OBJECTIVES: To compare cancer detection rates and concordance between MR-US fusion-guided prostate biopsy cores obtained from axial and sagittal approaches.
PATIENTS AND METHODS: Institutional records of MR-US fusion-guided biopsy were reviewed. Detection rates for all cancers, Gleason ≥3+4 cancers, and Gleason ≥4+3 cancers were computed. Agreement between axial and sagittal cores for cancer detection, and frequency where one upgraded the other was computed on a per-target and per-patient basis.
RESULTS: 893 encounters from 791 subjects that underwent MR-US fusion-guided biopsy in 2007-2013 were reviewed, yielding 4688 biopsy cores from 2344 targets for analysis. Mean age and PSA at each encounter was 61.8 years and 9.7ng/ml (median=6.45ng/ml). Detection rates for all cancers, ≥3+4 cancers, and ≥4+3 cancers were 25.9%, 17.2%, and 8.1% for axial cores, and 26.1%, 17.6%, and 8.6% for sagittal cores. Per-target agreement was 88.6%, 93.0%, and 96.5% respectively. On a per-target basis, the rates at which one core upgraded or detected a cancer missed on the other were 8.3% and 8.6% for axial and sagittal cores respectively. Even with the inclusion of systematic biopsies, omission of axial or sagittal cores would have resulted in missed detection or under-characterization of cancer in 4.7% or 5.2% of patients respectively.
CONCLUSION: Cancer detection rates, Gleason scores, and core involvement from axial and sagittal cores are similar, but significant cancer may be missed if only one core is obtained for each target. Discordance between axial and sagittal cores is greatest in intermediate-risk scenarios, where obtaining multiple cores may improve tissue characterization.
Written by:
Hong CW, Rais-Bahrami S, Walton-Diaz A, Shakir N, Su D, George AK, Merino MJ, Turkbey B, Choyke PL, Wood BJ, Pinto PA. Are you the author?
Center for Interventional Oncology, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
Reference: BJU Int. 2014 Jul 21. Epub ahead of print.
doi: 10.1111/bju.12871
PubMed Abstract
PMID: 25045781
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