Three-dimensional localization and targeting of prostate cancer foci with imaging and histopathologic correlation: establishing a multidisciplinary team for quality improvement.

Abstract

The current trend in image-based identification and characterization of prostate cancer (PCa) utilizing multiparametric MRI (mpMRI) has affected diagnostic and treatment planning in terms of targeted biopsy, risk stratification and prognostic evaluation, clinical management and follow-up. However, the accuracy of MRI to detect clinically significant disease is variable between different institutions. The role of quality control initiatives to increase the concordance between clinical-imaging-histopathological data and to improve accurate targeting of the suspicious lesions cannot be overemphasized. This article describes the approaches to correlate mpMRI findings with histopathology and the role of multidisciplinary teams for quality improvement and feedback interventions. Validating the mpMRI and image-targeted fusion biopsy findings with prostatectomy specimen histopathology as the gold standard is essential for assessment of the concordance between clinical-imaging-histopathological data. Utilization of a MRI-derived patient-specific prostate mold enables a direct comparison between histopathological versus imaging characteristics of cancer foci in the same sectional plane of the specimen versus MRI. Furthermore, 'reverse fusion' technology provides the ability to audit the quality of targeting following fusion biopsy. The development of a multidisciplinary team approach with group discussions, workflows to integrate and correlate clinical, imaging and histological data, as well as feedback and audit interventions can improve the quality of care when an image-based PCa diagnostic program is implemented. This needs to be executed at the local level to better understand each institutions' performance characteristics of mpMRI and image-targeted intervention.