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. 2022 Oct;40(10):2431-2438.
doi: 10.1007/s00345-022-04120-1. Epub 2022 Aug 4.

Head-to-head comparison of biparametric versus multiparametric MRI of the prostate before robot-assisted transperineal fusion prostate biopsy

Wolfgang M Thaiss  1   2 , Simone Moser  1 , Tobias Hepp  1 , Stephan Kruck  3 , Steffen Rausch  4 , Marcus Scharpf  5 , Konstantin Nikolaou  1 , Arnulf Stenzl  4 , Jens Bedke  6 , Sascha Kaufmann  1   7
Affiliations

Head-to-head comparison of biparametric versus multiparametric MRI of the prostate before robot-assisted transperineal fusion prostate biopsy

Wolfgang M Thaiss et al. World J Urol. 2022 Oct.

Abstract

Purpose: Prostate biparametric magnetic resonance imaging (bpMRI) including T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) might be an alternative to multiparametric MRI (mpMRI, including dynamic contrast imaging, DCE) to detect and guide targeted biopsy in patients with suspected prostate cancer (PCa). However, there is no upgrading peripheral zone PI-RADS 3 to PI-RADS 4 without DCE in bpMRI. The aim of this study was to evaluate bpMRI against mpMRI in biopsy-naïve men with elevated prostate-specific antigen (PSA) scheduled for robot-assisted-transperineal fusion-prostate biopsy (RA-TB).

Methods: Retrospective single-center-study of 563 biopsy-naïve men (from 01/2015 to 09/2018, mean PSA 9.7 ± 6.5 ng/mL) with PI-RADSv2.1 conform mpMRI at 3 T before RA-TB. Clinically significant prostate cancer (csPCa) was defined as ISUP grade ≥ 2 in any core. Two experienced readers independently evaluated images according to PI-RADSv2.1 criteria (separate readings for bpMRI and mpMRI sequences, 6-month interval). Reference standard was histology from RA-TB.

Results: PI-RADS 2 was scored in 5.1% of cases (3.4% cancer/3.4% csPCa), PI-RADS 3 in 16.9% (32.6%/3.2%), PI-RADS 4 in 57.6% (66.1%/58.3%) and PI-RADS 5 in 20.4% of cases (79.1%/74.8%). For mpMRI/bpMRI test comparison, sensitivity was 99.0%/97.1% (p < 0.001), specificity 47.5%/61.2% (p < 0.001), PPV 69.5%/75.1% (p < 0.001) and NPV 97.6%/94.6% (n.s.). csPCa was considered gold standard. 35 cases without cancer were upgraded to PI-RADS 4 (mpMRI) and six PI-RADS 3 cases with csPCa were not upgraded (bpMRI).

Conclusion: In patients planned for RA-TB with elevated PSA and clinical suspicion for PCa, specificity was higher in bpMRI vs. mpMRI, which could solve constrains regarding time and contrast agent.

Keywords: Dynamic contrasted-enhanced imaging; Image-guided biopsy; Magnetic resonance imaging; PI-RADS v2.1; Prostate cancer; Prostate imaging reporting and data system.

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Conflict of interest statement

The authors state that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Venn diagram of positive biopsy results for prostate cancer (n = 337) indicating positive findings in targeted and systematic biopsy
Fig. 2
Fig. 2
Flowchart for mpMRI reading (top) and bpMRI reading (bottom) with number and percentage of PI-RADS scores. Presence of cancer and number of clinically significant prostate cancer (csPCa) are outlined. PI-RADS 3 lesions located in the peripheral zone (PZ) that were positive in dynamic contrast-enhanced imaging (DCE +) are delineated
See this image and copyright information in PMC

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