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Targeted MRI-guided prostate biopsy: are two biopsy cores per MRI-lesion required?

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Abstract

Purpose

This study evaluates the feasibility of performing less than two core biopsies per MRI-lesion when performing targeted MR-guided in-bore prostate biopsy.

Methods

Retrospectively evaluated were 1545 biopsy cores of 774 intraprostatic lesions (two cores per lesion) in 290 patients (66 ± 7.8 years; median PSA 8.2 ng/ml) regarding prostate cancer (PCa) detection, Gleason score, and tumor infiltration of the first (FBC) compared to the second biopsy core (SBC). Biopsies were acquired under in-bore MR-guidance.

Results

For the biopsy cores, 491 were PCa positive, 239 of 774 (31 %) were FBC and 252 of 771 (33 %) were SBC (p = 0.4). Patient PCa detection rate based on the FBC vs. SBC were 46 % vs. 48 % (p = 0.6). For clinically significant PCa (Gleason score ≥4 + 3 = 7) the detection rate was 18 % for both, FBC and SBC (p = 0.9). Six hundred and eighty-seven SBC (89 %) showed no histologic difference. On the lesion level, 40 SBC detected PCa with negative FBC (7.5 %). Twenty SBC showed a Gleason upgrade from 3 + 3 = 6 to ≥3 + 4 = 7 (2.6 %) and 4 to ≥4 + 3 = 7 (0.5 %).

Conclusion

The benefit of a second targeted biopsy core per suspicious MRI-lesion is likely minor, especially regarding PCa detection rate and significant Gleason upgrading. Therefore, a further reduction of biopsy cores is reasonable when performing a targeted MR-guided in-bore prostate biopsy.

Key Points

• Higher PI-RADS overall score (IV-V) correlated well with PCa detection rate

• In more than 80 % SBC was concordant regarding overall PCa detection

• In almost 90 % there was no Gleason upgrading by the SBC

• Only 2/54 (3.7 %) csPCa was missed when the SBC was omitted

• For IB-GB a further reduction of biopsy cores is reasonable

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Abbreviations

mp-MRI:

Multiparametric magnetic resonance imaging

PCa:

Prostate cancer

csPCa:

Clinically significant prostate cancer (Gleason score ≥4 + 3 = 7)

ESUR:

European Society of Urogenital Radiology

PI-RADS:

Prostate Imaging Reporting and Data System, version 1

PSA:

Prostate specific antigen

TRUS-GB:

Trans-rectal ultrasound-guided biopsy

MR-GB:

MRI-guided biopsy

FUS-GB:

MRI/US fusion-guided biopsy

IB-GB:

MR-guided in-bore biopsy

FBC:

First targeted biopsy core of a particular intraprostatic lesion

SBC:

Second targeted biopsy core of a particular intraprostatic lesion

PSlesion :

PI-RADS lesion score (1 to 5)

PSoverall :

PI-RADS overall score (I to V)

IL:

Intraprostatic lesion

IQR:

Interquartile range

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Acknowledgments

The scientific guarantor of this publication is Lars Schimmöller. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study was not funded. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study.

Two hundred and thirty-four of the 290 patients have been previously reported in two prospective randomized trials:

1) Arsov C, Rabenalt R, Blondin D, Quentin M, Hiester A, Godehardt E, Gabbert HE, Becker N, Antoch G, Albers P, Schimmöller L (2015) Prospective Randomized Trial Comparing Magnetic Resonance Imaging (MRI)-guided In-bore Biopsy to MRI-ultrasound Fusion and Transrectal Ultrasound-guided Prostate Biopsy in Patients with Prior Negative Biopsies. Eur Urol [published online]

2) Quentin M, Blondin D, Arsov C, Schimmöller L, Hiester A, Godehardt E, Albers P, Antoch G, Rabenalt R (2014) Prospective Evaluation of Magnetic Resonance Imaging Guided in Bore Prostate Biopsy versus Systematic Transrectal Ultrasound Guided Prostate Biopsy in Biopsy Naïve Men with Elevated Prostate Specific Antigen. J Urol 192:1374-9. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany

    L. Schimmöller, M. Quentin, D. Blondin, F. Dietzel, C. Schleich, C. Thomas & G. Antoch

  2. Medical Faculty, Department of Urology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany

    A. Hiester, R. Rabenalt, P. Albers & C. Arsov

  3. Medical Faculty, Department of Pathology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany

    H. E. Gabbert

Authors
  1. L. Schimmöller
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  2. M. Quentin
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  3. D. Blondin
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  4. F. Dietzel
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  5. A. Hiester
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  6. C. Schleich
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  7. C. Thomas
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  8. R. Rabenalt
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  9. H. E. Gabbert
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  10. P. Albers
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  11. G. Antoch
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  12. C. Arsov
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Corresponding author

Correspondence to M. Quentin.

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Schimmöller, L., Quentin, M., Blondin, D. et al. Targeted MRI-guided prostate biopsy: are two biopsy cores per MRI-lesion required?. Eur Radiol 26, 3858–3864 (2016). https://doi.org/10.1007/s00330-016-4266-x

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  • DOI: https://doi.org/10.1007/s00330-016-4266-x

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