Bone biopsies in metastatic castrate-resistant prostate cancer (mCRPC) patients can be challenging. This study's objective was to prospectively validate a multiparametric bone MRI (mpBMRI) algorithm to facilitate target lesion selection in mCRPC patients with sclerotic bone disease for subsequent CT-guided bone biopsies.
20 CT-guided bone biopsies were prospectively performed between 02/2021 and 11/2021 in 17 mCRPC patients with only sclerotic bone disease. Biopsy targets were selected based on MRI, including diffusion-weighted (DWI) and T1-weighted VIBE Dixon MR images, allowing for calculation of the apparent diffusion coefficient (ADC) and the relative fat-fraction (rFF), respectively. Bone marrow with high DWI signal, ADC < 1100 µm2/s and rFF < 20% was the preferred biopsy target. Tumor content and NGS-feasibility was assessed by a pathologist. Prognostic routine laboratory blood parameters, target lesion size, biopsy tract length, visual CT density, means of HU, ADC and rFF were compared between successful and unsuccessful biopsies (p < 0.05 = significant).
Overall, 17/20 (85%) biopsies were tumor-positive and next-generation genomic sequencing (NGS) was feasible in 13/18 (72%) evaluated samples. Neither laboratory parameters, diameter, tract length nor visual CT density grading showed significant differences between a positive versus negative or NGS feasible versus non-feasible biopsy results (each p > 0.137). Lesion mean HU was 387 ± 187 HU in NGS feasible and 493 ± 218 HU in non-feasible biopsies (p = 0.521). For targets fulfilling all MRI selection algorithm criteria, 13/14 (93%) biopsies were tumor-positive and 10/12 (83%) provided NGS adequate tissue.
Multiparametric bone MRI can facilitate target lesion selection for subsequent CT-guided bone biopsy in mCPRC patients with sclerotic metastases.
Committee for Clinical Research of the Royal Marsden Hospital registration number SE1220.
Cancer imaging : the official publication of the International Cancer Imaging Society. 2023 Dec 15*** epublish ***
Ricardo Donners, Ines Figueiredo, Daniel Westaby, Dow-Mu Koh, Nina Tunariu, Suzanne Carreira, Johann S de Bono, Nicos Fotiadis
Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK. ., The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK., Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK., Department of Interventional Radiology, Royal Marsden Hospital, 203 Fulham Rd, London, SW3 6JJ, UK.