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Beyond the Learning Curve of Prostate MRI/TRUS Target Fusion Biopsy after More than 1000 Procedures

      Abstract

      Objective

      To evaluate the learning curve (LC) of two urology residents in the execution of fusion biopsy (FB) in terms of overall prostate cancer (PCa) and clinically significant (cs) PCa detection rate (DR) and according to different characteristics of the lesions on MRI

      Material and Methods

      We analyzed data from our prospective maintained FB database between January 2015 and December 2019. FB was performed using the BioJet fusion system (D&K Technologies, Barum, Germany) with a transrectal or transperineal approach. An ANOVA test was used to evaluate the homogeneity of our cohort. Multivariable linear and logistic regression analysis were used to evaluate the relationship between operator experience and DR for PCa and csPCa. Then, the postprocedural complication rate trend was evaluated.

      Results

      1005 patients were included. The overall DR of PCa was 61.2% (615/1005) [IC 0.58 – 0.64]; whilst DR for csPCA was 54.6% (549/1005) [IC 0.51 – 0.57]. Operator experience does not seem to influence the DR of overall PCa and csPCa; whilst for lesions <8 mm in diameter, PCa and csPCa DR increased significantly with operator experience (P = 0.048 and P = 0.038, respectively). Postprocedural complications remained stable during the whole study period (P = 0.75).

      Conclusion

      A standardized FB approach turned out to be feasible, safe, and effective since the beginning of the residents’ LC. PCa and csPCa DR remained stable, at 60% and 55% respectively, after more than 1,000 biopsies. However, for lesions smaller than 8 mm, at least 100 FB of experience is needed to correctly sample the area.
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      References

