Universität zu Köln

Hansen, Nienke L., Kesch, Claudia ORCID: 0000-0002-2656-2664, Barrett, Tristan, Koo, Brendan, Radtke, Jan P., Bonekamp, David, Schlemmer, Heinz-Peter, Warren, Anne Y., Wieczorek, Kathrin, Hohenfellner, Markus, Kastner, Christof and Hadaschik, Boris ORCID: 0000-0002-1052-2692 (2017). Multicentre evaluation of targeted and systematic biopsies using magnetic resonance and ultrasound image-fusion guided transperineal prostate biopsy in patients with a previous negative biopsy. BJU Int., 120 (5). S. 631 - 639. HOBOKEN: WILEY. ISSN 1464-410X

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Abstract

Objectives To evaluate the detection rates of targeted and systematic biopsies in magnetic resonance imaging (MRI) and ultrasound (US) image-fusion transperineal prostate biopsy for patients with previous benign transrectal biopsies in two high-volume centres. Patients and Methods A two centre prospective outcome study of 487 patients with previous benign biopsies that underwent transperineal MRI/US fusion-guided targeted and systematic saturation biopsy from 2012 to 2015. Multiparametric MRI (mpMRI) was reported according to Prostate Imaging Reporting and Data System (PI-RADS) Version 1. Detection of Gleason score 7-10 prostate cancer on biopsy was the primary outcome. Positive (PPV) and negative (NPV) predictive values including 95% confidence intervals (95% CIs) were calculated. Detection rates of targeted and systematic biopsies were compared using McNemar's test. Results The median (interquartile range) PSA level was 9.0 (6.7-13.4) ng/mL. PI-RADS 3-5 mpMRI lesions were reported in 343 (70%) patients and Gleason score 7-10 prostate cancer was detected in 149 (31%). The PPV (95% CI) for detecting Gleason score 7-10 prostate cancer was 0.20 (0.07) for PI-RADS 3, 0.32 (+/- 0.09) for PI-RADS 4, and 0.70 (+/- 0.08) for PI-RADS 5. The NPV (95% CI) of PI-RADS 1-2 was 0.92 (+/- 0.04) for Gleason score 7-10 and 0.99 (+/- 0.02) for Gleason score 4 + 3 cancer. Systematic biopsies alone found 125/138 (91%) Gleason score 7-10 cancers. In patients with suspicious lesions (PI-RADS 4-5) on mpMRI, systematic biopsies would not have detected 12/113 significant prostate cancers (11%), while targeted biopsies alone would have failed to diagnose 10/113 (9%). In equivocal lesions (PI-RADS 3), targeted biopsy alone would not have diagnosed 14/25 (56%) of Gleason score 7-10 cancers, whereas systematic biopsies alone would have missed 1/25 (4%). Combination with PSA density improved the area under the curve of PI-RADS from 0.822 to 0.846. Conclusion In patients with high probability mpMRI lesions, the highest detection rates of Gleason score 7-10 cancer still required combined targeted and systematic MRI/US image-fusion; however, systematic biopsy alone may be sufficient in patients with equivocal lesions. Repeated prostate biopsies may not be needed at all for patients with a low PSA density and a negative mpMRI read by experienced radiologists.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Hansen, Nienke L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kesch, Claudia UNSPECIFIED orcid.org/0000-0002-2656-2664 UNSPECIFIED Barrett, Tristan UNSPECIFIED UNSPECIFIED UNSPECIFIED Koo, Brendan UNSPECIFIED UNSPECIFIED UNSPECIFIED Radtke, Jan P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bonekamp, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Schlemmer, Heinz-Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Warren, Anne Y. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wieczorek, Kathrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Hohenfellner, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Kastner, Christof UNSPECIFIED UNSPECIFIED UNSPECIFIED Hadaschik, Boris UNSPECIFIED orcid.org/0000-0002-1052-2692 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-213346
DOI:	10.1111/bju.13711
Journal or Publication Title:	BJU Int.
Volume:	120
Number:	5
Page Range:	S. 631 - 639
Date:	2017
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	1464-410X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ISUP CONSENSUS CONFERENCE; CANCER DETECTION; INTERNATIONAL-SOCIETY; GUIDELINES; DIAGNOSIS; MRI; CARCINOMA; SPECIMENS; VALUES; TRIAL Multiple languages Urology & Nephrology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/21334