04:21 PM Abstract No. 382 MRI-fused cone-beam CT-guided biopsy of the prostate as a safe and novel method of prostate biopsy

Abstract

3D fluoroscopy guidance using cone-beam CT (CBCT) can be fused to MRI images, allowing direct coaxial needle placement into an MRI target using the real time fluoroscopy. We describe our experience using MRI fused CBCT guidance for prostate biopsy. There are no published reports on the use of CBCT guidance in prostate biopsies. We hypothesize this technique will have an adequate safety profile while accurately detecting prostate cancer. Patients were selected for this study if they had an MRI lesion graded as PiRads 3 or greater and was clinically suspected of protate cancer by the oncologic urologist. All of our prostate biopsies were completed using MRI fused CBCT as a navigation system using a transgluteal approach. Dedicated software (XperGuide, Philips Imaging) was used to plan the approach and confirm the location of the coaxial needle prior to biopsy. Biopsies were performed using a 17/18 gauge coaxial system. The patient did not receive pre-procedure antibiotics or bowel preparation. The immediate and 30 day complication rate and biopsy results were recorded. In total, 70 patients underwent CBCT-guided biopsy. The only observed immediate or 30 day complications were 2 transient events of hematuria that were self-resolving, and one event of urinary retention treated with 1 week of indwelling Foley catheter. There were no complications related to infection or sepsis. Gleason score ≥7 was observed in 1/5 (20%) patients with a PiRads 3 lesions, 6/31 (19.4%) patients with a PiRads 4 lesion, 18/34 (52.9%) patients with a PiRads 5 lesion. When compared to previous transrectal ultrasound-guided prostate (TRUSP) biopsy, PiRads 5 lesions were more likely to be upgraded to Gleason score ≥7 (18/34 patients) then PiRads 3 (1/5) or PiRads 4 lesions (6/31). MRI fused CBCT guidance targeted biopsy of suspected prostate cancer is technically feasible in our experience with 70 patients. Its complication profile is favorable when compared to TRUSP biopsies. It has the potential to upstage disease in patients with high PI-RADS lesions on MRI and previously negative or low Gleason score on TRUSP biopsies.