GB was superior in detection to TRUS-GB (0.83 vs. 0.63 [p = 0.02]). MRI-GB was superior in detection to TRUS-GB at avoiding detection of insignificant PCa. No MRI-GB technique was superior at detecting csPCa (IB-TB 0.87; COG TB 0.81; FUS-TB 0.81, [p = 0.55]). There was significant heterogeneity observed between the included studies. Conclusions In patients with suspected PCa on MRI, MRI-GB offers superior rates of csPCa detection and reduces detection of insignificant PCa compared to TRUS-GB. No individual MRI-GB technique was found to be better in csPCa detection. Prospective adequately powered randomized controlled trials are required.
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Affiliation(s)
- E J Bass
- Imperial Prostate. Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. .,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK.
| | - A Pantovic
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research -, Belgrade, Serbia
| | - M J Connor
- Imperial Prostate. Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - S Loeb
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, New York, NY, USA
| | - A R Rastinehad
- Department of Urology, Lenox Hill Hospital at Northwell Health, New York, NY, USA
| | - M Winkler
- Imperial Prostate. Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Rhian Gabe
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - H U Ahmed
- Imperial Prostate. Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
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Park BK. Image-Guided Prostate Biopsy: Necessity for Terminology Standardization. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:191-196. [PMID: 31257624 DOI: 10.1002/jum.15083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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10
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Yamada Y, Okihara K, Masui K, Ueno A, Shiraishi T, Nakamura Y, Saito Y, Fujihara A, Hongo F, Yamada K, Ukimura O. Focal salvage low-dose-rate brachytherapy for recurrent prostate cancer based on magnetic resonance imaging/transrectal ultrasound fusion biopsy technique. Int J Urol 2019; 27:149-155. [PMID: 31721315 DOI: 10.1111/iju.14151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/20/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the effect of permanent salvage brachytherapy in prostate cancer patients suffering recurrence after three-dimensional conformal external beam radiotherapy. METHODS The ultra-focal (target lesion alone), hemi-lobe (within a hemi-lobe) or focused whole-gland (focusing on the lesion, but extending into the whole gland) pattern was selected based on the Gleason score for the targeted biopsy, the numbers of positive cores in the targeted and systematic biopsies, and the locations of the positive cores. Novel dosimetry criteria derived from three-dimensional cancer mapping, which was based on targeted magnetic resonance imaging/transrectal ultrasound fusion biopsies, were used in these cases. RESULTS Permanent salvage brachytherapy was carried out in 13 patients who suffered prostate-specific antigen failure (prostate-specific antigen 2.1-6.8 ng/mL; age range 57-75 years; Gleason score ≤7 [n = 10], Gleason score ≥8 [n = 2] and Gleason score not available [n = 1]) since 2012. The targeted biopsy showed a single focus in three patients. The ultra-focal, hemi-lobe and focused whole-gland patterns were chosen in three, five and five patients, respectively. During the follow-up period (median duration 48 months), prostate-specific antigen failure occurred in zero of three, one of five and three of five of the patients treated with the ultra-focal, hemi-lobe and focused whole-gland patterns, respectively. The 4-year biochemical recurrence-free survival rate was 74%. No grade 3-4 adverse intestinal or urological events occurred. CONCLUSIONS Targeted fusion biopsy-based three-dimensional cancer mapping should be used for permanent salvage brachytherapy treatment planning to reduce the incidence of treatment-related adverse events while maintaining good oncological outcomes.
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Affiliation(s)
- Yasuhiro Yamada
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koji Okihara
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koji Masui
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akihisa Ueno
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takumi Shiraishi
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuichi Nakamura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yumiko Saito
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsuko Fujihara
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumiya Hongo
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kei Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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11
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Ma WK, Ho BS, Lai AS, Lam KC, Chan YS, Yip LK, Ng AT, Tsu JH, Yiu MK. Multiparametric magnetic resonance imaging/transrectal ultrasound fusion prostate biopsy with semi-robotic navigation in the Chinese population: initial results. Asian J Androl 2019; 20:93-94. [PMID: 28327476 PMCID: PMC5753563 DOI: 10.4103/1008-682x.196855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Wai Kit Ma
- Division of Urology, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Brian Sh Ho
- Division of Urology, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Andrew Sh Lai
- Department of Diagnostic Radiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Ka Cheong Lam
- Department of Diagnostic Radiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yun Sang Chan
- Division of Urology, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Lawrance Kc Yip
- Department of Diagnostic Radiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Ada Tl Ng
- Division of Urology, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - James Hl Tsu
- Division of Urology, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Ming Kwong Yiu
- Division of Urology, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Drost FH, Osses DF, Nieboer D, Steyerberg EW, Bangma CH, Roobol MJ, Schoots IG. Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer. Cochrane Database Syst Rev 2019; 4:CD012663. [PMID: 31022301 PMCID: PMC6483565 DOI: 10.1002/14651858.cd012663.pub2] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (MRI), with or without MRI-targeted biopsy, is an alternative test to systematic transrectal ultrasonography-guided biopsy in men suspected of having prostate cancer. At present, evidence on which test to use is insufficient to inform detailed evidence-based decision-making. OBJECTIVES To determine the diagnostic accuracy of the index tests MRI only, MRI-targeted biopsy, the MRI pathway (MRI with or without MRI-targeted biopsy) and systematic biopsy as compared to template-guided biopsy as the reference standard in detecting clinically significant prostate cancer as the target condition, defined as International Society of Urological Pathology (ISUP) grade 2 or higher. Secondary target conditions were the detection of grade 1 and grade 3 or higher-grade prostate cancer, and a potential change in the number of biopsy procedures. SEARCH METHODS We performed a comprehensive systematic literature search up to 31 July 2018. We searched CENTRAL, MEDLINE, Embase, eight other databases and one trials register. SELECTION CRITERIA We considered for inclusion any cross-sectional study if it investigated one or more index tests verified by the reference standard, or if it investigated the agreement between the MRI pathway and systematic biopsy, both performed in the same men. We included only studies on men who were biopsy naïve or who previously had a negative biopsy (or a mix of both). Studies involving MRI had to report on both MRI-positive and MRI-negative men. All studies had to report on the primary target condition. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed the risk of bias using the QUADAS-2 tool. To estimate test accuracy, we calculated sensitivity and specificity using the bivariate model. To estimate agreement between the MRI pathway and systematic biopsy, we synthesised detection ratios by performing random-effects meta-analyses. To estimate the proportions of participants with prostate cancer detected by only one of the index tests, we used random-effects multinomial or binary logistic regression models. For the main comparisions, we assessed the certainty of evidence using GRADE. MAIN RESULTS The test accuracy analyses included 18 studies overall.MRI compared to template-guided biopsy: Based on a pooled sensitivity of 0.91 (95% confidence interval (CI): 0.83 to 0.95; 12 studies; low certainty of evidence) and a pooled specificity of 0.37 (95% CI: 0.29 to 0.46; 12 studies; low certainty of evidence) using a baseline prevalence of 30%, MRI may result in 273 (95% CI: 249 to 285) true positives, 441 false positives (95% CI: 378 to 497), 259 true negatives (95% CI: 203 to 322) and 27 (95% CI: 15 to 51) false negatives per 1000 men. We downgraded the certainty of evidence for study limitations and inconsistency.MRI-targeted biopsy compared to template-guided biopsy: Based on a pooled sensitivity of 0.80 (95% CI: 0.69 to 0.87; 8 studies; low certainty of evidence) and a pooled specificity of 0.94 (95% CI: 0.90 to 0.97; 8 studies; low certainty of evidence) using a baseline prevalence of 30%, MRI-targeted biopsy may result in 240 (95% CI: 207 to 261) true positives, 42 (95% CI: 21 to 70) false positives, 658 (95% CI: 630 to 679) true negatives and 60 (95% CI: 39 to 93) false negatives per 1000 men. We downgraded the certainty of evidence for study limitations and inconsistency.The MRI pathway compared to template-guided biopsy: Based on a pooled sensitivity of 0.72 (95% CI: 0.60 to 0.82; 8 studies; low certainty of evidence) and a pooled specificity of 0.96 (95% CI: 0.94 to 0.98; 8 studies; low certainty of evidence) using a baseline prevalence of 30%, the MRI pathway may result in 216 (95% CI: 180 to 246) true positives, 28 (95% CI: 14 to 42) false positives, 672 (95% CI: 658 to 686) true negatives and 84 (95% CI: 54 to 120) false negatives per 1000 men. We downgraded the certainty of evidence for study limitations, inconsistency and imprecision.Systemic biopsy compared to template-guided biopsy: Based on a pooled sensitivity of 0.63 (95% CI: 0.19 to 0.93; 4 studies; low certainty of evidence) and a pooled specificity of 1.00 (95% CI: 0.91 to 1.00; 4 studies; low certainty of evidence) using a baseline prevalence of 30%, systematic biopsy may result in 189 (95% CI: 57 to 279) true positives, 0 (95% CI: 0 to 63) false positives, 700 (95% CI: 637 to 700) true negatives and 111 (95% CI: 21 to 243) false negatives per 1000 men. We downgraded the certainty of evidence for study limitations and inconsistency.Agreement analyses: In a mixed population of both biopsy-naïve and prior-negative biopsy men comparing the MRI pathway to systematic biopsy, we found a pooled detection ratio of 1.12 (95% CI: 1.02 to 1.23; 25 studies). We found pooled detection ratios of 1.44 (95% CI 1.19 to 1.75; 10 studies) in prior-negative biopsy men and 1.05 (95% CI: 0.95 to 1.16; 20 studies) in biopsy-naïve men. AUTHORS' CONCLUSIONS Among the diagnostic strategies considered, the MRI pathway has the most favourable diagnostic accuracy in clinically significant prostate cancer detection. Compared to systematic biopsy, it increases the number of significant cancer detected while reducing the number of insignificant cancer diagnosed. The certainty in our findings was reduced by study limitations, specifically issues surrounding selection bias, as well as inconsistency. Based on these findings, further improvement of prostate cancer diagnostic pathways should be pursued.
