A Comparison of Prostate Cancer Detection Between Visual-Estimation (Cognitive Registration) and Image-Fusion (Software Registration) Targeted Transperineal Prostate Biopsy
Khoo, Christopher C; Eldred-Evans, David; Peters, Max; van Son, Marieke; van Rossum, Peter; Connor, Martin J; Hosking-Jervis, Feargus; Tanaka, Mariana Bertoncelli; Reddy, Deepika; Bass, Edward; Powell, Laura; Ahmad, Shahzad; Pegers, Elizabeth; Joshi, Suchita; Sri, Denosshan; Wong, Kathie; Tam, Henry; Hrouda, David; Qazi, Hasan; Gordon, Stephen; McCracken, Stuart; Winkler, Mathias; Ahmed, Hashim U
(2021) The Journal of Urology, volume 205, issue 4, pp. 1075 - 1081
(Article)
Abstract
PURPOSE: We compared clinically significant prostate cancer detection by visual estimation and image fusion targeted transperineal prostate biopsy. MATERIALS AND METHODS: This multicenter study included patients with multiparametric magnetic resonance imaging lesions undergoing visual estimation or image fusion targeted transperineal biopsy (April 2017-March 2020). Propensity score matching was performed using
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demographics (age and ethnicity), clinical features (prostate specific antigen, prostate volume, prostate specific antigen density and digital rectal examination), multiparametric magnetic resonance imaging variables (number of lesions, PI-RADS® score, index lesion diameter, whether the lesion was diffuse and radiological T stage) and biopsy factors (number of cores, operator experience and anesthetic type). Matched groups were compared overall and by operator grade, PI-RADS score, lesion multiplicity, prostate volume and anesthetic type using targeted-only and targeted plus systematic histology. Multiple clinically significant prostate cancer thresholds were evaluated (primary: Gleason ≥3+4). RESULTS: A total of 1,071 patients with a median age of 67.3 years (IQR 61.3-72.4), median prostate specific antigen of 7.5 ng/ml (IQR 5.3-11.2) and 1,430 total lesions underwent targeted-only biopsies (visual estimation: 372 patients, 494 lesions; image fusion: 699 patients, 936 lesions). A total of 770 patients with a median age of 67.4 years (IQR 61-72.1), median prostate specific antigen of 7.1 ng/ml (IQR 5.2-10.6) and 919 total lesions underwent targeted plus systematic biopsies (visual estimation: 271 patients, 322 lesions; image fusion: 499 patients, 597 lesions). Matched comparisons demonstrated no overall difference in clinically significant prostate cancer detection between visual estimation and image fusion (primary: targeted-only 54% vs 57.4%, p=0.302; targeted plus systematic 51.2% vs 58.2%, p=0.123). Senior urologists had significantly higher detection rates using image fusion (primary: targeted-only 45.4% vs 63.7%, p=0.001; targeted plus systematic 39.4% vs 64.5%, p <0.001). CONCLUSIONS: We found no overall difference in clinically significant prostate cancer detection, although image fusion may be superior in experienced hands.
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Keywords: biopsy, multiparametric magnetic resonance imaging, prostatic neoplasms, Urology, Journal Article
ISSN: 0022-5347
Publisher: Elsevier
Note: Publisher Copyright: © 2021 Lippincott Williams and Wilkins. All rights reserved.
(Peer reviewed)