Comparison of MR-TRUS Fusion Biopsy and Cognitive Fusion Biopsy Techniques in Patients with Suspected Prostate Cancer with Mp-MRI

Öz

We aimed to compare the efficiency of MR-Transrectal Ultrasonography (MR-TRUS) guided fusion biopsy and Cognitive Fusion (CF) biopsy techniques used to detect prostate cancer in patients with PIRADS 3 (Prostate Imaging Reporting and Information System) and higher lesions in Multiparametric Magnetic Resonance (mp-MR) examination. In our clinic between 2017-2022, 96 patients had selected who pre-biopsy mp-MR examinations had PIRADS 3 and above lesions, a PSA value between 2-20 ng/ml, and never had a prostate biopsy before, retrospectivly. Ninety-six patients who underwent 48 MR-TRUS and 48 CF fusion biopsies were selected within the first 6 months after the mp-MR examination. Parameters such as patient age, PSA value, prostate volume, size of lesions, and PIRADS score were evaluated. There was no significant difference between the groups in demographic data, PSA values, prostate volumes, size of lesions, and PIRADS scores (p>0.05). The cancer detection rate in any localization was 41.7% (20/48 patients) in the CF group and 39.6% (19/48 patients) in the MR-TRUS fusion biopsy group. The difference between the two groups was not significant (p=0.835). Cancer detection rates were 85% (17/20 patients) in the CF group and 73.7% (14/19 patients) in the MR-TRUS group on the targeted lesion. No significant difference was observed between these two groups (p=0.518). In conclusion, the CF biopsy technique may be preferred to MR-fusion biopsy because the success of detecting cancer is similar, its application is more accessible, and its cost is lower.

Anahtar Kelimeler

• prostate cancer
• multiparametric magnetic resonance imaging (mp-MRI)
• MRI-fusion biopsy
• Cognitive fusion biopsy

Mp-MR ile Prostat Kanseri Şüphesi Bulunan Hastalarda, MR-TRUS Füzyon Biyopsi ve Kognitif Füzyon Biyopsi Tekniklerinin Karşılaştırılması

Öz

Bu çalışmada, Multiparametrik Manyetik Rezonans (mp-MR) tetkikinde PIRADS 3 (Prostat Görüntüleme Raporlama ve Bilgi Sistemi) ve üzeri lezyonu bulunan hastalarda MR- Transrektal Ultrasonografi (MR-TRUS) eşliğinde füzyon biyopsi ve kognitif Füzyon (KF) biyopsi tekniklerinin prostat kanseri saptamadaki etkinliklerinin karşılaştırılması amaçlanmıştır. Kliniğimizde 2017-2022 yılları arasında biyopsi öncesi yapılmış mp-MR tetkiklerinde PIRADS 3 ve üzeri lezyonu bulunan, PSA değeri 2-20 ng/ml arasında olan, daha önce hiç prostat biyopsisi yapılmamış ve mp-MR tetkiki sonrası ilk 6 ay içerisinde 48 MR-TRUS, 48 KF füzyon biyopsisi yapılmış 96 hasta seçildi. Hasta yaşı, PSA değeri, prostat volümü, lezyonların boyutu ve PIRADS skoru gibi parametreler değerlendirildi. Gruplar arasında demografik verilerde, PSA değerleri, prostat volümleri ve lezyonların boyut ve PIRADS skorlarında anlamlı farklılık saptanmadı (p>0.05). Kognitif füzyon yapılan grupta herhangi bir lokalizasyonda kanser yakalama oranı %41,7 (20/48 hasta), MR-TRUS füzyon biyopsi yapılan grupta %39,6 (19/48 hasta) bulundu. İki grup arasında istatistiksel olarak anlamlı farklılık saptanmadı (p=0,835). Hedefli biyopsi sonuçlarında ise kanser saptama oranları KF grubunda %85 (17/20 hasta), MR-TRUS grubunda %73,7 (14/19 hasta) bulundu. Bu iki grup arasında da anlamlı farklılık izlenmedi (p=0,518). Sonuç olarak, kanser yakalama başarısının benzer olması, uygulamasının daha kolay ve maliyetinin daha düşük olması nedeniyle KF biyopsi tekniği MR-füzyon biyopsisine tercih edilebilir.