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Affiliation(s)
- Frank‐Jan H Drost
- Erasmus University Medical CenterDepartment of Radiology and Nuclear Medicine's‐Gravendijkwal 230Room NA‐1710, P.O. Box 2040RotterdamZuid‐HollandNetherlands3015 CE
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Daniël F Osses
- Erasmus University Medical CenterDepartment of Radiology and Nuclear Medicine's‐Gravendijkwal 230Room NA‐1710, P.O. Box 2040RotterdamZuid‐HollandNetherlands3015 CE
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Daan Nieboer
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Ewout W Steyerberg
- Erasmus University Medical CenterDepartment of Public HealthPO Box 2040RotterdamNetherlands3000 CA
| | - Chris H Bangma
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Monique J Roobol
- Erasmus University Medical CenterDepartment of UrologyRotterdamNetherlands
| | - Ivo G Schoots
- Erasmus University Medical CenterDepartment of Radiology and Nuclear Medicine's‐Gravendijkwal 230Room NA‐1710, P.O. Box 2040RotterdamZuid‐HollandNetherlands3015 CE
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Queiroz MRG, Falsarella PM, Mariotti GC, Lemos GC, Baroni RH, Mussi TC, Garcia RG. Comparison of complications rates between multiparametric magnetic resonance imaging-transrectal ultrasound (TRUS) fusion and systematic TRUS prostatic biopsies. Abdom Radiol (NY) 2019; 44:732-738. [PMID: 30255444 DOI: 10.1007/s00261-018-1782-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to compare the complication rates between transrectal ultrasound (TRUS) systematic prostate biopsy and multiparametric magnetic resonance imaging (MRI)-TRUS fusion prostate biopsy techniques. MATERIALS AND METHODS This is a single-center retrospective study, institutional review board approved. Systematic TRUS and MRI-TRUS fusion prostate biopsy complication rates were compared in 967 men. A total of 319 patients were received systematic TRUS prostate biopsy and 648 patients underwent systematic TRUS + MRI-TRUS fusion prostate biopsy. Complications were divided into immediate (those that occurred during the hospital observation period) and late (those that occurred within 5 days after biopsy). RESULTS Seventeen complications were observed in patients who received either a systematic prostate biopsy or MRI-TRUS fusion prostate biopsy. Severe complications were not observed in both groups. Among patients who underwent systematic prostate biopsy, 6 (1.9%) cases of complications were observed and between those who received MRI-TRUS fusion prostate biopsy 11 (1.7%) cases of complications after the procedure (p = 0.873) were observed, with no statistical difference between groups. Also, no statistical differences between early and late complication groups (p > 0.999) were observed. CONCLUSIONS The complication rates were low in both groups, with no critical clinical outcomes and no significant difference of complication rates between systematic TRUS prostate biopsy and MRI-TRUS fusion prostate biopsy techniques.
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Affiliation(s)
- Marcos R G Queiroz
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Priscila M Falsarella
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | | | - Gustavo C Lemos
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, São Paulo, 05652-000, Brazil
| | - Ronaldo H Baroni
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, São Paulo, 05652-000, Brazil
| | - Thais Caldara Mussi
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, São Paulo, 05652-000, Brazil
| | - Rodrigo G Garcia
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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14
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Oderda M, Marra G, Albisinni S, Altobelli E, Baco E, Beatrici V, Cantiani A, Carbone A, Ciccariello M, Descotes JL, Dubreuil-Chambardel M, Eldred-Evans D, Fasolis G, Ferriero M, Fiard G, Forte V, Giacobbe A, Kumar P, Lacetera V, Mozer P, Muto G, Papalia R, Pastore A, Peltier A, Piechaud T, Simone G, Roche JB, Roupret M, Rouviere O, Van Velthoven R, Gontero P. Accuracy of elastic fusion biopsy in daily practice: Results of a multicenter study of 2115 patients. Int J Urol 2018; 25:990-997. [PMID: 30187529 DOI: 10.1111/iju.13796] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/05/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess the accuracy of Koelis fusion biopsy for the detection of prostate cancer and clinically significant prostate cancer in the everyday practice. METHODS We retrospectively enrolled 2115 patients from 15 institutions in four European countries undergoing transrectal Koelis fusion biopsy from 2010 to 2017. A variable number of target (usually 2-4) and random cores (usually 10-14) were carried out, depending on the clinical case and institution habits. The overall and clinically significant prostate cancer detection rates were assessed, evaluating the diagnostic role of additional random biopsies. The cancer detection rate was correlated to multiparametric magnetic resonance imaging features and clinical variables. RESULTS The mean number of targeted and random cores taken were 3.9 (standard deviation 2.1) and 10.5 (standard deviation 5.0), respectively. The cancer detection rate of Koelis biopsies was 58% for all cancers and 43% for clinically significant prostate cancer. The performance of additional, random cores improved the cancer detection rate of 13% for all cancers (P < 0.001) and 9% for clinically significant prostate cancer (P < 0.001). Prostate cancer was detected in 31%, 66% and 89% of patients with lesions scored as Prostate Imaging Reporting and Data System 3, 4 and 5, respectively. Clinical stage and Prostate Imaging Reporting and Data System score were predictors of prostate cancer detection in multivariate analyses. Prostate-specific antigen was associated with prostate cancer detection only for clinically significant prostate cancer. CONCLUSIONS Koelis fusion biopsy offers a good cancer detection rate, which is increased in patients with a high Prostate Imaging Reporting and Data System score and clinical stage. The performance of additional, random cores seems unavoidable for correct sampling. In our experience, the Prostate Imaging Reporting and Data System score and clinical stage are predictors of prostate cancer and clinically significant prostate cancer detection; prostate-specific antigen is associated only with clinically significant prostate cancer detection, and a higher number of biopsy cores are not associated with a higher cancer detection rate.
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Affiliation(s)
- Marco Oderda
- Department of Surgical Sciences - Urology, University of Turin, Turin, Italy.,Department of Urology, San Lazzaro Hospital, Alba, Italy
| | - Giancarlo Marra
- Department of Surgical Sciences - Urology, University of Turin, Turin, Italy
| | - Simone Albisinni
- Department of Urology, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Eduard Baco
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Valerio Beatrici
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano, Italy
| | | | - Antonio Carbone
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Mauro Ciccariello
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Jean-Luc Descotes
- Department of Urology, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Marine Dubreuil-Chambardel
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Université de Lyon, Lyon, France
| | | | | | | | - Gaelle Fiard
- Department of Urology, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Valerio Forte
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Pardeep Kumar
- Department of Urology, Royal Marsden Hospital, London, UK
| | - Vito Lacetera
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano, Italy
| | - Pierre Mozer
- Department of Urology, Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris, Universités Paris Sorbonne, Paris, France
| | - Giovanni Muto
- Department of Urology, Humanitas Gradenigo Hospital, Turin, Italy
| | - Rocco Papalia
- Department of Urology, Campus Biomedico University, Rome, Italy
| | - Antonio Pastore
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Alexandre Peltier
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Piechaud
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Morgan Roupret
- Department of Urology, Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris, Universités Paris Sorbonne, Paris, France
| | - Olivier Rouviere
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Université de Lyon, Lyon, France
| | - Roland Van Velthoven
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Paolo Gontero
- Department of Surgical Sciences - Urology, University of Turin, Turin, Italy
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15
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Huang S, Qin Y, Chen Y, Pan J, Xu C, Wu D, Chao WY, Wei JT, Tomlins SA, Wang X, Fowlkes JB, Carson PL, Cheng Q, Xu G. Interstitial assessment of aggressive prostate cancer by physio-chemical photoacoustics: An ex vivo study with intact human prostates. Med Phys 2018; 45:10.1002/mp.13061. [PMID: 29935081 PMCID: PMC6629517 DOI: 10.1002/mp.13061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 04/24/2018] [Accepted: 06/10/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Transrectal ultrasound (TRUS)-guided biopsy is the standard procedure for evaluating the presence and aggressiveness of prostate cancer. TRUS biopsy involves tissue removal, and suffers from low core yield as well as high false negative rate. A less invasive and more accurate diagnostic procedure for prostate cancer is therefore highly desired. Combining the optical sensitivity and ultrasonic resolution to resolve the spatial distribution of the major molecular components in tissue, photoacoustic (PA) technology could be an alternative approach for the diagnosis of prostate cancer. The purpose of this study was to examine the feasibility of identifying aggressive prostate cancer using interstitial PA measurements. METHODS Seventeen patients with prebiopsy magnetic resonance imaging (MRI), TRUS biopsies, and planned prostatectomies were enrolled in this study. The interstitial PA measurements were achieved using our recently developed needle PA probe, which was inserted into the ex vivo prostates in the fashion of a biopsy needle. A total of 70 interstitial PA measurements were acquired. The PA measurements were quantified by a previously established PA physio-chemical analysis (PAPCA) method. The histology has confirmed the nonaggressive and aggressive cancerous conditions at the insertion locations. The diagnostic accuracy was also compared to that provided by the prebiopsy MRI. RESULTS The quantitative study shows significant differences between the individual parameters of the nonaggressive and the aggressive cancerous regions (P < 0.005). Multivariate analysis of the quantitative features achieved a diagnostic accuracy of 78.6% for differentiating nonaggressive and aggressive prostate cancer tissues. CONCLUSIONS The proposed procedure has shown promises in the diagnosis of aggressive prostate cancer.
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Affiliation(s)
- Shengsong Huang
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Yu Qin
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai 200092, China
| | - Yingna Chen
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai 200092, China
| | - Jing Pan
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai 200092, China
| | - Chengdang Xu
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Denglong Wu
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Wan-Yu Chao
- Faculty of Science, University of Western Ontario, London, ON N6A 3K7, Canada
| | - John T. Wei
- Departement of Urology, University of Michigan, Ann Arbor, 48109, USA
| | - Scott A. Tomlins
- Departement of Pathology, University of Michigan, Ann Arbor, 48109, USA
| | - Xueding Wang
- Departement of Radiology, University of Michigan, Ann Arbor, 48109, USA
- Departement of Biomedical Engineering, University of Michigan, Ann Arbor, 48109, USA
| | - J. Brian Fowlkes
- Departement of Radiology, University of Michigan, Ann Arbor, 48109, USA
| | - Paul L. Carson
- Departement of Radiology, University of Michigan, Ann Arbor, 48109, USA
| | - Qian Cheng
- Institute of Acoustics, School of Physics Science and Engineering, Tongji University, Shanghai 200092, China
| | - Guan Xu
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
- Departement of Radiology, University of Michigan, Ann Arbor, 48109, USA
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16
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Tavolaro S, Mozer P, Roupret M, Comperat E, Rozet F, Barret E, Drouin S, Vaessen C, Lucidarme O, Cussenot O, Boudghène F, Renard-Penna R. Transition zone and anterior stromal prostate cancers: Evaluation of discriminant location criteria using multiparametric fusion-guided biopsy. Diagn Interv Imaging 2018; 99:403-411. [DOI: 10.1016/j.diii.2018.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 01/03/2018] [Accepted: 01/18/2018] [Indexed: 01/12/2023]
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17
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Hofbauer SL, Maxeiner A, Kittner B, Heckmann R, Reimann M, Wiemer L, Asbach P, Haas M, Penzkofer T, Stephan C, Friedersdorff F, Fuller F, Miller K, Cash H. Validation of Prostate Imaging Reporting and Data System Version 2 for the Detection of Prostate Cancer. J Urol 2018; 200:767-773. [PMID: 29733838 DOI: 10.1016/j.juro.2018.05.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The second version of the PI-RADS™ (Prostate Imaging Reporting and Data System) was introduced in 2015 to standardize the interpretation and reporting of prostate multiparametric magnetic resonance imaging. Recently low cancer detection rates were reported for PI-RADS version 2 category 4 lesions. Therefore the aim of the study was to evaluate the cancer detection rate of PI-RADS version 2 in a large prospective cohort. MATERIALS AND METHODS The study included 704 consecutive men with primary or prior negative biopsies who underwent magnetic resonance imaging/ultrasound fusion guided targeted biopsy and 10-core systematic prostate biopsy between September 2015 and May 2017. All lesions were rated according to PI-RADS version 2 and lesions with PI-RADS version 2 category 3 or greater were biopsied. An ISUP (International Society of Urological Pathology) score of 2 or greater (ie Gleason 3 + 4 or greater) was defined as clinically significant prostate cancer. RESULTS The overall cancer detection rate of PI-RADS version 2 categories 3, 4 and 5 was 39%, 72% and 91% for all prostate cancer, and 23%, 49% and 77% for all clinically significant prostate cancer, respectively. If only targeted biopsy had been performed, 59 clinically significant tumors (16%) would have been missed. The PI-RADS version 2 score was significantly associated with the presence of prostate cancer (p <0.001), the presence of clinically significant prostate cancer (p <0.001) and the ISUP grade (p <0.001). CONCLUSIONS PI-RADS version 2 is significantly associated with the presence of clinically significant prostate cancer. The cancer detection rate of PI-RADS version 2 category 4 lesions was considerably higher than previously reported. When performing targeted biopsy, the combination with systematic biopsy still provides the highest detection of clinically significant prostate cancer.
