Does Experience Affect the Cancer Detection Rate in Cognitive Fusion Prostate Biopsy? A Comparison of the First and Last 60 Cases

Yıl 2022, Cilt: 11 Sayı: 2, 223 - 230, 31.08.2022

Osman Akyüz Haydar Kamil Çam

https://doi.org/10.47493/abantmedj.996342

Öz

Objective: We aimed to determine the contribution of the clinical experience gained in cognitive fusion prostate biopsy with the increase in the number of cases to the cancer detection rate.

Materials and Methods: The records of 120 patients who underwent cognitive fusion biopsy were retrospectively analyzed. All patients underwent 3-T multiparametric magnetic resonance imaging (Mp-MRI) and they were evaluated with Prostate Imaging Reporting and Data System (PIRADS). The initial 60 cases were included in group 1, and the later subsequent 60 cases performed by the same surgeon were included in group 2. Any cancer and clinically significant prostate cancer (CSPrCa) detection rates in groups 1 and 2 were compared.

Results: The mean ages of the patients for group 1 and group 2 were determined as 64.08 ± 8.15 and 65.15 ± 6.93 years, respectively. Age, prostate specific antigen (PSA), prostate volumes and the number of suspicious lesions of the groups were similar. Any cancer positivity rate was 33.3% for group 1, and 40% for group 2, without any significant intergroup difference (p=0.494). CSPrCa positivity was 40% and 70.83% for groups 1 and 2, respectively, and there was a significant improvement in CSPrCa detection in favor of group 2 (p=0.027).

Conclusion: Regarding the cognitive fusion biopsies, a learning curve is required. It was concluded that the rate of detecting clinically significant prostate cancer was almost doubled with the increased experience in fusion biopsy.

Anahtar Kelimeler

Biopsy, Cognitive Fusion, Learning Curve, Magnetic Resonance İmaging, Prostate Cancer

Kognitif Füzyon Prostat Biyopsisinde Deneyim Kanser Tespit Oranını Etkiliyor Mu? İlk ve Son 60 Vakanın Karşılaştırılması

Öz

Amaç: Bilişsel füzyon prostat biyopsisinde elde edilen klinik deneyimin vaka sayısındaki artışla birlikte kanser tespit oranına katkısını belirlemeyi amaçladık.
Gereç ve Yöntemler: Kognitif füzyon biyopsisi yapılan 120 hastanın kayıtları geriye dönük olarak incelendi. Tüm hastalara 3-T multiparametrik manyetik rezonans görüntüleme (Mp-MRG) yapıldı ve Prostat Görüntüleme Raporlama ve Veri Sistemi (PIRADS) ile değerlendirildi. İlk 60 vaka grup 1'e dahil edildi ve daha sonra aynı cerrah tarafından gerçekleştirilen sonraki 60 vaka grup 2'ye dahil edildi. Herhangi bir kanser ve klinik olarak anlamlı prostat kanseri (CSPrCa) tespit oranları grup 1 ve 2'de karşılaştırıldı.
Bulgular: Grup 1 ve grup 2 hastaların yaş ortalamaları sırasıyla 64.08 ± 8.15 ve 65.15 ± 6.93 yıl olarak belirlendi. Grupların yaş, prostat spesifik antijen (PSA), prostat hacimleri ve şüpheli lezyon sayıları benzerdi. Herhangi bir kanser pozitifliği oranı grup 1 için %33.3 ve grup 2 için %40 idi ve gruplar arası anlamlı bir fark yoktu (p=0.494). Grup 1 ve 2 için CSPrCa pozitifliği sırasıyla %40 ve %70.83 idi ve CSPrCa tespitinde grup 2 lehine anlamlı bir gelişme vardı (p=0.027).
Sonuç: Bilişsel füzyon biyopsileri ile ilgili olarak bir öğrenme eğrisi gereklidir. Füzyon biyopsisinde artan deneyim ile klinik olarak anlamlı prostat kanseri tespit oranının neredeyse iki katına çıktığı sonucuna varıldı.

