Advertisement

Cognitive Versus Software Fusion for MRI-targeted Biopsy: Experience Before and After Implementation of Fusion

      Abstract

      Objective

      To compare the diagnostic performance of the 2 most common approaches of magnetic resonance imaging targeted biopsy (TB)—cognitive registration targeted biopsy (COG-TB) and software fusion targeted biopsy (FUS-TB)—we assessed our institutional experience with both methods. TB has emerged to complement systematic template biopsy (SB) in prostate cancer (PCa) diagnosis; however, which magnetic resonance imaging targeting methodology is diagnostically better remains unclear.

      Materials and methods

      A total of 510 patients underwent TB at our institution before and after the adoption of fusion software with the UroNav platform (Invivo Corporation, Gainsville, FL). All patients had concurrent 12-core SB. We compared rates of clinically significant PCa detection, and rates of upstaging and missed diagnosis in reference to SB among patients who received COG-TB and patients who received FUS-TB. We also compared both COG-TB and FUS-TB results to their paired SB results.

      Results

      The rates of upstaging or missing clinically significant PCa with FUS-TB (in reference to SB) was not significantly different from COG-TB (P = 0.172), nor was the risk of missing clinically significant PCa different between FUS-TB vs COG-TB on logistic regression ( Odds ratio = 0.55, P = 0.106). No significant difference in biopsy outcomes was observed between FUS-TB and COG-TB (P = 0.171). We did find significant differences between FUS-TB and SB and between COG-TB and SB, with SB finding more clinically insignificant PCa (P < 0.001 and P = 0.04).

      Conclusion

      In our institutional experience, no significant difference was observed between the diagnostic ability of COG-TB vs FUS-TB for detecting clinically significant PCa. Greater evidence demonstrating an advantage of FUS-TB over COG-TB would be required for clear recommendations in favor of FUS-TB.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Fütterer JJ
        • Briganti A
        • De Visschere P
        • et al.
        Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging?.
        A Syst Rev Lit. 2015; 8: 0-4https://doi.org/10.1016/j.eururo.2015.01.013
        • Weinreb JC
        • Barentsz JO
        • Choyke PL
        • et al.
        PI-RADS prostate imaging—reporting and data system: 2015, version 2.
        Eur Urol. 2016; 69: 16-40https://doi.org/10.1016/j.eururo.2015.08.052
      1. Samir S. Taneja, MD (Chair), Marc A. Bjurlin, DO, H. Ballentine Carter, et al.MD, Michael S. Cookson, MD, MMHC, Leonard G. Gomella, MD, FACS, David F. Penson, MD, MPH, Paul Schellhammer, MD, Steven Schlossberg MD, MBA, Dean Troyer, MD, Thomas M. Wheeler M. American urological association - optimal techniques of prostate biopsy and specimen handling. auanet.org. Available at: http://www.auanet.org/guidelines/prostate-biopsy-and-specimen-handling. Published 2015. Accessed March 3, 2018.

      2. Santis D, Henry A, Joniau S, et al. Prostate cancer EAU -ESTRO -SIOG guidelines on. Available at: https://uroweb.org/wp-content/uploads/EAU-Guidelines-Prostate-Cancer-2016.pdf. Accessed March 3, 2018.