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Affiliation(s)
| | - Andreas Maxeiner
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Beatrice Kittner
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Robin Heckmann
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Laura Wiemer
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Haas
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Carsten Stephan
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Florian Fuller
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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18
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Fourcade A, Payrard C, Tissot V, Perrouin-Verbe MA, Demany N, Serey-Effeil S, Callerot P, Coquet JB, Doucet L, Deruelle C, Joulin V, Nonent M, Fournier G, Valeri A. The combination of targeted and systematic prostate biopsies is the best protocol for the detection of clinically significant prostate cancer. Scand J Urol 2018; 52:174-179. [PMID: 29463177 DOI: 10.1080/21681805.2018.1438509] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Compared with standard systematic transrectal ultrasound (TRUS)-guided biopsies (SBx), targeted biopsies (TBx) using magnetic resonance imaging (MRI)/TRUS fusion could increase the detection of clinically significant prostate cancer (PCa-s) and reduce non-significant PCa (PCa-ns). This study aimed to compare the performance of the two approaches. MATERIALS AND METHODS A prospective, single-center study was conducted on all consecutive patients with PCa suspicion who underwent prebiopsy multiparametric MRI (mpMRI) using the Prostate Imaging Reporting and Data System (PI-RADS). All patients underwent mpMRI/TRUS fusion TBx (two to four cores/target) using UroStation™ (Koelis, Grenoble, France) and SBx (10-12 cores) during the same session. PCa-s was defined as a maximal positive core length ≥4 mm or Gleason score ≥7. RESULTS The study included 191 patients (at least one suspicious lesion: PI-RADS ≥3). PCa was detected in 55.5% (106/191) of the cases. The overall PCa detection rate and the PCa-s detection rate were not significantly higher in TBx alone versus SBx (44.5% vs 46.1%, p = .7, and 38.2% vs 33.5%, p = .2, respectively). Combined TBx and SBx diagnosed significantly more PCa-s than SBx alone (45% vs 33.5%, p = .02). PCa-s was detected only by TBx in 12% of cases (23/191) and only by SBx in 7.3% (14/191). Gleason score was upgraded by TBx in 16.8% (32/191) and by SBx in 13.6% (26/191) of patients (p = .4). CONCLUSIONS The combination of TBx and SBx achieved the best results for the detection and prognosis of PCa-s. The use of SBx alone would have missed the detection of PCa-s in 12% of patients.
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Affiliation(s)
- Alexandre Fourcade
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Charlotte Payrard
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Valentin Tissot
- b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France.,d Service de Radiologie , CHU Brest , Brest , France
| | - Marie-Aimée Perrouin-Verbe
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Nicolas Demany
- b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France.,d Service de Radiologie , CHU Brest , Brest , France
| | - Sophie Serey-Effeil
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Pierre Callerot
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Jean-Baptiste Coquet
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Laurent Doucet
- e Laboratoire d'Anatomo-Pathologie , CHU Brest , Brest , France
| | | | | | - Michel Nonent
- b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France.,d Service de Radiologie , CHU Brest , Brest , France
| | - Georges Fournier
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France.,f Centre de Recherche sur les Pathologies Prostatiques et Urologiques (CeRePP) , Paris , France
| | - Antoine Valeri
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France.,f Centre de Recherche sur les Pathologies Prostatiques et Urologiques (CeRePP) , Paris , France
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19
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Bey E, Gaget O, Descotes JL, Franquet Q, Rambeaud JJ, Long JA, Fiard G. Transrectal ultrasound-guided prostate biopsies vs. magnetic resonance imaging ultrasound fusion targeted biopsies: Who are the best candidates? Can Urol Assoc J 2018; 12:E10-E14. [PMID: 29173269 PMCID: PMC5783701 DOI: 10.5489/cuaj.4571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to compare the results of ultrasound-guided prostate biopsies (US-PB) and magnetic resonance imaging-ultrasound fusion biopsies (MRI-PB) in two contemporary cohorts and to describe the parameters orienting the choice of technique. METHODS Two contemporary cohorts of patients undergoing US-PB or MR-PB using the Urostation® (Koelis, Grenoble, France) between November 2010 and July 2015 were analyzed retrospectively. Patients with metastatic cancer or recurrence after treatment, saturation biopsies, and US-PB performed after a negative MRI were excluded. Comparison of populations, biopsy results, and clinical and biological parameters guiding the choice of technique were studied on multivariate analysis (logistic regression) taking into account the following confounding factors: age, prostate-specific antigen (PSA) rate, prostatic volume, number of previous biopsies, and abnormal digital rectal examination. RESULTS One hundred fourteen patients were included in the US-PB group and 118 in the MR-PB group. Prostate cancer was diagnosed among 65 patients in the US-PB group (detection rate 57.0%) and 70 patients in the MR-PB group (detection rate 59.3%) (odds ratio [OR] 3.00; 95% confidence interval [CI] 1.52-6.17; p=0.002). Among the cancers diagnosed in the MR-PB group, 21 were diagnosed by the two targeted biopsy cores only (15.5%). Patients undergoing MR-PB were significantly younger (p=0.0005), with a higher number of previous biopsy sessions (p<10-7) and larger prostate volume (p=0.001). PSA rate alone (p=0.23) and digital rectal examination (p=0.48) did not significantly interfere with the choice of a technique. CONCLUSIONS Younger patients with larger prostates and prior negative biopsy were more likely to be offered the MR-PB technique. On multivariate analysis, the detection rate was higher in the MR-PB group.
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Affiliation(s)
- Elsa Bey
- Department of Urology, Grenoble University Hospital, France
| | - Olivier Gaget
- Department of Public Health, Grenoble University Hospital, France
| | - Jean-Luc Descotes
- Department of Urology, Grenoble University Hospital, France
- CNRS, TIMC-IMAG, France
| | | | - Jean-Jacques Rambeaud
- Department of Urology, Grenoble University Hospital, France
- Université Grenoble Alpes; Grenoble, France
| | - Jean-Alexandre Long
- Department of Urology, Grenoble University Hospital, France
- CNRS, TIMC-IMAG, France
- Université Grenoble Alpes; Grenoble, France
| | - Gaelle Fiard
- Department of Urology, Grenoble University Hospital, France
- CNRS, TIMC-IMAG, France
- Université Grenoble Alpes; Grenoble, France
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20
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Tang Y, Liu Z, Tang L, Zhang R, Lu Y, Liang J, Zou Z, Zhou C, Wang Y. Significance of MRI/Transrectal Ultrasound Fusion Three-Dimensional Model-Guided, Targeted Biopsy Based on Transrectal Ultrasound-Guided Systematic Biopsy in Prostate Cancer Detection: A Systematic Review and Meta-Analysis. Urol Int 2017; 100:57-65. [PMID: 29084410 DOI: 10.1159/000484144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/10/2017] [Indexed: 09/19/2023]
Abstract
PURPOSE To assess MRI/Transrectal Ultrasound (TRUS) fusion three-dimensional model-guided targeted biopsy (3D-Tb) versus TRUS-guided systematic biopsy (Sb) in detecting overall and high-Gleason-score (≥7) prostate cancer (PCa). METHODS Pubmed and Web of science were searched. Studies with men having a suspicious lesion on MRI were included, which were divided into initial biopsy, previous negative biopsy, and mixed groups in meta-analysis. RESULTS Totally 13 cohorts in 12 studies, with 3,225 men were included. In total population, 3D-Tb and Sb did not differ significantly in the PCa detection rate (43.1 vs. 42.6%, p = 0.36), but after excluding initial biopsy group, the superiority of 3D-Tb became significant (p = 0.01); 3D-Tb had a significantly higher detection rate of high-Gleason-score PCa compared to Sb (30.0 vs. 24.1%, p < 0.05); 3D-Tb plus Sb significantly improved the PCa detection rate based on Sb alone (52.7 vs. 42.6%, p < 0.05). CONCLUSIONS In men with increased serum PSA and/or abnormal DRE and suspicious lesion on MRI but non-previous evidence of PCa, 3D-Tb plus Sb improves the PCa detection rate based on Sb alone. 3D-Tb alone has better performance in detecting high-Gleason-score PCa, and tends to have a higher PCa detection rate in population with previous negative biopsy compared to Sb.