Anahtar Kelimeler

Biyopsi, Kognitif Füzyon, Öğrenme Eğrisi, Manyetik Rezonans Görüntüleme, Prostat Kanseri

Kaynakça

• 1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;Nov;68(6):394-424. DOI:10.3322/caac.21492.
• 2. Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 1989;142: 71-74. DOI:10.1016/s0022-5347(17)38664-0.
• 3. Meng MV, Elkin EP, DuChane J, Carroll PR. Impact of increased number of biopsies on the nature of prostate cancer identified. J Urol 2006;176: 63-68. DOI:10.1016/S0022-5347(06)00493-9.
• 4. Mottet N, Cornford P, RCN van den Bergh, et al. Prostate cancer, European Association of Urology Guidelines 2020. http://uroweb.org/guideline/prostate-cancer.
• 5. Yamada Y, Shiraishi T, Ueno A, et al. Magnetic resonance imaging-guided targeted prostate biopsy: Comparison between computer-software-based fusion versus cognitive fusion technique in biopsy-naïve patients. Int J Urol 2019; Oct 6. doi: 10.1111/iju.14127.
• 6. 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 Mar;2(2):135-140. DOI: 10.1016/j.euo.2018.07.005.
• 7. Weinreb JC, Barentsz JO, Choyke PL, et al. PI-RADS prostate imaging and reporting and data system: 2015, version 2. Eur Urol 2016;Jan;69(1):16-40. DOI:10.1016/j.eururo.2015.08.052.
• 8. Moore CM, Kasivisvanathan V, Eggener S, et al. START Consortium. START Consortium. Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group. Eur Urol 2013;64:544-52. DOI:10.1016/j.eururo.2013.03.030
• 9. Brown AM, Elbuluk O, Mertan F, et al. Recent advances in image-guided targeted prostate biopsy. Abdom Imaging 2015;40:1788-99. DOI:10.1007/s00261-015-0353-8.
• 10. Kam J, Yuminaga Y, Kim R, et al. Does magnetic resonance imaging-guided biopsy improve prostate cancer detection? A comparison of systematic, cognitive fusion and ultrasound fusion prostate biopsy. Prostate Int 2018;Sep;6(3):88-93. DOI:10.1016/j.prnil.2017.10.003.
• 11. Schoots IG, Roobol MJ, Nieboer D, et al. Magnetic Resonance Imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standart transrectal ultrasound-guided biopsy: a systematic review and meta- analysis. Eur Urol 2015;68:438-50. DOI:10.1016/j.eururo.2014.11.037.
• 12. Murphy IG, NiMhurchu E, Gibney RG, McMahon CJ. MRI-directed cognitive fusion- guided biopsy of the anterior prostate tumors. Diagn Intrev Radiol 2017;23:87-93. DOI:10.5152/dir.2016.15445.
• 13. Venderink W, Bomers JG, Overduin CG, et al. Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know. Part 3: Targeted Biopsy. Eur Urol 2019;Nov 29. DOI:https://doi.org/10.1016/j.eururo.2019.10.009.
• 14. Wegelin O, Exterkate L, van der Leest M, et al. The FUTURE trial: a multicenter randomised 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: 582–90. DOI: 10.1016/j.eururo.2018.11.040.
• 15. Wysock JS, Rosenkratz AB, Huang WC, et al. A prospective, blinded comparison of MR Imaging-Ultrasound fusion and visual estimation in the performance of MR-targeted prostate biopsy: the PROFUS trial. Eur Urol 2014;66: 343-51. DOI: 10.1016/j.eururo.2013.10.048.
• 16. Kasivisvanathan V, Rannikko AS, Borghi M, et al. PRECISION Study Group Collaborators. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 2018;378:1767–1777. DOI: 10.1056/NEJMoa1801993.
• 17. Ahmed HU, Bosaily AE, Brown LC, et al. Diagnostic accuracy of multi-parametric MRI and TR/US biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017;389:815–22. DOI: 10.1016/S0140-6736(16)32401-1.
• 18. Acar Ö, Esen T, Çolakoğlu B, et al. Multiparametric MRI guidance in first-time prostate biopsies: what is the real benefit? Diagn Interv Radiol 2015; Jul-Aug; 21(4): 271–276. DOI: 10.5152/dir.2015.46014.