MRI-US Fusion Imaging for primary diagnosis of prostatic cancer: baseline biopsy on supected areas targeted with Fusion Imaging: Preliminary experience

Emanuele Daglio1, Gian Maria Badano1, Antonia Di Domenico1, Elvis RIkani1, Tomaso Montanaro1, Giorgio Canepa2, Fabio Campodonico2, RIccardo Sartoris3, Luca Timossi1, Carlo Introini1
  • 1 Ospedale Evangelico Internazionale (Genova)
  • 2 E.O. Ospedali Galliera, S.C. Urologia (Genova)
  • 3 IRCCS Azienda Ospedaliera Ospedale San Martino (Genova)

Objective

Aims of our study were to verify the success rate of Multiparametric Magnetic Resonance (mpMRI)-TRUS
Fusion Imaging guided targeted prostate biopsy in a primary baseline setting, and to compare the diagnostic performance of Fusion Imaging guided biopsy with that of conventional 16-cores transrectal systematic conventional TRUS-guided biopsy. The primary objective is to verify the success rate of baseline biopsy, performed for lesion targeted with MRI-US fusion imaging.

Materials and Methods

68 patients (mean age ± standard deviation (SD): 65 ± 16 y, range: 48–78 y) with clinical suspicion of prostate cancer (PCa) (negative rectal examination and elevated PSA levels: 12.07 ± 4.71) underwent a mpMRI to detect nodular lesions. Exclusion criteria were the inability to attend an MRI examination, controindications to MRI examination and uncorrectable coagulopathy. The degree of PCa suspicion from mpMRI findings was classified according to the PI-RADS scoring system. We performed mpMRI-TRUS Fusion Imaging guided biopsy on suspected areas, from 2- 4 cores were keep from any suspicious areas,
and 16-cores systematic biopsies in the whole gland. mpMRI was performed with a 1,5 Tesla whole body scanner (GE Healthcare) with a phased array coil. All biopsy procedures were performed in an operating room with a LOGIQ-E9 Ultrasound machine with V-NAV fusion imaging system and two position sensors attached to the base of the probe.

Results

All the mpMRI examinations showed almost a suspected area by means of T2 weighted morphological sequences, DWI and/or Perfusion dynamic imaging. All mpMRI detected lesions were not visible on conventional TRUS. Targeted biopsies were performed on 82 nodules in 68 patients and the final histological diagnosis was: 36 adenocarcinoma, 1 ASAP, 1 HGPIN, 22 prostatic inflammation e 8 negative biopsies. 16-Core Systematic Biopsies were performed in the same 68 patients and the final histological diagnosis in the whole gland was: 20 adenocarcinoma, 1 HGPIN, 20 prostatic inflammations, 27 negative biopsies. The combination oft he two type of biopsies showed these histological results: 46 adenocarcinoma, 1 HGPIN, 1 ASAP, 8 prostatic inflammation and 12 negative biopsies.

Discussions

The results confirm that Targeted biopsies have detection rates superior to systematic biopsies. This was especially true for higher-grade disease. The higher-grade carcinoma is the disease which should be treated with radical surgeon so the importance to perform accurate biopsies.The prostate is much larger than 16-Core in a systematic biopsy and it is widely accepted that there are regions of the gland, including the central and anterior portions, that are commonly undersampled and in which tumors cannot be detected on digital rectal examination. Targeted biopsies can be particularly useful in indicating to the physician the importance in sampling these regions. There are studies which reported that anteriorly located cancerous lesions were missed in up to 46% to 16-Core systematic biopsy.

Conclusion

Among men undergoing biopsy for suspected prostate cancer, targeted biopsy, compared with systematic ultrasound-guided biopsy, was associated with increased detection of high-risk prostate cancer and decreased detection of low-risk prostate cancer.
MRI-TRUS Fusion Imaging seems to be a powerful tool for primary diagnosis of prostatic cancer and an important guidance system for baseline biopsy on supected areas. The development of this technique could lead to the reduction of systematic sampling of the prostate. Reducing the use of systematic biopsies with TRUS-guidance alone. This system MRI-TRUS Fusion Imaging has the advantage of using a standard ultrasound scanner without the need to have a dedicated system for prostate biopsies; in this way, costs are reduced and the learning curve is shortened.

References

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