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Affiliation(s)
- Yongquan Tang
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Zhihong Liu
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Liangyou Tang
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Ruochen Zhang
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Yiping Lu
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Jiayu Liang
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Zijun Zou
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Chuan Zhou
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Yujie Wang
- Department of Urology/Institute of Urology, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
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Franz T, von Hardenberg J, Blana A, Cash H, Baumunk D, Salomon G, Hadaschik B, Henkel T, Herrmann J, Kahmann F, Köhrmann KU, Köllermann J, Kruck S, Liehr UB, Machtens S, Peters I, Radtke JP, Roosen A, Schlemmer HP, Sentker L, Wendler JJ, Witzsch U, Stolzenburg JU, Schostak M, Ganzer R. [MRI/TRUS fusion-guided prostate biopsy : Value in the context of focal therapy]. Urologe A 2017; 56:208-216. [PMID: 27844131 DOI: 10.1007/s00120-016-0268-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Several systems for MRI/TRUS fusion-guided biopsy of the prostate are commercially available. Many studies have shown superiority of fusion systems for tumor detection and diagnostic quality compared to random biopsy. The benefit of fusion systems in focal therapy of prostate cancer (PC) is less clear. OBJECTIVES Critical considerations of fusion systems for planning and monitoring of focal therapy of PC were investigated. MATERIALS AND METHODS A systematic literature review of available fusion systems for the period 2013-5/2016 was performed. A checklist of technical details, suitability for special anatomic situations and suitability for focal therapy was established by the German working group for focal therapy (Arbeitskreis fokale und Mikrotherapie). RESULTS Eight fusion systems were considered (Artemis™, BioJet, BiopSee®, iSR´obot™ Mona Lisa, Hitachi HI-RVS, UroNav and Urostation®). Differences were found for biopsy mode (transrectal, perineal, both), fusion mode (elastic or rigid), navigation (image-based, electromagnetic sensor-based or mechanical sensor-based) and space requirements. DISCUSSION Several consensus groups recommend fusion systems for focal therapy. Useful features are "needle tracking" and compatibility between fusion system and treatment device (available for Artemis™, BiopSee® and Urostation® with Focal One®; BiopSee®, Hitachi HI-RVS with NanoKnife®; BioJet, BiopSee® with cryoablation, brachytherapy). CONCLUSIONS There are a few studies for treatment planning. However, studies on treatment monitoring after focal therapy are missing.
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Affiliation(s)
- T Franz
- Klinik und Poliklinik für Urologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - J von Hardenberg
- Klinik für Urologie, Universitätsmedizin Mannheim der Universität Heidelberg, Mannheim, Deutschland
| | - A Blana
- Klinik für Urologie und Kinderurologie, Klinikum Fürth, Fürth, Deutschland
| | - H Cash
- Klinik für Urologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - D Baumunk
- Universitätsklinik für Urologie und Kinderurologie, Universität Magdeburg, Magdeburg, Deutschland
| | - G Salomon
- Martini-Klinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - B Hadaschik
- Urologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - T Henkel
- Praxis Urologie Britz, Berlin, Deutschland
| | - J Herrmann
- Klinik für Urologie, Universitätsmedizin Mannheim der Universität Heidelberg, Mannheim, Deutschland
| | - F Kahmann
- Praxis Urologie Britz, Berlin, Deutschland
| | - K-U Köhrmann
- Abteilung für Urologie, Theresienkrankenhaus Mannheim, Mannheim, Deutschland
| | - J Köllermann
- Institut für Pathologie, Sana Klinikum Offenbach, Offenbach, Deutschland
| | - S Kruck
- Klinik für Urologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - U-B Liehr
- Universitätsklinik für Urologie und Kinderurologie, Universität Magdeburg, Magdeburg, Deutschland
| | - S Machtens
- Klinik für Urologie, Marien-Krankenhaus, Bergisch Gladbach, Deutschland
| | - I Peters
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - J P Radtke
- Urologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - A Roosen
- Klinik für Urologie, Augusta-Kranken-Anstalt GmbH, Bochum, Deutschland
| | - H-P Schlemmer
- Abteilung für Radiologie, Deutsches Krebsforschungszentrum Heidelberg, Heidelberg, Deutschland
| | - L Sentker
- Zentrum f. Urologie Sinsheim/Walldorf/Wiesloch, Sinsheim, Deutschland
| | - J J Wendler
- Universitätsklinik für Urologie und Kinderurologie, Universität Magdeburg, Magdeburg, Deutschland
| | - U Witzsch
- Klinik für Urologie und Kinderurologie, Klinikum Nordwest, Frankfurt am Main, Deutschland
| | - J-U Stolzenburg
- Klinik und Poliklinik für Urologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - M Schostak
- Universitätsklinik für Urologie und Kinderurologie, Universität Magdeburg, Magdeburg, Deutschland
| | - R Ganzer
- Klinik und Poliklinik für Urologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
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Incremental diagnostic value of targeted biopsy using mpMRI-TRUS fusion versus 14-fragments prostatic biopsy: a prospective controlled study. Eur Radiol 2017; 28:11-16. [DOI: 10.1007/s00330-017-4939-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
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Marien A, De Castro Abreu A, Gill I, Villers A, Ukimura O. [Interest using 3D ultrasound and MRI fusion biopsy for prostate cancer detection]. Prog Urol 2017. [PMID: 28629785 DOI: 10.1016/j.purol.2017.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The strategic therapy for prostate cancer depends on histo-pronostics data, which could be upgraded by obtaining targeted biopsies (TB) with MRI (magnetic resonance imagery) fusion 3D ultrasound. OBJECTIVES To compare diagnostic yield of image fusion guided prostate biopsy using image fusion of multi-parametric MRI (mpMRI) with 3D-TRUS. MATERIALS AND METHODS Between January 2010 and April 2013, 179 consecutive patients underwent outpatient TRUS biopsy using the real-time 3D TRUS tracking system (Urostation™). These patients underwent MRI-TRUS fusion targeted biopsies (TB) with 3D volume data of the MRI elastically fused with 3D TRUS at the time of biopsy. RESULTS A hundred and seventy-three patients had TBs with fusion. Mean biopsy core per patient were 11.1 (6-14) for SB and 2.4 (1-6) for TB. SBs were positive in 11% compared to 56% for TB (P<0.001). TB outperformed systematic biopsy(SB) in overall any cancer detection rate, detection of clinically significant cancer (58% vs. 36%), cancer core length (6.8mm vs. 2.8mm), and cancer rate per core (P<0.001). In multivariable logistic regression, with TB we have more chance to find a clinically significant cancer (OR:3.72 [2-6.95]). When both TRUS and MRI are positive, there is 2.73 more chance to find a clinically significant cancer. CONCLUSION MR/TRUS elastic fusion-guided biopsies outperform systematic random biopsies in diagnosing clinically significant cancer. Ability of interpretation of real-time TRUS is essential to perform the higher level of MR/US fusion and should be use for active surveillance. LEVEL OF PROOF 4.
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Affiliation(s)
- A Marien
- Service d'urologie, hôpital Huriez, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
| | - A De Castro Abreu
- Urology department, University of Southern California, Los Angeles, États-Unis
| | - I Gill
- Urology department, University of Southern California, Los Angeles, États-Unis
| | - A Villers
- Service d'urologie, hôpital Huriez, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - O Ukimura
- Urology department, University of Southern California, Los Angeles, États-Unis
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Park BK. Ultrasound-guided genitourinary interventions: principles and techniques. Ultrasonography 2017; 36:336-348. [PMID: 28736429 PMCID: PMC5621800 DOI: 10.14366/usg.17026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/28/2017] [Accepted: 05/29/2017] [Indexed: 12/30/2022] Open
Abstract
Ultrasound (US) is often used to guide various interventional procedures in the genitourinary (GU) tract because it can provide real-time imaging without any radiation hazard. Moreover, US can clearly visualize the pathway of an aspiration or biopsy needle to ensure the safety of the intervention. US guidance also helps clinicians to access lesions via the transabdominal, transhepatic, transvaginal, transrectal, and transperineal routes. Hence, US-guided procedures are useful for radiologists who wish to perform GU interventions. However, US-guided procedures and interventions are difficult for beginners because they involve a steep initial learning curve. The purpose of this review is to describe the basic principles and techniques of US-guided GU interventions.
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Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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25
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Guo G, Xu Y, Zhang X. TRUS-guided transperineal prostate 12+X core biopsy with template for the diagnosis of prostate cancer. Oncol Lett 2017; 13:4863-4867. [PMID: 28588732 DOI: 10.3892/ol.2017.6051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/16/2016] [Indexed: 02/02/2023] Open
Abstract
The objective of the present study was to explore the clinical value and safety of trans-rectal ultrasound (TRUS)-guided transperineal prostate 12+X core biopsy in the diagnosis of prostate cancer. Patients who received a TRUS-guided transperineal prostate biopsy for suspected prostate cancer at the General Hospital of The People's Liberation Army between September 2009 and May 2014 were retrospectively analyzed, this consisted of 1,300 patients. These patients were randomly divided into the 12+X core group or the standard 12-core group. The mean age of all the patients was 70.5 years old. Levels of prostate-specific antigen, digital rectal examination, transrectal ultrasound and magnetic resonance imaging (MRI) were checked and used as reference prior and subsequent to the biopsy procedure. The 12+X core group consisted of 937 patients and the 12-core group consisted of 363 patients. The mean number of core samples taken from both groups was 14.5 (ranging from 12 to 24) and the mean operative time of the whole group was 20.4 min (ranging from 15 to 40 min). The puncture positive detection rate of abnormal rectal examination, trans-rectal ultrasound, and MRI was 24.0, 30.1, and 59.2%, respectively, whereas the puncture positive rate was 47.2% in 12+X core group and 34.5% in 12-core group. Improved prostate needle biopsy with 12+X cores was found to have significantly higher detection rate than that with 12 cores as well as fewer post-operative complications, therefore making the method ideal for diagnosing prostate cancer.
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Affiliation(s)
- Gang Guo
- Department of Urology, General Hospital of The People's Liberation Army, Beijing 100853, P.R. China
| | - Yong Xu
- Department of Urology, General Hospital of The People's Liberation Army, Beijing 100853, P.R. China
| | - Xu Zhang
- Department of Urology, General Hospital of The People's Liberation Army, Beijing 100853, P.R. China
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Jelidi A, Ohana M, Labani A, Alemann G, Lang H, Roy C. Prostate cancer diagnosis: Efficacy of a simple electromagnetic MRI-TRUS fusion method to target biopsies. Eur J Radiol 2017; 86:127-134. [DOI: 10.1016/j.ejrad.2016.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 11/17/2022]
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Comparison of free-hand transperineal mpMRI/TRUS fusion-guided biopsy with transperineal 12-core systematic biopsy for the diagnosis of prostate cancer: a single-center prospective study in China. Int Urol Nephrol 2016; 49:439-448. [PMID: 28005230 DOI: 10.1007/s11255-016-1484-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/07/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To prospectively compare biopsy outcomes between free-hand transperineal mpMRI/TRUS fusion targeted biopsy (TB) and transperineal systematic biopsy (SB) in patients with first prostate biopsy. PATIENTS AND METHODS In all, 224 consecutive patients with the suspicion of PCa were investigated. All patients were evaluated by 3.0-T mpMRI applying the ESUR criteria. All patients underwent free-hand transperineal mpMRI/TRUS fusion TB and additionally a transperineal SB. Pathological findings of TB, SB, and step-sectioned RP specimens were analyzed. RESULTS The median age of the patients was 69 (40-85) years, median PSA level was 10.05 (3.61-78.39) ng/mL, and median prostate volume was 45.5 (22-77) mL. Overall, the PCa detection rate was 50.45% (113/224). TB detected significantly more cancer [44.2% (99/224) vs. 34.8% (78/224); P = 0.001] and clinically significant PCa [75.75% (75/99) vs. 62.82% (49/78); P = 0.005] than SB. For the upgrading of Gleason score, 39.74% (31/78), more clinically significant PCa was detected by using additional TB than by SB alone. Conversely, 5.05% (5/99) more clinically significant PCa was found by SB in addition to that by TB. The location of 96.67% (58/60) and Gleason score of 60% (36/60) of TB-proven ITs were correctly identified, as corroborated by RP specimens. The median IT volume was 1.125 (0.21-19.87) ml on MRI and 1.41 (0.13-9.56) ml in RP specimens. CONCLUSIONS Free-hand transperineal mpMRI/TRUS fusion biopsy was associated with a higher detection rate of clinically significant PCa while taking fewer cores. Moreover, this technique can reliably predict the location, and relatively reliably predict cancer volume and Gleason score of ITs.
