Abstract
PurposeTo establish an individualized prostate biopsy model that reduces unnecessary biopsy cores based on multiparameter MRI (mpMRI).Materials and MethodsThis retrospective, non-inferiority dual-center study retrospectively included 609 patients from the Changhai Hospital from June 2017 to November 2020 and 431 patients from the Fujian Union Hospital between 2014 and 2019. Clinical, radiological, and pathological data were analyzed. Data from the Changhai Hospital were used for modeling by calculating the patients’ disease risk scores. Data from the Fujian Union Hospital were used for external verification.ResultsBased on the data of 609 patients from the Changhai Hospital, we divided the patients evenly into five layers according to the disease risk score. The area under the receiver operating characteristic (ROC) curve (AUC) with 95% confidence intervals (CI) was analyzed. Twelve-core systemic biopsy (12-SBx) was used as the reference standard. The SBx cores from each layer were reduced to 9, 6, 5, 4, and 4. The data of 279 patients with benign pathological results from the Fujian Union Hospital were incorporated into the model. No patients were in the first layer. The accuracies of the models for the other layers were 88, 96.43, 94.87, and 94.59%. The accuracy of each layer would be increased to 96, 100, 100, and 97.30% if the diagnosis of non-clinically significant prostate cancer was excluded.ConclusionsIn this study, we established an individualized biopsy model using data from a dual center. The results showed great accuracy of the model, indicating its future clinical application.
Highlights
Prostate biopsy is the standard procedure for tissue acquisition for pathological diagnosis
Since the 1980s, when transrectal ultrasound guided (TRUS)-guided 6-core systematic biopsy was proposed by Hodge et al [1], it was found to have a 33% misdiagnosis rate for Pca [2]
It is still unclear how to decrease the number of cores under the condition that more clinically significant prostate cancer (csPCa) is diagnosed [7, 8]
Summary
Prostate biopsy is the standard procedure for tissue acquisition for pathological diagnosis. 8-, 10-, or 12-core and even saturation biopsies are recommended to improve the detection rate, even though they increase the risk of rectal bleeding, urinary tract infection, erectile dysfunction, and other complications [3, 4]. Since MRI-guided prostate biopsy was first performed by D’Amico in 2000 [5], it has been proven to detect more csPCa with fewer biopsy cores than system biopsy by high-quality research [6]. Because mpMRI inter-reader reproducibility remains moderate at best [9, 10], the accuracy and reproducibility of targeted biopsy still need to be improved [11], and the optimal core number and site for MRI-targeted biopsy have not been clearly elucidated [12]. The EAU Guidelines recommend combining targeted and systematic biopsy in patients who are naïve in biopsy when mpMRI is positive (i.e., PI-RADS ≥3) [14], which will increase the risk of complications [15]
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