Abstract
BackgroundTo report a new standardized cognitive fusion technique on transperineal targeted biopsy (TB) of prostate, and to evaluate its efficacy for cancer detection combined with systematic biopsy (SB) .MethodsWe present a retrospective review of consecutive patients undergoing multiparametric magnetic resonance (mpMRI) imaging of the prostate with subsequent transperineal prostate biopsy from January 2016 to December 2018. A free-hand 12-core SB was performed for each patient. PI-RADS 3–5 lesions were further targeted for biopsy with our TB technique. Firstly, a central point of suspicious lesion (B′) was registered cognitively on a transverse section of transrectal ultrasound (TRUS). Then, biopsy gun punctured vertically through a fixed pioneer site (A) on skin of perineum, and deep into the TRUS section to get A’. Next, targeted site (B), the surface-projection of B′, would be determined on skin of perineum by A and distance from B′ to A’. Finally, puncture through B to reach B′. Pathological findings of SB and TB were analyzed.ResultsA total of 126 patients underwent transperineal prostate biopsy (47 SB only, 79 SB + TB). The age of the patients was 68.7 ± 9.2 years. The median preoperative PSA value was 11.8 ng/mL. Preoperative prostate volume was 60.5 ± 50.0 mL. The numbers of patients with PI-RADS scores of 1 through 5 were 4, 43, 27, 21 and 31, respectively. The overall detection rate of cancer was 61/126 (48.4%), and it was significantly higher in the combination cohort (56/79, 70.9%) compared with the SB only cohort (5/47, 10.6%, p<0.001). When focused on the combination cohort, TB detected a similar overall rate of PCa (53/79, 67.1% vs 52/79, 65.8%; p = 0.87) compared with SB. The clinically significant PCa (csPC) detection rate was 52/79 (65.8%), while for TB and SB the csPC/PC rate was 51/53 (96.2%) and 48/52 (92.3%), respectively(p = 0.44). TB demonstrated a better sampling performance (positive rate for each core) compared with SB (51.0% vs 31.3%, p < 0.001).ConclusionsSurface-projection-based transperineal cognitive fusion targeted biopsy of the prostate has a good efficacy in detecting PCa.
Highlights
To report a new standardized cognitive fusion technique on transperineal targeted biopsy (TB) of prostate, and to evaluate its efficacy for cancer detection combined with systematic biopsy (SB)
The conventional systematic method of prostate biopsy has been shown to have limited sensitivity for detecting prostate cancer in recent years [9], while multiparametric magnetic resonance imaging of the prostate has become a very useful tool to improve the accuracy of prostate cancer detection
32 patients who underwent transrectal biopsy of the prostate, three who had no multiparametric magnetic resonance (mpMRI) before biopsy, and five who had prior negative biopsy were excluded
Summary
To report a new standardized cognitive fusion technique on transperineal targeted biopsy (TB) of prostate, and to evaluate its efficacy for cancer detection combined with systematic biopsy (SB). There are three primary modalities to perform a targeted biopsy: 1) MRI guided biopsy, in which biopsy is guided by real-time MRI images This modality offers an increased sensitivity and specificity for prostate biopsy guidance; the disadvantages of being time-consuming and requiring specialized equipment has resulted in it not being widely used [13]. 3) Cognitive fusion technique, called visual registration biopsy This technique does not need any additional equipment but needs the operator to possess skills in reading both MRI and TURS images. It is convenient but usually requires a long learning curve [16, 17]
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