        • Wegelin O
        • van Melick HHE
        • Hooft L
        • et al.
        Comparing three different techniques for magnetic resonance imaging-targeted prostate biopsies: a systematic review of in-bore versus magnetic resonance imaging-transrectal ultrasound fusion versus cognitive registration. is there a preferred technique.
        Eur Urol. 2017; 71: 517-531https://doi.org/10.1016/j.eururo.2016.07.041
        • Siddiqui MM
        • Rais-Bahrami S
        • Turkbey B
        • et al.
        Comparison of MR/Ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer.
        JAMA. 2015; 313: 390https://doi.org/10.1001/jama.2014.17942
        • Kasivisvanathan V
        • Rannikko AS
        • Borghi M
        • et al.
        MRI-targeted or standard biopsy for prostate-cancer diagnosis.
        N Engl J Med. March 2018; (NEJMoa1801993)https://doi.org/10.1056/NEJMoa1801993
        • Hambrock T
        • Hoeks C
        • Hulsbergen-van de Kaa C
        • et al.
        Prospective assessment of prostate cancer aggressiveness using 3-T diffusion-weighted magnetic resonance imaging-guided biopsies versus a systematic 10-Core transrectal ultrasound prostate biopsy cohort.
        Eur Urol. 2012; 61: 177-184https://doi.org/10.1016/j.eururo.2011.08.042
        • Wysock JS
        • Rosenkrantz AB
        • Huang WC
        • et al.
        A prospective, blinded comparison of magnetic resonance (MR) imaging-ultrasound fusion and visual estimation in the performance of MR-targeted prostate biopsy: the PROFUS trial.
        Eur Urol. 2014; 66: 343-351https://doi.org/10.1016/j.eururo.2013.10.048
        • Puech P
        • Rouvière O
        • Renard-Penna R
        • et al.
        Prostate cancer diagnosis: multiparametric MR-targeted biopsy with cognitive and transrectal US–MR fusion guidance versus systematic biopsy—prospective multicenter study.
        Radiology. 2013; 268: 461-469https://doi.org/10.1148/radiol.13121501
        • Delongchamps NB
        • Peyromaure M
        • Schull A
        • et al.
        Prebiopsy magnetic resonance imaging and prostate cancer detection: comparison of random and targeted biopsies.
        JURO. 2013; 189: 493-499https://doi.org/10.1016/j.juro.2012.08.195
        • Oberlin DT
        • Casalino DD
        • Miller FH
        • et al.
        Diagnostic value of guided biopsies: fusion and cognitive-registration magnetic resonance imaging versus conventional ultrasound biopsy of the prostate.
        Urology. 2016; 92: 75-79https://doi.org/10.1016/j.urology.2016.02.041
      3. Cornud F, Roumiguié M, Barry De Longchamps N, et al. Precision matters in MR imaging–targeted prostate biopsies: evidence from a prospective study of cognitive and elastic fusion registration transrectal biopsies 1. Radiology. 2018;287:534–542. Available at:http://pubs.rsna.org.ezp.slu.edu/doi/pdf/10.1148/radiol.2017162916. Accessed March 3, 2018.

        • Rosenkrantz AB
        • Verma S
        • Choyke P
        • et al.
        Prostate magnetic resonance imaging and magnetic resonance imaging targeted biopsy in patients with a prior negative biopsy: a consensus statement by AUA and SAR.
        J Urol. 2016; 196: 1613-1618https://doi.org/10.1016/j.juro.2016.06.079
        • Kim EH
        • Vemana G
        • Johnson MH
        • et al.
        Magnetic resonance imaging-targeted vs. conventional transrectal ultrasound-guided prostate biopsy: single-institution, matched cohort comparison.
        Urol Oncol Semin Orig Investig. 2015; 33 (109.e1-109.e6)https://doi.org/10.1016/j.urolonc.2014.09.004
        • Kim EH
        • Weaver JK
        • Shetty AS
        • Vetter JM
        • Andriole GL
        • Strope SA
        Magnetic resonance imaging provides added value to the prostate cancer prevention trial risk calculator for patients with estimated risk of high-grade prostate cancer less than or equal to 10%.
        Urology. 2017; 102: 183-189https://doi.org/10.1016/j.urology.2016.08.074
        • Barentsz JO
        • Richenberg J
        • Clements R
        • et al.
        ESUR prostate MR guidelines 2012.
        Eur Radiol. 2012; 22: 746-757https://doi.org/10.1007/s00330-011-2377-y
        • Polanec S
        • Helbich TH
        • Bickel H
        • et al.
        Head-to-head comparison of PI-RADS v2 and PI-RADS v1.
        Eur J Radiol. 2016; 85: 1125-1131https://doi.org/10.1016/j.ejrad.2016.03.025
        • Weaver JK
        • Kim EH
        • Vetter JM
        • Fowler KJ
        • Siegel CL
        • Andriole GL
        Presence of Magnetic resonance imaging suspicious lesion predicts Gleason 7 or greater prostate cancer in biopsy-naive patients.
        Urology. 2016; 88: 119-124https://doi.org/10.1016/j.urology.2015.10.023
        • Lee DJ
        • Recabal P
        • Sjoberg DD
        • et al.
        Comparative effectiveness of targeted prostate biopsy using MRI-US fusion software and visual targeting: a prospective study.
        J Urol. 2016; 196: 697-702https://doi.org/10.1016/j.juro.2016.03.149
        • Chen ME
        • Troncoso P
        • Johnston D
        • Tang K
        • Babaian RJ
        Prostate cancer detection: relationship to prostate size.
        Urology. 1999; 53: 764-768https://doi.org/10.1016/S0090-4295(98)00574-3