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28
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Cool DW, Romagnoli C, Izawa JI, Chin J, Gardi L, Tessier D, Mercado A, Mandel J, Ward AD, Fenster A. Comparison of prostate MRI-3D transrectal ultrasound fusion biopsy for first-time and repeat biopsy patients with previous atypical small acinar proliferation. Can Urol Assoc J 2016; 10:342-348. [PMID: 27800057 DOI: 10.5489/cuaj.3831] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION This study evaluates the clinical benefit of magnetic resonance-transrectal ultrasound (MR-TRUS) fusion biopsy over systematic biopsy between first-time and repeat prostate biopsy patients with prior atypical small acinar proliferation (ASAP). MATERIALS 100 patients were enrolled in a single-centre prospective cohort study: 50 for first biopsy, 50 for repeat biopsy with prior ASAP. Multiparameteric magnetic resonance imaging (MP-MRI) and standard 12-core ultrasound biopsy (Std-Bx) were performed on all patients. Targeted biopsy using MRI-TRUS fusion (Fn-Bx) was performed f suspicious lesions were identified on the pre-biopsy MP-MRI. Classification of clinically significant disease was assessed independently for the Std-Bx vs. Fn-Bx cores to compare the two approaches. RESULTS Adenocarcinoma was detected in 49/100 patients (26 first biopsy, 23 ASAP biopsy), with 25 having significant disease (17 first, 8 ASAP). Fn-Bx demonstrated significantly higher per-core cancer detection rates, cancer involvement, and Gleason scores for first-time and ASAP patients. However, Fn-Bx was significantly more likely to detect significant cancer missed on Std-Bx for ASAP patients than first-time biopsy patients. The addition of Fn-Bx to Std-Bx for ASAP patients had a 166.7% relative risk reduction for missing Gleason ≥ 3 + 4 disease (number needed to image with MP-MRI=10 patients) compared to 6.3% for first biopsy (number to image=50 patients). Negative predictive value of MP-MRI for negative biopsy was 79% for first-time and 100% for ASAP patients, with median followup of 32.1 ± 15.5 months. CONCLUSIONS MR-TRUS Fn-Bx has a greater clinical impact for repeat biopsy patients with prior ASAP than biopsy-naïve patients by detecting more significant cancers that are missed on Std-Bx.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Aaron D Ward
- Department of Biophysics; University of Western Ontario, London, ON, Canada
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Is magnetic resonance/ultrasound fusion prostate biopsy better than systematic prostate biopsy? An updated meta- and trial sequential analysis. Oncotarget 2016; 6:43571-80. [PMID: 26498362 PMCID: PMC4791251 DOI: 10.18632/oncotarget.6201] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 10/11/2015] [Indexed: 02/05/2023] Open
Abstract
We systematically reviewed the literature to determine whether Magnetic Resonance/Ultrasound (MR/US) fusion prostate biopsy is better than systematic biopsy for making a definitive diagnosis of prostate cancer. The two strategies were also compared for their ability to detect lesions with different degrees of suspicion on MRI and clinically significant prostate cancer, and the number of cores needed for diagnosis. The Cochrane Library, Embase, Web of Knowledge, and Medline were searched from inception until May 1, 2015. Meta-analysis was conducted via RevMan 5.2 software. Data was expressed as risk ratio (RR) and 95% confidence interval. Trial sequential analysis was used to assess risk of random errors. Fourteen trials were included, encompassing a total of 3105 participants. We found that MR/US fusion biopsy detected more prostate cancers than systematic biopsy (46.9% vs. 44.2%, p=0.03). In men with moderate/high MRI suspicion, MR/US fusion biopsy did better than systematic biopsy (RR = 1.46; p < 0.05) for making a diagnosis. Moreover, MR/US fusion biopsy detected more clinically significant cancers than systematic biopsy (RR = 1.19; p < 0.05). We recommend that MR/US fusion prostate biopsy be used to better detect prostate cancer, particularly in patients with moderate/high suspicion lesions on MRI.
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Mariotti GC, Costa DN, Pedrosa I, Falsarella PM, Martins T, Roehrborn CG, Rofsky NM, Xi Y, M. Andrade TC, Queiroz MR, Lotan Y, Garcia RG, Lemos GC, Baroni RH. Magnetic resonance/transrectal ultrasound fusion biopsy of the prostate compared to systematic 12-core biopsy for the diagnosis and characterization of prostate cancer: multi-institutional retrospective analysis of 389 patients. Urol Oncol 2016; 34:416.e9-416.e14. [DOI: 10.1016/j.urolonc.2016.04.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/12/2016] [Accepted: 04/13/2016] [Indexed: 11/26/2022]
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Wegelin O, van Melick HHE, Hooft L, Bosch JLHR, Reitsma HB, Barentsz JO, Somford DM. Comparing Three Different Techniques for Magnetic Resonance Imaging-targeted Prostate Biopsies: A Systematic Review of In-bore versus Magnetic Resonance Imaging-transrectal Ultrasound fusion versus Cognitive Registration. Is There a Preferred Technique? Eur Urol 2016; 71:517-531. [PMID: 27568655 DOI: 10.1016/j.eururo.2016.07.041] [Citation(s) in RCA: 282] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/22/2016] [Indexed: 12/01/2022]
Abstract
CONTEXT The introduction of magnetic resonance imaging-guided biopsies (MRI-GB) has changed the paradigm concerning prostate biopsies. Three techniques of MRI-GB are available: (1) in-bore MRI target biopsy (MRI-TB), (2) MRI-transrectal ultrasound fusion (FUS-TB), and (3) cognitive registration (COG-TB). OBJECTIVE To evaluate whether MRI-GB has increased detection rates of (clinically significant) prostate cancer (PCa) compared with transrectal ultrasound-guided biopsy (TRUS-GB) in patients at risk for PCa, and which technique of MRI-GB has the highest detection rate of (clinically significant) PCa. EVIDENCE ACQUISITION We performed a literature search in PubMed, Embase, and CENTRAL databases. Studies were evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 checklist and START recommendations. The initial search identified 2562 studies and 43 were included in the meta-analysis. EVIDENCE SYNTHESIS Among the included studies 11 used MRI-TB, 17 used FUS-TB, 11 used COG-TB, and four used a combination of techniques. In 34 studies concurrent TRUS-GB was performed. There was no significant difference between MRI-GB (all techniques combined) and TRUS-GB for overall PCa detection (relative risk [RR] 0.97 [0.90-1.07]). MRI-GB had higher detection rates of clinically significant PCa (csPCa) compared with TRUS-GB (RR 1.16 [1.02-1.32]), and a lower yield of insignificant PCa (RR 0.47 [0.35-0.63]). There was a significant advantage (p = 0.02) of MRI-TB compared with COG-TB for overall PCa detection. For overall PCa detection there was no significant advantage of MRI-TB compared with FUS-TB (p=0.13), and neither for FUS-TB compared with COG-TB (p=0.11). For csPCa detection there was no significant advantage of any one technique of MRI-GB. The impact of lesion characteristics such as size and localisation could not be assessed. CONCLUSIONS MRI-GB had similar overall PCa detection rates compared with TRUS-GB, increased rates of csPCa, and decreased rates of insignificant PCa. MRI-TB has a superior overall PCa detection compared with COG-TB. FUS-TB and MRI-TB appear to have similar detection rates. Head-to-head comparisons of MRI-GB techniques are limited and are needed to confirm our findings. PATIENT SUMMARY Our review shows that magnetic resonance imaging-guided biopsy detects more clinically significant prostate cancer (PCa) and less insignificant PCa compared with systematic biopsy in men at risk for PCa.
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Affiliation(s)
- Olivier Wegelin
- Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands.
| | - Harm H E van Melick
- Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Lotty Hooft
- Cochrane Netherlands, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - J L H Ruud Bosch
- Department of Urology, University Medical Centre Utrecht, The Netherlands
| | - Hans B Reitsma
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Jelle O Barentsz
- Department of Radiology, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Diederik M Somford
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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Liu L, Tian Z, Zhang Z, Fei B. Computer-aided Detection of Prostate Cancer with MRI: Technology and Applications. Acad Radiol 2016; 23:1024-46. [PMID: 27133005 PMCID: PMC5355004 DOI: 10.1016/j.acra.2016.03.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 01/10/2023]
Abstract
One in six men will develop prostate cancer in his lifetime. Early detection and accurate diagnosis of the disease can improve cancer survival and reduce treatment costs. Recently, imaging of prostate cancer has greatly advanced since the introduction of multiparametric magnetic resonance imaging (mp-MRI). Mp-MRI consists of T2-weighted sequences combined with functional sequences including dynamic contrast-enhanced MRI, diffusion-weighted MRI, and magnetic resonance spectroscopy imaging. Because of the big data and variations in imaging sequences, detection can be affected by multiple factors such as observer variability and visibility and complexity of the lesions. To improve quantitative assessment of the disease, various computer-aided detection systems have been designed to help radiologists in their clinical practice. This review paper presents an overview of literatures on computer-aided detection of prostate cancer with mp-MRI, which include the technology and its applications. The aim of the survey is threefold: an introduction for those new to the field, an overview for those working in the field, and a reference for those searching for literature on a specific application.
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Affiliation(s)
- Lizhi Liu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1841 Clifton Road NE, Atlanta, GA 30329; Center of Medical Imaging and Image-guided Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Zhiqiang Tian
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1841 Clifton Road NE, Atlanta, GA 30329
| | - Zhenfeng Zhang
- Center of Medical Imaging and Image-guided Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Baowei Fei
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1841 Clifton Road NE, Atlanta, GA 30329; Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, 1841 Clifton Road NE, Atlanta, Georgia 30329; Winship Cancer Institute of Emory University, 1841 Clifton Road NE, Atlanta, Georgia 30329.
