Korean J Urol.  2014 Nov;55(11):725-731. 10.4111/kju.2014.55.11.725.

What Is the Ideal Core Number for Ultrasound-Guided Prostate Biopsy?

• Chambo RC
• Tsuji FH
• de Oliveira Lima F
• Yamamoto H
• de Jesus C

• KMID: 2069914
• DOI: http://doi.org/10.4111/kju.2014.55.11.725

Abstract

PURPOSE
We evaluated the utility of 10-, 12-, and 16-core prostate biopsies for detecting prostate cancer (PCa) and correlated the results with prostate-specific antigen (PSA) levels, prostate volumes, Gleason scores, and detection rates of high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP).
MATERIALS AND METHODS
A prospective controlled study was conducted in 354 consecutive patients with various indications for prostate biopsy. Sixteen-core biopsy specimens were obtained from 351 patients. The first 10-core biopsy specimens were obtained bilaterally from the base, middle third, apex, medial, and latero-lateral regions. Afterward, six additional punctures were performed bilaterally in the areas more lateral to the base, middle third, and apex regions, yielding a total of 16-core biopsy specimens. The detection rate of carcinoma in the initial 10-core specimens was compared with that in the 12- and 16-core specimens.
RESULTS
No significant differences in the cancer detection rate were found between the three biopsy protocols. PCa was found in 102 patients (29.06%) using the 10-core protocol, in 99 patients (28.21%) using the 12-core protocol, and in 107 patients (30.48%) using the 16-core protocol (p=0.798). The 10-, 12-, and 16-core protocols were compared with stratified PSA levels, stratified prostate volumes, Gleason scores, and detection rates of HGPIN and ASAP; no significant differences were found.
CONCLUSIONS
Cancer positivity with the 10-core protocol was not significantly different from that with the 12- and 16-core protocols, which indicates that the 10-core protocol is acceptable for performing a first biopsy.

Keyword

Needle biopsy; Prostate; Prostatic neoplasms

MeSH Terms

Adult
Aged
Cell Proliferation
Endosonography/*methods
Equipment Design
Follow-Up Studies
Humans
Image-Guided Biopsy/*instrumentation
Male
Middle Aged
Neoplasm Grading
Neoplasm Staging
Prospective Studies
Prostate/metabolism/pathology
Prostate-Specific Antigen/metabolism
Prostatic Intraepithelial Neoplasia/metabolism/*pathology
Prostatic Neoplasms/metabolism/*pathology
Rectum
Reproducibility of Results
Prostate-Specific Antigen

Figure

• 

  FIG. 1 Regions where punctures were made to collect prostate cores: 1, right base; 2, right middle third; 3, right apex; 4, latero-lateral right; 5, right medial; 6, left base; 7, left middle third; 8, left apex; 9, latero-lateral left; 10, left medial.

• 

  FIG. 2 Biopsy protocols: Protocol of Botucatu Medical School with 10 cores (A) - Protocol of Brazilian Society of Urology with 12 cores (B) - Overall total with 16 cores (C). 1, right base; 2, right middle third; 3, right apex; 4, latero-lateral right; 5, right medial; 6, left base; 7, left middle third; 8, left apex; 9, latero-lateral left; 10, left medial: 11, right base; 12, right middle third; 13, right apex; 14, left base; 15, left middle third; and 16, left apex.

• 

  FIG. 3 Percentage of cancer positivity by the number of core biopsy specimens collected.

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