Use of multiparametric magnetic resonance and transrectal ultrasound software fusion – guided prostate biopsy not only for significant prostate cancer

Czech version

Authors: Tomáš Vavřík ¹; Olga Dolejšová ¹; Hana Sedláčková ¹; Dušan Mrkos ¹; Jiří Ferda ²; Jan Kastner ²; Radka Fuchsová ³; Ondřej Topolčan ³; Ondřej Hes ⁴; Milan Hora ¹
Authors‘ workplace: Urologická klinika LF UK a FN Plzeň ¹; Klinika zobrazovacích metod LF UK a FN Plzeň ²; Laboratoř imunochemické diagnostiky LF UK a FN Plzeň ³; Šiklův ústav patologie LF UK a FN Plzeň ⁴
Published in: Ces Urol 2018; 22(4): 257-265
Category: Original Articles

Overview

The aim:

Evaluation of the first results of software fusion – guided prostate biopsies in our workplace using multiparametric magnetic resonance and transrectal ultrasonography.

Methods:

Overall, 128 patients underwent 3 T mpMRI/TRUS fusion software‑based targeted biopsy of prostate from 1/2017 to 3/2018. 22 of them, were biopsy‑naive men with suspicion of prostate cancer. Re‑biopsy were performed in 106 men with persistent suspicion of prostate cancer after previously negative standard biopsy. The average age of patients was 66.5 years (49–84). Median PSA was 8.49 ng/ml (3.87–60.16 ng/ml) and median PHI was 55.84 (18–266). Results: In total, prostate cancer was bioptically verified in 77 patients (60.2%). In 50 cases (65%) Gleason score (GS) 6 (3+3), in 19 cases (24.7%) GS 7 (3+4), by five patients (6.5%) GS 7 (4+3), two patients (2.5%) GS 8 (4+4), one patient (1.3%) GS 9 (4+5). PI‑RADS v2 SCORE was evaluated in 128 patients. 33 patients had a PI‑RADS score 3, of whom 14 were positive (42%), score 4 was present in 54 patients – 33 of whom were positive (61.1%) and score 5 was in 41 patients – 29 of whom were positive (70.7 %).

Conclusion:

In our sample of patients we observed a high percentage of GS 6 (3+3). Our results are different compared to world literature, which shows large identification of significant prostate cancer detected by mpMRI. This finding may be due to several reasons, poor selection of patients, inaccurate radiological description, or a patologist’s histological specimen. Detection of biopsy‑verified prostate cancer using 3 T mpMRI/TRUS fusion software‑based targeted biopsy increases proportionally compared to the increasing PI‑RADS score version 2. To confirm these results, an extended patient population study is required.

KEY WORDS

Magnetic resonance imaging, prostate cancer, software fusion guided prostate biopsy.

Sources

1. Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin. 2013; 63: 11–30.

2. Roehl KA, Antenor JA, Catalona WJ. Serial biopsy results in prostate cancer screening study. J Urol. 2002; 167: 2435–2439.

3. de Rooij M, Hamoen EHJ, Fütterer JJ, Barentsz JO, Rovers MM. Accuracy of multiparametric MRI for prostate cancer detection: a meta‑analysis. American Journal of Roentgenology 2014; 202(2): 343–351.

4. Dickinson L, Ahmed HU, Allen C, et al. Magnetic resonance imaging for the detection, localisation, and characterisation of prostate cancer: recommendations from a European consensus meeting. European Urology 2011; 59(4): 477–494).

5. Bratan F, Niaf E, Melodelima C, et al. Influence of imaging and histological factors on prostate cancer detection and localisation on multiparametric MRI: a prospective study. European Radiology 2013; 23(7): 2019–2029.

6. Pinto PA, Chung PH, Rastinehad AR, et al. Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging J Urol 2011; 186(4): 1281–1285.

7. Kaplan I, Oldenburg NE, Meskell P, Blake M, Church P, Holupka EJ. Real time MRI‑ultrasound image guided stereotactic prostate biopsy. Magn Reson Imaging 2002; 20(3): 295–299.

8. Xu S, Kruecker J, Guion P, et al. Closed‑loop control in fused MR‑TRUS image‑guided prostate biopsy. Med Image Comput Assist Interv. 2007; 10(1): 128–135.

9. Sonn GA, Natarajan S, Margolis DJ, et al. Targeted biopsy in the detection of prostate cancer using an office based magnetic resonance ultrasound fusion device. J Urol. 2013; 189(1): 86–91.

10. Franz T, von Hardenberg J, Blana A, et al. MRI/TRUS fusion‑guided prostate biopsy: value in the context of focal therapy. Der Urologe A 2017; 56(2): 208–216.

11. Dolejšová O, Eret V, Šobrová A, et al. Využití multiparametrické magnetické rezonance a srovnání s ostatními moderními zobrazovacími metodami v předoperační diagnostice karcinomu prostaty. Ces Urol 2014; 18(4): 300–309.