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Venderink W, de Rooij M, Sedelaar JPM, Huisman HJ, Fütterer JJ. Elastic Versus Rigid Image Registration in Magnetic Resonance Imaging-transrectal Ultrasound Fusion Prostate Biopsy: A Systematic Review and Meta-analysis. Eur Urol Focus 2016; 4:219-227. [PMID: 28753777 DOI: 10.1016/j.euf.2016.07.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 06/27/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
Abstract
CONTEXT The main difference between the available magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion platforms for prostate biopsy is the method of image registration being either rigid or elastic. As elastic registration compensates for possible deformation caused by the introduction of an ultrasound probe for example, it is expected that it would perform better than rigid registration. OBJECTIVE The aim of this meta-analysis is to compare rigid with elastic registration by calculating the detection odds ratio (OR) for both subgroups. The detection OR is defined as the ratio of the odds of detecting clinically significant prostate cancer (csPCa) by MRI-TRUS fusion biopsy compared with systematic TRUS biopsy. Secondary objectives were the OR for any PCa and the OR after pooling both registration techniques. EVIDENCE ACQUISITION The electronic databases PubMed, Embase, and Cochrane were systematically searched for relevant studies according to the Preferred Reporting Items for Systematic Review and Meta-analysis Statement. Studies comparing MRI-TRUS fusion and systematic TRUS-guided biopsies in the same patient were included. The quality assessment of included studies was performed using the Quality Assessment of Diagnostic Accuracy Studies version 2. EVIDENCE SYNTHESIS Eleven papers describing elastic and 10 describing rigid registration were included. Meta-analysis showed an OR of csPCa for elastic and rigid registration of 1.45 (95% confidence interval [CI]: 1.21-1.73, p<0.0001) and 1.40 (95% CI: 1.13-1.75, p=0.002), respectively. No significant difference was seen between the subgroups (p=0.83). Pooling subgroups resulted in an OR of 1.43 (95% CI: 1.25-1.63, p<0.00001). CONCLUSIONS No significant difference was identified between rigid and elastic registration for MRI-TRUS fusion-guided biopsy in the detection of csPCa; however, both techniques detected more csPCa than TRUS-guided biopsy alone. PATIENT SUMMARY We did not identify any significant differences in prostate cancer detection between two distinct magnetic resonance imaging-transrectal ultrasound fusion systems which vary in their method of compensating for prostate deformation.
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Affiliation(s)
- Wulphert Venderink
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Maarten de Rooij
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J P Michiel Sedelaar
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henkjan J Huisman
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Jiang X, Zhang J, Tang J, Xu Z, Zhang W, Zhang Q, Guo H, Zhou W. Magnetic resonance imaging - ultrasound fusion targeted biopsy outperforms standard approaches in detecting prostate cancer: A meta-analysis. Mol Clin Oncol 2016; 5:301-309. [PMID: 27446568 PMCID: PMC4950783 DOI: 10.3892/mco.2016.906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/09/2016] [Indexed: 12/16/2022] Open
Abstract
The aim of the present study was to determine whether magnetic resonance imaging - ultrasound (MRI-US) fusion prostate biopsy is superior to systematic biopsy for making a definitive diagnosis of prostate cancer. The two strategies were also compared regarding their ability to detect clinically significant and insignificant prostate cancer. A literature search was conducted through the PubMed, EMBASE and China National Knowledge Infrastructure databases using appropriate search terms. A total of 3,415 cases from 21 studies were included in the present meta-analysis. Data were expressed as relative risk (RR) and 95% confidence interval. The results revealed that MRI-US fusion biopsy achieved a higher rate of overall prostate cancer detection compared with systematic biopsy (RR=1.09; P=0.047). Moreover, MRI-US fusion biopsy detected more clinically significant cancers compared with systematic biopsy (RR=1.22; P<0.01). It is therefore recommended that multi-parametric MRI-US is performed in men suspected of having prostate cancer to optimize the detection of clinically significant disease, while reducing the burden of biopsies.
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Affiliation(s)
- Xuping Jiang
- Department of Urology, Yixing People's Hospital, Yixing, Jiangsu 214200, P.R. China; State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Jiayi Zhang
- State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Jingyuan Tang
- State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Zhen Xu
- State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Wei Zhang
- State Key Laboratory of Reproductive Medicine, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Qing Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Hongqian Guo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Weimin Zhou
- Department of Urology, Yixing People's Hospital, Yixing, Jiangsu 214200, P.R. China
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Langley SEM, Uribe J, Challacombe BJ, Bott SRJ. A practical approach to investigating a man with a raised prostate-specific antigen in the modern era. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415816654596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Urologists in the UK are encouraged to follow the National Institute for Health and Care Excellence (NICE) guidelines for patient management. In 2014, members of the British Association of Urological Surgeons (BAUS) were asked in a survey what diagnostic pathway they would follow for themselves or their relatives if they had a raised prostate-specific antigen (PSA). It was found that only a quarter would follow NICE guidance. The current recommendations rely on pathological assessment of prostate tissue obtained at a transrectal ultrasound guided biopsy. Increasing evidence indicates that pre-biopsy multiparametric magnetic resonance imaging (mp-MRI) coupled with targeted biopsy approaches outperform random biopsies in the detection of clinically significant disease. Herein we discuss the role of magnetic resonance imaging and targeted biopsy approaches to diagnose prostate cancer in the modern era.
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Affiliation(s)
- SEM Langley
- St Luke’s Cancer Centre, The Royal Surrey County Hospital National Health Service (NHS) Foundation Trust, UK
| | - J Uribe
- St Luke’s Cancer Centre, The Royal Surrey County Hospital National Health Service (NHS) Foundation Trust, UK
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Oderda M, Faletti R, Battisti G, Dalmasso E, Falcone M, Marra G, Palazzetti A, Zitella A, Bergamasco L, Gandini G, Gontero P. Prostate Cancer Detection Rate with Koelis Fusion Biopsies versus Cognitive Biopsies: A Comparative Study. Urol Int 2016; 97:230-7. [PMID: 27256369 DOI: 10.1159/000445524] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/17/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Targeted fusion biopsies have led to an improved prostate cancer (PCa) detection rate (CDR). Our aim was to assess if device-assisted fusion biopsies are superior to cognitive ones in terms of CDR. The association between multiparametric MRI parameters and PCa was also evaluated. METHODS We retrospectively enrolled 50 patients who underwent transrectal biopsy with elastic fusion (Koelis; group KB, n = 25) or cognitive approach (group CB, n = 25). Targeted biopsies were done on targets, while a variable number of random biopsies were performed depending on the clinical case. RESULTS The groups did not significantly differ in terms of age, prostate-specific antigen, prostate volume and previous biopsies. Mean number of random cores was significantly inferior in KB group (8.4 vs. 12.1) and mean number of targeted biopsies was significantly higher (3.6 vs. 2.6). CDR was higher in fusion biopsies (64 vs. 40%), with the gap becoming significant when considering CDR of MRI targets only (59 vs. 27%). The difference was marked for lesions ≤10 mm, where CDR was 52% in KB against 21% in CB group. CONCLUSIONS According to our study, elastic fusion biopsies performed with Koelis achieve an increased per-patient and per-lesion CDR as compared to cognitive biopsies, especially in the case of lesions ≤10 mm.
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Affiliation(s)
- Marco Oderda
- Department of Surgical Sciences, Urology, University of Turin, Turin, Italy
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Haider MA, Yao X, Loblaw A, Finelli A. Multiparametric Magnetic Resonance Imaging in the Diagnosis of Prostate Cancer: A Systematic Review. Clin Oncol (R Coll Radiol) 2016; 28:550-67. [PMID: 27256655 DOI: 10.1016/j.clon.2016.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 03/15/2016] [Accepted: 03/17/2016] [Indexed: 10/21/2022]
Abstract
A systematic review was conducted to investigate the use of multiparametric magnetic resonance imaging (MPMRI) followed by targeted biopsy in the diagnosis of clinically significant prostate cancer (CSPC) and to compare it with transrectal ultrasound-guided (TRUS-guided) systematic biopsy in patients with an elevated risk of prostate cancer who are either biopsy-naive or who have a previous negative TRUS-guided biopsy. MEDLINE, PubMed and EMBASE (1997 to April 2014), the Cochrane Library and six relevant conferences were searched to find eligible studies. Search terms indicative of 'prostate cancer' and 'magnetic resonance imaging' with their alternatives were used. Twelve systematic reviews, 52 full texts and 28 abstracts met the preplanned study selection criteria; data from 15 articles were extracted. In patients with an elevated risk of prostate cancer who were biopsy-naive, MPMRI followed by targeted biopsy could detect 2-13% of CSPC patients whom TRUS-guided systematic biopsy missed; TRUS-guided systematic biopsy could detect 0-7% of CSPC patients whom MPMRI followed by targeted biopsy missed. In patients with an elevated risk of prostate cancer who had a previous negative TRUS-guided biopsy, MPMRI followed by targeted biopsy detected more CSPC patients than repeated TRUS-guided systematic biopsy in all four studies, with a total of 516 patients, but only one study reached a statistically significant difference. In patients with an elevated risk of prostate cancer who are biopsy-naive, there is insufficient evidence for MPMRI followed by targeted biopsy to be considered the standard of care. In patients who had a prior negative TRUS-guided systematic biopsy and show a growing risk of having CSPC, MPMRI followed by targeted biopsy may be helpful to detect more CSPC cases as opposed to a repeat TRUS-guided systematic biopsy.
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Affiliation(s)
- M A Haider
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - X Yao
- Cancer Care Ontario, Program in Evidence-Based Care, McMaster University, Hamilton, Ontario, Canada.
| | - A Loblaw
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - A Finelli
- Princess Margaret Hospital, Toronto, Ontario, Canada
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Lee DH, Nam JK, Park SW, Lee SS, Han JY, Lee SD, Lee JW, Chung MK. Visually Estimated MRI Targeted Prostate Biopsy Could Improve the Detection of Significant Prostate Cancer in Patients with a PSA Level <10 ng/mL. Yonsei Med J 2016; 57:565-71. [PMID: 26996553 PMCID: PMC4800343 DOI: 10.3349/ymj.2016.57.3.565] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/26/2015] [Accepted: 08/02/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To compare prostate cancer detection rates between 12 cores transrectal ultrasound-guided prostate biopsy (TRUS-Bx) and visually estimated multiparametric magnetic resonance imaging (mp-MRI)-targeted prostate biopsy (MRI-visual-Bx) for patients with prostate specific antigen (PSA) level less than 10 ng/mL. MATERIALS AND METHODS In total, 76 patients with PSA levels below 10 ng/mL underwent 3.0 Tesla mp-MRI and TRUS-Bx prospectively in 2014. In patients with abnormal lesions on mp-MRI, we performed additional MRI-visual-Bx. We compared pathologic results, including the rate of clinically significant prostate cancer cores (cancer length greater than 5 mm and/or any Gleason grade greater than 3 in the biopsy core). RESULTS The mean PSA was 6.43 ng/mL. In total, 48 of 76 (63.2%) patients had abnormal lesions on mp-MRI, and 116 targeted biopsy cores, an average of 2.42 per patient, were taken. The overall detection rates of prostate cancer using TRUS-Bx and MRI-visual-Bx were 26/76 (34.2%) and 23/48 (47.9%), respectively. In comparing the pathologic results of TRUS-Bx and MRI-visual-Bx cores, the positive rates were 8.4% (77 of 912 cores) and 46.6% (54 of 116 cores), respectively (p<0.001). Mean cancer core lengths and mean cancer core percentages were 3.2 mm and 24.5%, respectively, in TRUS-Bx and 6.3 mm and 45.4% in MRI-visual-Bx (p<0.001). In addition, Gleason score ≥7 was noted more frequently using MRI-visual-Bx (p=0.028). The detection rate of clinically significant prostate cancer was 27/77 (35.1%) and 40/54 (74.1%) for TRUS-Bx and MRI-visual-Bx, respectively (p<0.001). CONCLUSION MRI-visual-Bx showed better performance in the detection of clinically significant prostate cancer, compared to TRUS-Bx among patients with a PSA level less than 10 ng/mL.