Anahtar Kelimeler

• prostat kanseri
• multiparametrik manyetik rezonans görüntüleme (mp-MRG)
• MR-Füzyon biyopsi
• Kognitif füzyon biyopsi

Kaynakça

1. 1.Mertan FV, Berman R, Szajek K, et al. Evaluating the Role of mpMRI in Prostate Cancer Assessment. Expert Rev Med Devices 2016; 13: 129-41.
2. 2.American College of Radiology. Prostate Imaging – Reporting and Data System. 2019. Version 2.1. PI-RADS.
3. 3.Mottet N, van den Bergh RCN, Briers E, et al. EAU guidelines: prostate cancer. 2019. [Cited 06,10,2019.] Available fromURL: https://uroweb.org/guidelines/prostate-cancer/.
4. 4.Baco E, Rud E, Magne L, et al. A randomized controlled trial to assess and compare the outcomes of two-core prostate biopsy guided by fused magnetic resonance and transrectal ultrasound images and traditional 12-core systematic biopsy. Eur Urol2016; 69: 149–56.
5. 5.Mariotti GC, Costa DN, Pedrosa I, et al. Magnetic resonance/transrectal ultrasound fusion biopsy of the prostate compared to systematic 12-core biopsy for the diagnosis and characterization of prostate cancer: multi-institutional retrospective analysis of 389 patients. Urol Oncol 2016; 34: 416.e9–e14.
6. 6.Hendriks R, Padhani AR, Catto J, Vickers A. Platinum priority –prostate cancer – editor’s choice head-to-head comparison oftransrectal ultrasoundguided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-na€ıve men with elevated prostate-specific antigen: a large prospective multicenter clinical study. Eur Urol 2018; 5: 579–81.
7. 7.Td O, Wegelin IF, Van Melick HHE, et al. Comparing threedifferent techniques for magnetic resonance imaging-targeted prostate biopsies: a systematic review of in-bore versusmagnetic resonance imaging-transrectal ultrasound fusionversus cognitive registration. Is there a preferred technique? Eur Urol 2017; 71: 517–31.
8. 8.Rosario DJ, Walton TJ, Kennish SJ. In-bore multiparametric magnetic resonance imaging targeted biopsy: as good as it gets? Eur Urol 2018; 75: 579–81.

9. 9.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.
10. 10.Kasivisvanathan V, Rannikko AS, BorghiM, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med. 2018;378:1767–1777.
11. 11.Siddiqui MM, Rais-Bahrami S, Truong H, et al. Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy. Eur Urol 2013;64:713–719.
12. 12.Logan JK, Rais-Bahrami S, Turkbey B, et al. Current status ofmagnetic resonance imaging (MRI) and ultrasonography fusionsoftware platforms for guidance of prostate biopsies. BJU Int 2014;114:641–652.
13. 13.Puech P, Rouvière O, Renard-Penna R, et al. Prostate cancerdiagnosis: multiparametric MR-targeted biopsy with cognitive and transrectal US-MR fusion guidance versus systematic biopsy—prospective multicenter study. Radiology.2013;268:461–469.
14. 14.Wegelin O, van Melick HHE, Hooft L, et al. Comparing ThreeDifferent 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 Apr;71(4):517-531.
15. 15.Turkay R, Inci E, Yildiz O, Ozgur E, Taşci Aİ. CognitiveVersus Magnetic Resonance-Ultrasound Fusion Prostate Biopsy: Which One Is Worthier to Perform? Ultrasound Q. 2020;36:345-349.
16. 16.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 ofMR-targeted prostate biopsy: the PROFUS trial. Eur Urol. 2014 Aug;66(2):343-51.
17. 17.Yamada Y, Shiraishi T, Ueno A, et al. Magnetic resonance imaging-guided targeted prostate biopsy: Comparison betweencomputer-software-based fusion versus cognitive fusiontechnique in biopsy-naïve patients. Int J Urol 2020;27:67-71.
18. 18.Cool DW, Zhang X, Romagnoli C, et al. Evaluation of MRI-TRUS fusion versus cognitive registration accuracy for MRI-targeted, TRUS-guided prostate biopsy. Am J Roentgenol.2015;204:83–91.
19. 19.Kwak JT, Hong CW, Pinto Pa, et al. Is visual registration equivalent to semiautomated registration in prostate biopsy?Biomed Res Int 2015;2015:394742.