Diagnostic value of MRI-ultrasound fusion-targeted prostate biopsy for non-index lesions combined with the index lesion biopsy.
While the clinical value of magnetic resonance imaging (MRI)-ultrasound fusion-targeted prostate biopsy (TB) for index lesions (ILs) has been established, the utility of TB for non-index lesions (nILs) remains unclear. We evaluated the diagnostic benefit of combining TB for nILs (nIL-TB) with TB for ILs (IL-TB) in patients with multiple MRI-identified lesions.
A total of 304 patients with multiple Prostate Imaging-Reporting and Data System (PI-RADS)≥3 lesions who underwent IL-TB, nIL-TB, and systematic biopsy (SB) were included. One or 2 nILs per case, defined as lesions with lower PI-RADS category or smaller size than the IL, were targeted. Detection rates of grade group (GG) ≥2 and GG 1 cancer were compared between different biopsy strategies, and the added values of SB and nIL-TB to IL-TB were assessed. Risk factors for missing GG≥2 cancer in IL-TB and detecting it in nIL-TB were explored using multivariable analysis.
Detection rates of GG≥2 cancer were 55.9% in IL-TB alone, 70.4% in IL-TB+SB, and 68.8% in IL-TB+nIL-TB, revealing no significant difference in the added value between SB and nIL-TB(14.5% vs.12.8%, p = 0.398). GG 1 cancer was detected more frequently in IL-TB+SB than in IL-TB+nIL-TB(11.5% vs.6.6%, p = 0.004). Small IL volume and IL confined to the transition zone were independent predictors of missing GG≥2 cancer in IL-TB and detecting it in nIL-TB (p = 0.002, odds ratio[OR]=3.07; p = 0.018, OR=2.41).
Combining IL-TB and nIL-TB provides a comparable detection rate of GG≥2 cancer with fewer cores than combined biopsy with IL-TB and SB and avoids the detection of GG 1 cancer. nIL-TB may be an alternative to SB in patients with multiple MRI-identified lesions.
A total of 304 patients with multiple Prostate Imaging-Reporting and Data System (PI-RADS)≥3 lesions who underwent IL-TB, nIL-TB, and systematic biopsy (SB) were included. One or 2 nILs per case, defined as lesions with lower PI-RADS category or smaller size than the IL, were targeted. Detection rates of grade group (GG) ≥2 and GG 1 cancer were compared between different biopsy strategies, and the added values of SB and nIL-TB to IL-TB were assessed. Risk factors for missing GG≥2 cancer in IL-TB and detecting it in nIL-TB were explored using multivariable analysis.
Detection rates of GG≥2 cancer were 55.9% in IL-TB alone, 70.4% in IL-TB+SB, and 68.8% in IL-TB+nIL-TB, revealing no significant difference in the added value between SB and nIL-TB(14.5% vs.12.8%, p = 0.398). GG 1 cancer was detected more frequently in IL-TB+SB than in IL-TB+nIL-TB(11.5% vs.6.6%, p = 0.004). Small IL volume and IL confined to the transition zone were independent predictors of missing GG≥2 cancer in IL-TB and detecting it in nIL-TB (p = 0.002, odds ratio[OR]=3.07; p = 0.018, OR=2.41).
Combining IL-TB and nIL-TB provides a comparable detection rate of GG≥2 cancer with fewer cores than combined biopsy with IL-TB and SB and avoids the detection of GG 1 cancer. nIL-TB may be an alternative to SB in patients with multiple MRI-identified lesions.
Authors
Kobayashi Kobayashi, Matsuoka Matsuoka, Kimura Kimura, Matsumoto Matsumoto, Fujiwara Fujiwara, Nakamura Nakamura, Ishikawa Ishikawa, Fukuda Fukuda, Fukushima Fukushima, Waseda Waseda, Yasuda Yasuda, Tanaka Tanaka, Yoshida Yoshida, Fujii Fujii
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