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. 2015 Oct;29(10):1115-21.
doi: 10.1089/end.2015.0027. Epub 2015 Jul 23.

Magnetic Resonance Imaging/Transrectal Ultrasonography Fusion Prostate Biopsy Significantly Outperforms Systematic 12-Core Biopsy for Prediction of Total Magnetic Resonance Imaging Tumor Volume in Active Surveillance Patients

Chinonyerem Okoro  1 , Arvin K George  1 , M Minhaj Siddiqui  1 , Soroush Rais-Bahrami  1 , Annerleim Walton-Diaz  1 , Nabeel A Shakir  1 , Jason T Rothwax  1 , Dima Raskolnikov  1 , Lambros Stamatakis  1 , Daniel Su  1 , Baris Turkbey  2 , Peter L Choyke  2 , Maria J Merino  3 , Howard L Parnes  4 , Bradford J Wood  1   5 , Peter A Pinto  1   5
Affiliations

Magnetic Resonance Imaging/Transrectal Ultrasonography Fusion Prostate Biopsy Significantly Outperforms Systematic 12-Core Biopsy for Prediction of Total Magnetic Resonance Imaging Tumor Volume in Active Surveillance Patients

Chinonyerem Okoro et al. J Endourol. 2015 Oct.

Abstract

Objective: To correlate the highest percentage core involvement (HPCI) and corresponding tumor length (CTL) on systematic 12-core biopsy (SBx) and targeted magnetic resonance imaging/transrectal ultrasonography (MRI/TRUS) fusion biopsy (TBx), with total MRI prostate cancer (PCa) tumor volume (TV).

Patients and methods: Fifty patients meeting criteria for active surveillance (AS) based on outside SBx, who underwent 3.0T multiparametric prostate MRI (MP-MRI), followed by SBx and TBx during the same session at our institution were examined. PCa TVs were calculated using MP-MRI and then correlated using bivariate analysis with the HPCI and CTL for SBx and TBx.

Results: For TBx, HPCI and CTL showed a positive correlation (R(2)=0.31, P<0.0001 and R(2)=0.37, P<0.0001, respectively) with total MRI PCa TV, whereas for SBx, these parameters showed a poor correlation (R(2)=0.00006, P=0.96 and R(2)=0.0004, P=0.89, respectively). For detection of patients with clinically significant MRI derived tumor burden greater than 500 mm(3), SBx was 25% sensitive, 90.9% specific (falsely elevated because of missed tumors and extremely low sensitivity), and 54% accurate in comparison with TBx, which was 53.6% sensitive, 86.4% specific, and 68% accurate.

Conclusions: HPCI and CTL on TBx positively correlates with total MRI PCa TV, whereas there was no correlation seen with SBx. TBx is superior to SBx for detecting tumor burden greater than 500 mm(3). When using biopsy positive MRI derived TVs, TBx better reflects overall disease burden, improving risk stratification among candidates for active surveillance.

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Figures

<b>FIG. 1.</b>
FIG. 1.
Correlation of highest percentage core involvement to total positive tumor volume for systematic 12-core biopsy and targeted magnetic resonance imaging/transrectal untrasonography fusion biopsy (Bx). PCa=prostate cancer.
<b>FIG. 2.</b>
FIG. 2.
Correlation of tumor length in core with highest percentage core involvement to total positive tumor volume for systematic 12-core biopsy and targeted magnetic resonance imaging/transrectal untrasonography fusion biopsy (Bx).
See this image and copyright information in PMC

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