The diagnostic and staging performance of mpMRI/US guided fusion prostate biopsy: prospective analysis on 41 consecutive whole mount radical prostatectomy specimens
The ultimate assessment of MRI/US diagnostic and staging performance requires a meticulous comparison of biopsy and whole mount radical prostatectomy specimens. In this study we assessed the diagnostic and staging performance of mpMRI/US fusion prostate biopsy comparing core biopsy findings with whole mount radical prostatectomy specimens in 41 consecutive patients treated in a single centre series.
Materials and Methods
Baseline, clinical and pathologic data of 41 consecutive patients with prostate cancer diagnosis at mp-MRI/US guided “fusion” biopsy who underwent minimally invasive radical prostatectomy and whole mount sections of pathologic specimens were prospectively collected.
All fusion biopsies were performed using the UroStation™ (Koelis, France) with an end-fire 3D TRUS transducer.
Diagnostic performance of MRI-US fusion biopsy was evaluated at different levels: 1. core biopsy correspondence with pathologic findings of whole mount sections; 2. Correct identification of the index lesion; 3. Gleason score upgrading at final pathology; 4. presence of extraprostatic extension and of nodal involvement.
Out of 107 cases with positive fusion US/MRI guided prostate biopsy performed, fifty-nine patients underwent minimally invasive radical prostatectomy. Forty-one specimens were analyzed using whole mount sections. Clinical and pathologic data of this cohort are reported into Table 1.
Out of 41 patients, 25 (60.1%) had a clinically significant PCa not identified by MRI/US guided fusion biopsy. At a per core analysis 150/701 (21.4%) cores were positive for GS>6 out of the suspicious ROI at MRI.
The mean ratio of tumor foci/suspicious ROI was 0.56 ± 0.27.
The index lesion was correctly identified by mpMRI-US fusion biopsy in 63.4% (26/41) of the patients.
Gleason score of fusion US-MRI guided prostate biopsy was upgraded at final pathologic report in 9 (21.9%) cases.
The staging accuracy in predicting tumor side, extraprostatic extension and nodal involvement was 75.6% (31/41), 70.3 % (29/41) and 90.2% (37/41), respectively.
mpMRI and Fusion US/MRI guided prostate biopsy provided a reliable diagnostic and staging performance for patients receiving a surgical treament. Systematic core biopsy seems still to have a clinical role in detecting clinically significant PCa otherwise missed by MRI.
-Multiparametric Magnetic Resonance Imaging (MRI) and MRI-Transrectal Ultrasound Fusion Biopsy for Index Tumor Detection: Correlation with Radical Prostatectomy Specimen.
Radtke JP, Schwab C, Wolf MB, Freitag MT, Alt CD, Kesch C, Popeneciu IV, Huettenbrink C, Gasch C, Klein T, Bonekamp D, Duensing S, Roth W, Schueler S, Stock C, Schlemmer HP, Roethke M, Hohenfellner M, Hadaschik BA.
Eur Urol. 2016 Nov;70(5):846-853. doi: 10.1016/j.eururo.2015.12.052.