MRI in-bore biopsy following MRI/US fusion-guided biopsy in patients with persistent suspicion of clinically significant prostate cancer

M Quentin; M Boschheidgen; J P Radtke; F Spohn; T Ullrich; L Drewes; B Valentin; J Lakes; Al-Monajjed; C Arsov; I Esposito; P Albers; G Antoch; L Schimmöller

doi:10.1016/j.ejrad.2024.111436

MRI in-bore biopsy following MRI/US fusion-guided biopsy in patients with persistent suspicion of clinically significant prostate cancer

Eur J Radiol. 2024 Jun:175:111436. doi: 10.1016/j.ejrad.2024.111436. Epub 2024 Mar 21.

Authors

M Quentin¹, M Boschheidgen², J P Radtke³, F Spohn⁴, T Ullrich⁵, L Drewes⁶, B Valentin⁷, J Lakes⁸, Al-Monajjed⁹, C Arsov¹⁰, I Esposito¹¹, P Albers¹², G Antoch¹³, L Schimmöller¹⁴

Affiliations

¹ University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany. Electronic address: [email protected].
² University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany. Electronic address: [email protected].
³ University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany. Electronic address: [email protected].
⁴ University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany. Electronic address: [email protected].
⁵ University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany. Electronic address: [email protected].
⁶ University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany. Electronic address: [email protected].
⁷ University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany. Electronic address: [email protected].
⁸ University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany. Electronic address: [email protected].
⁹ University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany. Electronic address: [email protected].
¹⁰ University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany; Elisabeth-Krankenhaus Rheydt, Departement of Urology and Paediatric Urology, Staedtische Kliniken Moenchengladbach GmbH, Moenchengladbach, Germany. Electronic address: [email protected].
¹¹ University Dusseldorf, Medical Faculty, Institute of Pathology, D-40225 Dusseldorf, Germany. Electronic address: [email protected].
¹² University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany. Electronic address: [email protected].
¹³ University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany. Electronic address: [email protected].
¹⁴ University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany; Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany. Electronic address: [email protected].

PMID: 38522396
DOI: 10.1016/j.ejrad.2024.111436

Abstract

Purpose: Patients with suspicion of clinically significant prostate cancer (csPC) on multiparametric prostate MRI (mpMRI) but negative or inconclusive MRI/US fusion-guided biopsy (FB) can be challenging in clinical practice. To assess the utility of MRI in-bore biopsy (IB) in patients with discordant imaging and histopathological findings after FB.

Methods: Consecutive patients with Prostate Imaging Reporting and Data System (PI-RADS) category 4 or 5 on mpMRI at 3T after FB without histologically confirmed csPC who underwent IB between 01/2014 and 05/2022, were retrospectively included. The primary objective was to assess the detection rate of csPC. Secondary objectives were to analyze clinical parameters, MRI parameters, and lesion localization.

Results: In the final cohort of 51 patients, the IB resulted in an overall detection rate of 71% for PC and 47% for csPC. Furthermore, in 55% of cases with initial low-grade PC, the Gleason score was upgraded after IB. CsPC was often detected apical and/or anterior. The detection rate for PC was 58% in PI-RADS category 4 and 94% in PI-RADS category 5 (csPC 39% and 61%, respectively). Patients with csPC had statistically significant smaller prostate volumes, a higher PI-RADS category, a higher prostate-specific antigen density (PSAD), and were older.

Conclusions: For a relevant proportion of patients with PI-RADS category 4 or 5 and negative or inconclusive findings on previous FB, but with persistent suspicion of csPC, a subsequent IB verified the presence of csPC. Therefore, IB can be a backup in cases of uncertainty.

Keywords: Image guided biopsy; Pathology; Prostate MRI; Prostate cancer.

MeSH terms

Aged
Humans
Image-Guided Biopsy* / methods
Magnetic Resonance Imaging / methods
Magnetic Resonance Imaging, Interventional / methods
Male
Middle Aged
Multimodal Imaging / methods
Multiparametric Magnetic Resonance Imaging / methods
Prostatic Neoplasms* / diagnostic imaging
Prostatic Neoplasms* / pathology
Reproducibility of Results
Retrospective Studies
Ultrasonography, Interventional