      1. Mottet N, van den Bergh RCN, Briers E, et al. EAU Guidelines. Available at: https://uroweb.org/guidelines/2020

        • Wegelin O
        • Exterkate L
        • van der Leest M
        • et al.
        The FUTURE trial: a multicenter randomized controlled trial on target biopsy techniques based on magnetic resonance imaging in the diagnosis of prostate cancer in patients with prior negative biopsies.
        Eur Urol. 2019; 75: 582-590
        • Klotz L
        • Loblaw A
        • Sugar L
        • et al.
        Active surveillance magnetic resonance imaging study (ASIST): results of a randomized multicenter prospective trial.
        Eur Urol. 2019; 75: 300-309
        • von Hardenberg J
        • Westhoff N
        • Baumunk D
        • et al.
        Prostate cancer treatment by the latest focal HIFU device with MRI/TRUS-fusion control biopsies: aprospective evaluation.
        Urol Oncol. 2018; 36: 401
        • Kasivisvanathan V
        • Stabile A
        • Neves JB
        • et al.
        Magnetic resonance imaging-targeted biopsy vs systematic biopsy in the detection of prostate cancer: Aasystematic review and meta-analysis.
        Eur Urol. 2019; 76: 284-303
        • Engels RRM
        • Israël B
        • Padhani AR
        • Barentsz JO.
        Multiparametric magnetic resonance imaging for the detection of clinically significant prostate cancer: what urologists need to know. part 1: acquisition.
        Eur Urol. 2020; 77: 457-468
        • de Rooij M
        • Israël B
        • Tummers M
        • et al.
        ESUR/ESUI consensus statements on multi-parametric MRI for the detection of clinically significant prostate cancer: quality requirements for image acquisition, interpretation and radiologists' training.
        Eur Radiol. 2020; 30: 5404-5416
        • van der Leest M
        • Israël B
        • Cornel EB
        • et al.
        High diagnostic performance of short magnetic resonance imaging protocols for prostate cancer detection in biopsy-naïve men: the next step in magnetic resonance imaging accessibility.
        Eur Urol. 2019; 76: 574-581
        • Kasabwala K
        • Patel N
        • Cricco-Lizza E
        • et al.
        The learning curve for magnetic resonance imaging/ultrasound fusion-guided prostate biopsy.
        Eur Urol Oncol. 2019; 2: 135-140
        • Barentsz JO
        • Richenberg J
        • Clements R
        • et al.
        ESUR prostate MR guidelines 2012.
        Eur Radiol. 2012; 22: 746-757
        • Barentsz JO
        • Weinreb JC
        • Verma S
        • et al.
        Synopsis of the PI-RADS v2 guidelines for multiparametric prostate magnetic resonance imaging and recommendations for Use.
        Eur Urol. 2016; 69: 41-49
        • Russo F
        • Regge D
        • Armando E
        • et al.
        Detection of prostate cancer index lesions with multiparametric magnetic resonance imaging (mp-MRI) using whole-mount histological sections as the reference standard.
        BJU Int. 2016; 118: 84-94
        • Porpiglia F
        • Manfredi M
        • Mele F
        • et al.
        Diagnostic pathway with multiparametric magnetic resonance imaging vs standard pathway: results from a randomized prospective study in biopsy-naïve patients with suspected prostate cancer.
        Eur Urol. 2017; 72: 282-288
        • Porpiglia F
        • De Luca S
        • Passera R
        • et al.
        Multiparametric magnetic resonance/ultrasound fusion prostate biopsy: number and spatial distribution of cores for better index tumor detection and characterization.
        J Urol. 2017; 198: 58-64
        • Moore CM
        • Kasivisvanathan V
        • Eggener S
        • et al.
        Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group.
        Eur Urol. 2013; 64: 544-552
        • Dindo D
        • Demartines N
        • Clavien PA.
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • Kasivisvanathan V
        • Rannikko AS
        • Borghi M
        • et al.
        MRI-targeted or standard biopsy for prostate-cancer diagnosis.
        N Engl J Med. 2018; 378: 1767-1777
        • Cash H
        • Günzel K
        • Maxeiner A
        • et al.
        Prostate cancer detection on transrectal ultrasonography-guided random biopsy despite negative real-time magnetic resonance imaging/ultrasonography fusion-guided targeted biopsy: reasons for targeted biopsy failure.
        BJU Int. 2016; 118: 35-43
        • Calio B
        • Sidana A
        • Sugano D
        • et al.
        Changes in prostate cancer detection rate of MRI-TRUS fusion vs systematic biopsy over time: evidence of a learning curve.
        Prostate Cancer Prostatic Dis. 2017; 20: 436-441
        • Mager R
        • Brandt MP
        • Borgmann H
        • Gust KM
        • Haferkamp A
        • Kurosch M.
        From novice to expert: analyzing the learning curve for MRI-transrectal ultrasonography fusion-guided transrectal prostate biopsy.
        Int Urol Nephrol. 2017; 49: 1537-1544
        • Kuru TH
        • Roethke MC
        • Seidenader J
        • et al.
        Critical evaluation of magnetic resonance imaging targeted, transrectal ultrasound guided transperineal fusion biopsy for detection of prostate cancer.
        J Urol. 2013; 190: 1380-1386
        • Akin O
        • Riedl CC
        • Ishill NM
        • Moskowitz CS
        • Zhang J
        • Hricak H.
        Interactive dedicated training curriculum improves accuracy in the interpretation of MR imaging of prostate cancer.
        Eur Radiol. 2010; 20: 995-1002
        • Gaziev G
        • Wadhwa K
        • Barrett T
        • et al.
        Defining the learning curve for multiparametric magnetic resonance imaging (MRI) of the prostate using MRI-transrectal ultrasonography (TRUS) fusion-guided transperineal prostate biopsies as a validation tool.
        BJU Int. 2016; 117: 80-86
        • Checcucci E
        • De Cillis S
        • Piramide F
        • et al.
        The role of additional standard biopsy in the MRI-targeted biopsy era.
        Minerva Urol Nefrol. 2020; 72: 637-639
      2. Tschirdewahn S, Wiesenfarth M, Bonekamp D, et al. Detection of significant prostate cancer using target saturation in transperineal magnetic resonance imaging/transrectal ultrasonography-fusion biopsy [published online ahead of print, 2020 Jul 10]. Eur Urol Focus. 2020;S2405-4569(20)30186-3.

        • Checcucci E
        • De Cillis S
        • Amparore D
        • et al.
        Naive patients with suspicious prostate cancer and positive multiparametric magnetic resonance imaging (mp-MRI): is it time for fusion target biopsy alone?.
        J Clin Urol. 2021; https://doi.org/10.1177/20514158211023713
        • Checcucci E
        • Autorino R
        • Cacciamani GE
        • et al.
        Artificial intelligence and neural networks in urology: current clinical applications.
        Minerva Urol Nefrol. 2020; 72: 49-57
        • Checcucci E
        • De Cillis S
        • Granato S
        • et al.
        Applications of neural networks in urology: a systematic review.
        Curr Opin Urol. 2020; 30: 788-807
        • Stanzione A
        • Gambardella M
        • Cuocolo R
        • Ponsiglione A
        • Romeo V
        • Imbriaco M.
        Prostate MRI radiomics: a systematic review and radiomic quality score assessment.
        Eur J Radiol. 2020; 129109095