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Affiliation(s)
- Dong Hoon Lee
- Department of Urology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Jong Kil Nam
- Department of Urology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sung Woo Park
- Department of Urology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Seung Soo Lee
- Department of Urology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Ji-Yeon Han
- Department of Urology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Don Lee
- Department of Urology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Joon Woo Lee
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Moon Kee Chung
- Department of Urology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
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Bjurlin MA, Mendhiratta N, Wysock JS, Taneja SS. Multiparametric MRI and targeted prostate biopsy: Improvements in cancer detection, localization, and risk assessment. Cent European J Urol 2016; 69:9-18. [PMID: 27123316 PMCID: PMC4846729 DOI: 10.5173/ceju.2016.734] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/22/2015] [Accepted: 12/26/2015] [Indexed: 01/03/2023] Open
Abstract
Introduction Multiparametric-MRI (mp-MRI) is an evolving noninvasive imaging modality that increases the accurate localization of prostate cancer at the time of MRI targeted biopsy, thereby enhancing clinical risk assessment, and improving the ability to appropriately counsel patients regarding therapy. Material and methods We used MEDLINE/PubMed to conduct a comprehensive search of the English medical literature. Articles were reviewed, data was extracted, analyzed, and summarized. In this review, we discuss the mp-MRI prostate exam, its role in targeted prostate biopsy, along with clinical applications and outcomes of MRI targeted biopsies. Results Mp-MRI, consisting of T2-weighted imaging, diffusion-weighted imaging, dynamic contrast-enhanced imaging, and possibly MR spectroscopy, has demonstrated improved specificity in prostate cancer detection as compared to conventional T2-weighted images alone. An MRI suspicion score has been developed and is depicted using an institutional Likert or, more recently, a standardized reporting scale (PI-RADS). Techniques of MRI-targeted biopsy include in-gantry MRI guided biopsy, TRUS-guided visual estimation biopsy, and software co-registered MRI-US guided biopsy (MRI-US fusion). Among men with no previous biopsy, MRI-US fusion biopsy demonstrates up to a 20% increase in detection of clinically significant cancers compared to systematic biopsy while avoiding a significant portion of low risk disease. These data suggest a potential role in reducing over-detection and, ultimately, over-treatment. Among men with previous negative biopsy, 72–87% of cancers detected by MRI targeted biopsy are clinically significant. Among men with known low risk cancer, repeat biopsy by MR-targeting improves risk stratification in selecting men appropriate for active surveillance secondarily reducing the need for repetitive biopsy during surveillance. Conclusions Use of mp-MRI for targeting prostate biopsies has the potential to reduce the sampling error associated with conventional biopsy by providing better disease localization and sampling. MRI-ultrasound fusion-targeted prostate biopsy may improve the identification of clinically significant prostate cancer while limiting detection of indolent disease, ultimately facilitating more accurate risk stratification. Literature supports the clinical applications of MRI-targeted biopsy in men who have never been biopsied before, those with a prior negative biopsy, and those with low risk disease considering active surveillance.
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Affiliation(s)
- Marc A Bjurlin
- Division of Urology, Department of Surgery, New York University Lutheran Medical Center, New York University Langone Health System, NY, USA
| | - Neil Mendhiratta
- School of Medicine, New York University Langone Medical Center, NY, USA
| | - James S Wysock
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, NY, USA
| | - Samir S Taneja
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, NY, USA
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Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MM. Magnetic Resonance Imaging–targeted Biopsy May Enhance the Diagnostic Accuracy of Significant Prostate Cancer Detection Compared to Standard Transrectal Ultrasound-guided Biopsy: A Systematic Review and Meta-analysis. Eur Urol 2015; 68:438-50. [DOI: 10.1016/j.eururo.2014.11.037] [Citation(s) in RCA: 413] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/19/2014] [Indexed: 12/13/2022]
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Gayet M, van der Aa A, Beerlage HP, Schrier BP, Mulders PFA, Wijkstra H. The value of magnetic resonance imaging and ultrasonography (MRI/US)-fusion biopsy platforms in prostate cancer detection: a systematic review. BJU Int 2015; 117:392-400. [PMID: 26237632 DOI: 10.1111/bju.13247] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite limitations considering the presence, staging and aggressiveness of prostate cancer, ultrasonography (US)-guided systematic biopsies (SBs) are still the 'gold standard' for the diagnosis of prostate cancer. Recently, promising results have been published for targeted prostate biopsies (TBs) using magnetic resonance imaging (MRI) and ultrasonography (MRI/US)-fusion platforms. Different platforms are USA Food and Drug Administration registered and have, mostly subjective, strengths and weaknesses. To our knowledge, no systematic review exists that objectively compares prostate cancer detection rates between the different platforms available. To assess the value of the different MRI/US-fusion platforms in prostate cancer detection, we compared platform-guided TB with SB, and other ways of MRI TB (cognitive fusion or in-bore MR fusion). We performed a systematic review of well-designed prospective randomised and non-randomised trials in the English language published between 1 January 2004 and 17 February 2015, using PubMed, Embase and Cochrane Library databases. Search terms included: 'prostate cancer', 'MR/ultrasound(US) fusion' and 'targeted biopsies'. Extraction of articles was performed by two authors (M.G. and A.A.) and were evaluated by the other authors. Randomised and non-randomised prospective clinical trials comparing TB using MRI/US-fusion platforms and SB, or other ways of TB (cognitive fusion or MR in-bore fusion) were included. In all, 11 of 1865 studies met the inclusion criteria, involving seven different fusion platforms and 2626 patients: 1119 biopsy naïve, 1433 with prior negative biopsy, 50 not mentioned (either biopsy naïve or with prior negative biopsy) and 24 on active surveillance (who were disregarded). The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the quality of included articles. No clear advantage of MRI/US fusion-guided TBs was seen for cancer detection rates (CDRs) of all prostate cancers. However, MRI/US fusion-guided TBs tended to give higher CDRs for clinically significant prostate cancers in our analysis. Important limitations of the present systematic review include: the limited number of included studies, lack of a general definition of 'clinically significant' prostate cancer, the heterogeneous study population, and a reference test with low sensitivity and specificity. Today, a limited number of prospective studies have reported the CDRs of fusion platforms. Although MRI/US-fusion TB has proved its value in men with prior negative biopsies, general use of this technique in diagnosing prostate cancer should only be performed after critical consideration. Before bringing MRI/US fusion-guided TB in to general practice, there is a need for more prospective studies on prostate cancer diagnosis.
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Affiliation(s)
- Maudy Gayet
- Department of Urology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Anouk van der Aa
- Department of Urology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Harrie P Beerlage
- Department of Urology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Bart Ph Schrier
- Department of Urology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Peter F A Mulders
- Department of Urology, Radboudumc University Hospital, Nijmegen, The Netherlands
| | - Hessel Wijkstra
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
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Le JD, Huang J, Marks LS. Targeted prostate biopsy: value of multiparametric magnetic resonance imaging in detection of localized cancer. Asian J Androl 2015; 16:522-9. [PMID: 24589455 PMCID: PMC4104074 DOI: 10.4103/1008-682x.122864] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Prostate cancer is the second most common cancer in men, with 1.1 million new cases worldwide reported by the World Health Organization in one recent year. Transrectal ultrasound (TRUS)-guided biopsy has been used for the diagnosis of prostate cancer for over 2 decades, but the technique is usually blind to cancer location. Moreover, the false negative rate of TRUS biopsy has been reported to be as high as 47%. Multiparametric magnetic resonance imaging (mp-MRI) includes T1- and T2-weighted imaging as well as dynamic contrast-enhanced (DCE) and diffusion-weighted imaging (DWI). mp-MRI is a major advance in the imaging of prostate cancer, enabling targeted biopsy of suspicious lesions. Evolving targeted biopsy techniques-including direct in-bore biopsy, cognitive fusion and software-based MRI-ultrasound (MRI-US) fusion-have led to a several-fold improvement in cancer detection compared to the earlier method. Importantly, the detection of clinically significant cancers has been greatly facilitated by targeting, compared to systematic biopsy alone. Targeted biopsy via MRI-US fusion may dramatically alter the way prostate cancer is diagnosed and managed.
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Affiliation(s)
| | | | - Leonard S Marks
- Department of Urology, University of California, Los Angeles, USA
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Abstract
The optimal strategy for prostate cancer diagnosis is to avoid overdiagnosis, defined as diagnosis of clinically insignificant disease, and undersampling of the gland, which leads to missing clinically significant disease. Targeted prostate biopsy is a potential solution for decreasing the rate of both overdiagnosis and undersampling of prostate cancer. We focus here on different techniques for targeting prostate lesions identified on multiparametric MR imaging and review different clinical settings in which MR imaging-targeted prostate biopsies are performed.