12. Ferda J, Hora M, Hes O, et al. Zobrazení prostaty na 3 T MRI u nemocných se zvýšenou hladinou PSA. Ces Radiol 2012; 66(1): 9–17.

13. Kongnyuy M, George AK, Rastinehad AR, Pinto PA. Magnetic resonance imaging‑ultrasound fusion‑guided prostate biopsy: Review of technology, techniques, and outcomes. Curr Urol Rep 2016; 17: 32.

14. Ukimura O, Desai MM, Palmer S, et al. 3-Dimensional elastic registration system of prostate biopsy location by real‑time 3-dimensional transrectal ultrasound guidance with magnetic resonance/transrectal ultrasound image fusion. J Urol 2012; 187(3): 1080–1086.

15. Barentsz OJ, Richenberg J, Clements R, et al. ESUR prostate MR guidelines 2012. Eur Radiol. 2012; 22: 746–757.

16. Rosenkrantz AB, Kim S, Lim RP, et al. Prostate cancer localization using multiparametric MR imaging: comparison of Prostate Imaging Reporting and Data System (PI‑RADS) and Likert scales. Radiology 2013; 269(2): 482–492.

17. Moore CM, Kasivisvanathan V, Eggener S, et al. Standards of reporting for MRI‑targeted biopsy studies (START) of the prostate: recommendations from an International Working Group. Eur Urol 2013; 64: 544–552.

18. Šobrová E, Eret V, Dolejšová O, et al. Komparace multiparametrické magnetické rezonance se silou magnetického pole 3 Tesla s transrektální sonografií naváděnou biopsií prostaty. Ces Urol 2014; 18(3): 225–233.

19. Ukimura O, Hung AJ, Gill IS. Innovations in prostate biopsy strategies for active surveillance and focal therapy. Curr Opin Urol. 2011; 21: 115–120.

20. Ghilezan MJ, Jaffray DA, Siewerdsen JH, et al. Prostate gland motion assessed with cine‑magnetic resonance imaging (cine‑MRI) Int J Radiat Oncol Biol Phys. 2005; 62: 406–417.

21. Baumann M, Mozer P, Daanen V, Troccaz J. Prostate biopsy tracking with deformation estimation. Med Image Anal. 2012; 16: 562–576.

22. Siddiqui MM, Rais‑Bahrami S, Turkbey B, et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound- guided biopsy for the diagnosis of prostate cancer. JAMA 2015; 313(4): 390–397.

23. Puech P, Rouvière O, Renard‑Penna R, et al. Prostate cancer diagnosis: multiparametric MR‑targeted biopsy with cognitive and transrectal US‑MR fusion guidance versus systematic biopsy – prospective multicenter study. Radiology. 2013; 268: 461–469.

24. Borkowetz A, Platzek I, Toma M, et al. Comparison of systematic transrectal biopsy to transperineal magnetic resonance imaging/ ultrasound‑fusion biopsy for the diagnosis of prostate cancer. BJU Int 2015; 116: 873

25. Junker D, Schäfer G, Edlinger M, et al. Evaluation of the PI‑RADS scoring system for classifying mpMRI findings in men with suspicion of prostate cancer. BioMed Research International 2013; 2013: 252939.

26. Ghai S, Haider MA. Multiparametric‑MRI in diagnosis of prostate cancer. Indian Journal of Urology: IJU: Journal of the Urological Society of India 2015; 31(3): 194–201.

27. Mowatt G, Scotland G, Boachie C, et al. The diagnostic accuracy and cost‑effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localisation of prostate abnormalities for biopsy: a systematic review and economic evaluation. Health Technol Assess (Winchester, England) 2013; 17: 1–281. Vii.xix.

28. Kudláčková Š, Král M, Kurfürstová D, et al. Role multiparametrické magnetické rezonance v režimu active surveillance karcinomu prostaty. Ces Urol 2017; 21(3): 225–230.

29. Pivovarčíková, K, Branžovský J, Bauleth K, et al. Radikální prostatektomie – analýza 191 případů vyšetřovaných metodikou celoplošných řezů (whole‑Mount Section). Ces Urol 2014; 18(1): 26–32.

30. Kudláčková Š, Záťura F, et al. Cílená biopsie prostaty pomocí magnetické rezonance – 1. část. Interní Med. 2017; 18(2): 69–72.

31. Dolejsova O, Kucera R, Fuchsova R, et al. The ability of Prostate Health Index (PHI) to predict Gleason score in patients with prostate cancer and discriminate patients between Gleason score 6 and Gleason score higher than 6 – a study on 320 patients after radical prostatectomy. Technology in Cancer Research & Treatment. 2018; 17: 1533033818787377.

32. Ahmed HU, El‑Shater Bosaily A, Brown LC, et al. Diagnostic accuracy of multi‑parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017; 389(10071): 815–822.