Yonsei Med J.  2019 Apr;60(4):346-351. 10.3349/ymj.2019.60.4.346.

Effectiveness of Bi-Parametric MR/US Fusion Biopsy for Detecting Clinically Significant Prostate Cancer in Prostate Biopsy Naïve Men

• Kim YJ
• Huh JS
• Park KK

• KMID: 2450189
• DOI: http://doi.org/10.3349/ymj.2019.60.4.346

Abstract

PURPOSE
To explore the effect of bi-parametric MRI-ultrasound (MR/US) fusion prostate biopsy on the detection of overall cancer and significant prostate cancer (sPCa).
MATERIALS AND METHODS
We examined 140 patients with suspected prostate cancer lesions on MRI from August 2016 to March 2018. All patients had undergone 3T pre-biopsy bi-parametric (T2 weighted and diffusion-weighted) prostate MRI (bpMRI), and their MRI images were evaluated with Prostate Imaging Reporting and Data System (PI-RADS) version 2.0. MR/US fusion targeted prostate biopsy was performed for lesions with a PI-RADS score ≥3 before systemic biopsy. The results of targeted and systemic biopsy were evaluated in regards to detection rate according to PI-RADS score.
RESULTS
Of the patients (mean age=67.2 years, mean prostate-specific antigen level=8.1 ng/mL), 66 (47.1%) and 37 (26.4%) patients were diagnosed with cancer and significant prostate cancer, respectively. The rate of positive targeted biopsy increased with higher PI-RADS score (3: 40.4%, 4: 56.7%, 5: 90.0%). The proportion of significant prostate cancer among positive target lesions was 65.3% (32/49).
CONCLUSION
bpMRI is a feasible tool with which to identify sPCa. MR/US fusion biopsy, rather than systemic biopsy, can help identify sPCa. We recommend using supplemental tools to increase prostate cancer detection in patients with PI-RADS 3 lesions.

Keyword

Prostate cancer; MRI; ultrasound; image-guided biopsy; diffusion

MeSH Terms

Biopsy*
Diffusion
Humans
Image-Guided Biopsy
Information Systems
Magnetic Resonance Imaging
Male
Prostate*
Prostate-Specific Antigen
Prostatic Neoplasms*
Ultrasonography
Prostate-Specific Antigen

Figure

• 

  Fig. 1 Negative and positive predictive values according to lesion and PI-RADS score. The numbers at the bottom of the graph are PI-RADS scores. Total biopsy detection rate: 47.1% (66/140). *p=0.019, †p<0.001 (There was a significant difference between PZ and TZ in PI-RADS 3 and 4). PPV, positive predictive value; cPCa, clinically significant prostate cancer; NPV, negative predictive value; PZ, peripheral zone of the prostate; TZ, transitional zone of the prostate.

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