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Comparison of patient comfort between MR-guided in-bore and MRI/ultrasound fusion-guided prostate biopsies within a prospective randomized trial. World J Urol 2015; 34:215-20. [PMID: 26055645 DOI: 10.1007/s00345-015-1612-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE The objective of this study was to compare patient comfort between MR-guided in-bore prostate biopsy (IB-GB) and MRI/ultrasound fusion-guided prostate biopsy (FUS-GB) with additional systematic 12-core transrectal ultrasound (TRUS)-guided biopsy within a prospective randomized trial. METHODS Two hundred and ten consecutive patients were randomly assigned in a 1:1 ratio to receive either IB-GB and prior intrarectal instillation of a 2% lidocaine gel (n = 106) or FUS-GB plus additional systematic 12-core TRUS-guided biopsy and prior application of a periprostatic nerve block (PPNB) with 2% mepivacaine (n = 104). The maximal procedural pain (MPP) on a 0-10 visual analog scale and the operating room time were recorded for each biopsy session. RESULTS Baseline characteristics and mean number of targeted biopsy cores (5.6 ± 0.8 vs 5.4 ± 1.2 for IB-GB and FUS-GB, respectively; p = 0.278) were similar in both study arms. In relation to the IB-GB arm, the total number of biopsy cores in the FUS-GB arm, including the systematic 12-core TRUS-guided biopsy, was significantly higher (17.4 ± 1.2; p < 0.001). Patients with IB-GB had significantly higher MPP scores (2.95 ± 2.15) compared with subjects with FUS-GB (1.95 ± 1.56; p < 0.001). FUS-GB required significantly less time (28.22 ± 11.61 min) in comparison with IB-GB (42.09 ± 11.37 min; p < 0.001). CONCLUSIONS The PPNB can easily be administered just prior to performing FUS-GB. Thus, patients have significantly lower pain levels in comparison with IB-GB, which is usually done with intrarectal anesthetic gels. Although the addition of a systematic 12-core TRUS-guided biopsy significantly increases the number of biopsy cores, FUS-GB still requires significantly less time in comparison with IB-GB.
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The use of targeted MR-guided prostate biopsy reduces the risk of Gleason upgrading on radical prostatectomy. J Cancer Res Clin Oncol 2015; 141:2061-8. [PMID: 26013424 DOI: 10.1007/s00432-015-1991-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Gleason grading is the strongest predictor of prostate cancer outcome and commonly used to decide for or against the different treatment options. However, Gleason upgrading between systematic transrectal ultrasound-guided prostate biopsy (TRUS-GB) and radical prostatectomy (RPE) has frequently been observed. With respect to the high accuracy of multiparametric MRI (mpMRI) for high-grade cancers and the higher percentage of cancer involvement per biopsy core in targeted MR-guided prostate biopsy (MR-GB), we hypothesized that MR-GB reduces the risk of Gleason upgrading on RPE as compared to the gold standard. The purpose of this study was to compare the rate of Gleason upgrading on RPE for MR-GB, TRUS-GB, and the combination of both biopsy modalities. METHODS Overall, 52 consecutive patients with RPE had received an mpMRI of the prostate and subsequently underwent targeted MR-GB prior to surgery. All patients underwent an additional TRUS-GB during the same biopsy session. Gleason grading was measured by two different methods: the conventional Gleason score (cGS = primary + secondary pattern) and the highest Gleason pattern (hGP). RESULTS In relation to TRUS-GB, MR-GB alone showed lower rates of upgrading when comparing the cGS (40.4 vs. 50.0 %) and the hGP (21.2 vs. 32.7 %). The combination of MR-GB and TRUS-GB showed the lowest rates of upgrading (cGS: 28.8 %; hGP: 11.5 %), and compared to TRUS-GB, significantly reduced the risk of upgrading for both measurements of Gleason grading (cGS: OR 0.41, 95 % CL 0.18-0.91, p = 0.0289; hGP: OR 0.27, 95 % CL 0.10-0.75, p = 0.0123). CONCLUSION MpMRI and targeted MR-GB are useful tools to better characterize and stage the extent of disease, and therefore enable the urologist to better risk-stratify and counsel the patient. The combined use of targeted MR-GB and TRUS-GB presents the least risk of Gleason underestimation.
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Borkowetz A, Platzek I, Toma M, Laniado M, Baretton G, Froehner M, Koch R, Wirth M, Zastrow S. Comparison of systematic transrectal biopsy to transperineal magnetic resonance imaging/ultrasound-fusion biopsy for the diagnosis of prostate cancer. BJU Int 2015; 116:873-9. [PMID: 25523210 DOI: 10.1111/bju.13023] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To compare targeted, transperineal magnetic resonance imaging (MRI)/ultrasound (US)-fusion biopsy to systematic transrectal biopsy in patients with previous negative or first prostate biopsy and to evaluate the gain in diagnostic information with systematic biopsies in addition to targeted MRI/US-fusion biopsies. PATIENTS AND METHODS In all, 263 consecutive patients with suspicion of prostate cancer were investigated. All patients were evaluated by 3-T multiparametric MRI (mpMRI) applying the European Society of Urogenital Radiology criteria. All patients underwent MRI/US-fusion biopsy transperineally (mean nine cores) and additionally a systematic transrectal biopsy (mean 12 cores). RESULTS In all, 195 patients underwent repeat biopsy and 68 patients underwent first biopsy. The median age was 66 years, median PSA level was 8.3 ng/mL and median prostate volume was 50 mL. Overall, the prostate cancer detection rate was 52% (137/263). MRI/US-fusion biopsy detected significantly more cancer than systematic prostate biopsy (44% [116/263] vs 35% [91/263]; P = 0.002). In repeat biopsy, the detection rate was 44% (85/195) in targeted and 32% (62/195) in systematic biopsy (P = 0.002). In first biopsy, the detection rate was 46% (31/68) in targeted and 43% (29/68) in systematic biopsy (P = 0.527). In all, 80% (110/137) of biopsy confirmed prostate cancers were clinically significant. For the upgrading of Gleason score, 44% (32/72) more clinically significant prostate cancer was detected by using additional targeted biopsy than by systematic biopsy alone. Conversely, 12% (10/94) more clinically significant cancer was found by systematic biopsy additionally to targeted biopsy. CONCLUSIONS MRI/US-fusion biopsy was associated with a higher detection rate of clinically significant prostate cancer while taking fewer cores, especially in patients with prior negative biopsy. Due to a high portion of additional tumours with Gleason score ≥7 detected in addition to targeted biopsy, systematic biopsy should still be performed additionally to targeted biopsy.
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Affiliation(s)
| | - Ivan Platzek
- Department of Radiology and Interventional Radiology, Technische Universität, Dresden, Germany
| | - Marieta Toma
- Department of Pathology, Technische Universität, Dresden, Germany
| | - Michael Laniado
- Department of Radiology and Interventional Radiology, Technische Universität, Dresden, Germany
| | - Gustavo Baretton
- Department of Pathology, Technische Universität, Dresden, Germany
| | | | - Rainer Koch
- Institution of Medical Statistics and Epidemiology, Technische Universität, Dresden, Germany
| | - Manfred Wirth
- Department of Urology, Technische Universität, Dresden, Germany
| | - Stefan Zastrow
- Department of Urology, Technische Universität, Dresden, Germany
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Free-hand transperineal targeted prostate biopsy with real-time fusion imaging of multiparametric magnetic resonance imaging and transrectal ultrasound: single-center experience in China. Int Urol Nephrol 2015; 47:727-33. [DOI: 10.1007/s11255-015-0957-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
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Evaluation of MRI-TRUS fusion versus cognitive registration accuracy for MRI-targeted, TRUS-guided prostate biopsy. AJR Am J Roentgenol 2015; 204:83-91. [PMID: 25539241 DOI: 10.2214/ajr.14.12681] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The purpose of this article is to compare transrectal ultrasound (TRUS) biopsy accuracies of operators with different levels of prostate MRI experience using cognitive registration versus MRI-TRUS fusion to assess the preferred method of TRUS prostate biopsy for MRI-identified lesions. SUBJECTS AND METHODS; One hundred patients from a prospective prostate MRI-TRUS fusion biopsy study were reviewed to identify all patients with clinically significant prostate adenocarcinoma (PCA) detected on MRI-targeted biopsy. Twenty-five PCA tumors were incorporated into a validated TRUS prostate biopsy simulator. Three prostate biopsy experts, each with different levels of experience in prostate MRI and MRI-TRUS fusion biopsy, performed a total of 225 simulated targeted biopsies on the MRI lesions as well as regional biopsy targets. Simulated biopsies performed using cognitive registration with 2D TRUS and 3D TRUS were compared with biopsies performed under MRI-TRUS fusion. RESULTS Two-dimensional and 3D TRUS sampled only 48% and 45% of clinically significant PCA MRI lesions, respectively, compared with 100% with MRI-TRUS fusion. Lesion sampling accuracy did not statistically significantly vary according to operator experience or tumor volume. MRI-TRUS fusion-naïve operators showed consistent errors in targeting of the apex, midgland, and anterior targets, suggesting that there is biased error in cognitive registration. The MRI-TRUS fusion expert correctly targeted the prostate apex; however, his midgland and anterior mistargeting was similar to that of the less-experienced operators. CONCLUSION MRI-targeted TRUS-guided prostate biopsy using cognitive registration appears to be inferior to MRI-TRUS fusion, with fewer than 50% of clinically significant PCA lesions successfully sampled. No statistically significant difference in biopsy accuracy was seen according to operator experience with prostate MRI or MRI-TRUS fusion.
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MRI-targeted biopsies versus systematic transrectal ultrasound guided biopsies for the diagnosis of localized prostate cancer in biopsy naïve men. BIOMED RESEARCH INTERNATIONAL 2015; 2015:571708. [PMID: 25692142 PMCID: PMC4323072 DOI: 10.1155/2015/571708] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/12/2015] [Indexed: 12/26/2022]
Abstract
Introduction. To compare, in the same cohort of men, the detection of clinically significant disease in standard (STD) cores versus multiparametric magnetic resonance imaging (mpMRI) targeted (TAR) cores. Material and Methods. A prospective study was conducted on 129 biopsy naïve men with clinical suspicion of prostate cancer. These patients underwent prebiopsy mpMRI with STD systematic biopsies and TAR biopsies when lesions were found. The agreement between the TAR and the STD protocols was measured using Cohen's kappa coefficient. Results. Cancer detection rate of MRI-targeted biopsy was 62.7%. TAR protocol demonstrated higher detection rate of clinically significant disease compared to STD protocol. The proportion of cores positive for clinically significant cancer in TAR cores was 28.9% versus 9.8% for STD cores (P < 0.001). The proportion of men with clinically significant cancer and the proportion of men with Gleason score 7 were higher with the TAR protocol than with the STD protocol (P = 0.003; P = 0.0008, resp.). Conclusion. mpMRI improved clinically significant prostate cancer detection rate compared to STD protocol alone with less tissue sampling and higher Gleason score. Further development in imaging as well as multicentre studies using the START recommendation is needed to elucidate the role of mpMRI targeted biopsy in the management of prostate cancer.
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Loch R, Fowler K, Schmidt R, Ippolito J, Siegel C, Narra V. Prostate Magnetic Resonance Imaging: Challenges of Implementation. Curr Probl Diagn Radiol 2015; 44:26-37. [DOI: 10.1067/j.cpradiol.2014.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 05/20/2014] [Accepted: 05/21/2014] [Indexed: 01/13/2023]
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