Compare Cancer Detection Rates Research Articles

Performance of high-resolution diffusion-weighted magnetic resonance imaging for detecting clinically occult early breast cancers: a multi-reader study.

To compare mammography, breast ultrasound (US), high-resolution diffusion-weighted magnetic resonance imaging (DW-MRI), dynamic contrast-enhanced breast MRI (DCE-MRI), and their combinations for detecting clinically occult early breast cancers (EBCs), including ductal carcinoma in situ (DCIS). Three hundred and three consecutive women with screening imaging-detected early breast cancers (60 pure DCIS, 36 DCIS with microinvasion, and 207 invasive carcinoma less than 20mm) who underwent breast MRI at 3T including DW-MRI (b-values of 0, 800 and 1200s/mm2; in-plane resolution, 1.1 × 1.1 mm2 or 1.3 × 1.3 mm2; section thickness, 3mm) were retrospectively reviewed. Three radiologists independently reviewed each examination. Statistical analysis included Chi-square test, McNemar test for comparison of cancer detection rates, and Fleiss' Kappa for interreader agreement. Mixed-effect logistic regression analysis was employed to evaluate factors associated with cancer detection on DW-MRI. The overall cancer detection rates were 54.8% on mammography, 71.0% on breast US, 81.5% on DW-MRI, and 87.1% on DCE-MRI. On McNemar test, DW-MRI detected more cancers than mammography (adjusted p < 0.001), and its combination with mammography showed a similar cancer detection rate to DCE-MRI combined with mammography (adjusted p = 0.808). On multivariable analysis, histologic type, lesion size, ADC and CNR on DW-MRI were independent factors for cancer detection on DW-MRI. The interreader agreement for cancer detection was moderate to substantial (Fleiss' kappa: 0.52-0.65) across each modality. High-resolution DW-MRI plus mammography showed comparable cancer detection rate to DCE-MRI plus mammography for detecting clinically occult EBCs including DCIS.

Transperineal biopsy as a new technique versus well-established transrectal biopsy for diagnosis of prostate cancer - A comparative study.

Transrectal (TR) prostate biopsy has been the gold standard for prostate cancer diagnosis for years. With the emergence of transperineal (TP) prostatic biopsy, there is a shift in practice across medical services to adopt TP biopsy as the primary method of prostatic biopsy. The objective of the study is to compare cancer detection rates and complications between TP and TR biopsies in our region providing single-center experience with introduction of TP biopsy. This is a retrospective study utilizing a prospectively designed database comparing consecutive 80 cases of TP biopsy to 80 cases of TR biopsy in a single center. Prebiopsy PSA was 14.2 ± 24.9 ng/dl in the TP group versus 23.7 ± 71.3 ng/dl in the TR group with P = 0.108. Prostate Imaging-Reporting and Data System (PIRAD) 4 and 5 lesions were found in 47 (58.9%) cases of TP biopsy versus 44 (60.3%) of TR group cases and P = 0.131. Cancer was detected in 49 (61.25%) patients in the TP group versus 45 (56.25%) in the TR group with no statistically significant difference and P = 0.665. No cases of hematochezia was reported in TP group, vs 14 (17.5%) reported in TR group with P value <.001. There were no statistically significant differences regarding the incidence of febrile urinary tract infection (UTI), hematuria, and hematospermia in the TP group 0 (0%), 7 (8.75%), and 3 (3.75%) versus 2 (2.50%), 14 (17.50%), and 5 (6.25%) in the TR group with P = 0.497, 0.159, and 0.719 consecutively. TP and TR biopsy have comparable cancer detection rates. TP biopsy has a significantly lower rectal bleeding rate than TR biopsy. There is a trend toward lower febrile UTI in the TP group; however, it did not reach statistical significance.

Targeted biopsy added to systematic biopsy improves cancer detection in prostate cancer screening.

Magnetic resonance imaging (MRI)/ultrasound targeted biopsy has frequently been used together with a 12-core systematic biopsy for prostate cancer screening in the past few years. However, the efficacy of targeted biopsy compared to systematic biopsy, as well as its clinical-histologic correlation, has been assessed by a limited number of studies and is further investigated in this study. We collected 960 cases with both targeted and systematic prostate biopsies from 04/2019 to 04/2022 (Table 1). We compared cancer detection rates between targeted and systematic prostate biopsies in different grade groups. Correlations with the size of prostate lesions, prostate-specific antigen (PSA) level, and Prostate Imaging-Reporting and Data System (PI-RADS) scale were also analyzed for each of these biopsy methods. Among the 960 men who underwent targeted biopsy with systematic biopsy, prostatic adenocarcinoma was diagnosed in 652 (67.9%) cases. 489 (50.9%) cases were diagnosed by targeted biopsy and 576 (60.0%) cases were diagnosed by systematic biopsy. In the 384 cases diagnosed negative by systematic biopsy, targeted biopsy identified cancer in 76 (8%) cases. Systematic biopsy was able to detect 163 cancer cases that were missed by targeted biopsy. Systematic biopsy detected more grade group 1 cancers compared to targeted biopsy. However, for higher grade cancers, the differences between the cancer detection rates of targeted biopsy and systematic biopsy became negligible. Targeted biopsy upgraded the grade group categorized by systematic biopsy in several cases (3.8%, 7.0%, 2.6%, 1.1% and 0.9% in Grade Groups 1, 2, 3, 4, and 5 respectively). Targeted biopsy was more likely to detect cancer in larger lesions (13.17 mm VS 11.41 mm, P=0.0056) and for higher PI-RADS scales (4.19 VS 3.68, P<0.0001). The cancers detected by targeted biopsy also had higher PSA levels (10.38 ng/ml VS 6.39 ng/ml, P=0.0026). Targeted biopsy with systematic biopsy improved cancer detection rate compared to systematic biopsy alone. Targeted biopsy is not more sensitive for grade groups 1, 4, or 5 cancers but is as sensitive as systematic biopsy for detecting grade group 2 and 3 cancers. Targeted biopsy is more effective at detecting cancers when patients have larger lesions, higher PI-RADS scales, and higher PSA levels.

Do cancer detection rates differ between transperineal and transrectal micro-ultrasound mpMRI-fusion-targeted prostate biopsies? A propensity score-matched study.

High-resolution micro-ultrasound (micro-US) is a novel precise imaging modality that allows targeted prostate biopsies and multiparametric magnet resonance imaging (mpMRI) fusion. Its high resolution relying on a 29 MHz transducer allows real-time visualisation of prostate cancer lesions; this might overcome the inaccuracy of conventional MRI-US fusion biopsy strategies. We compared cancer detection rates in patients who underwent transrectal (TR-B) versus transperineal (TP-B) MR-micro-US fusion biopsy. 1:2 propensity score matching was performed in 322 consecutive procedures: 56 TR-B and 266 TP-B. All prostate biopsies were performed using ExactVuTM micro-US system with mpMRI image fusion. Clinically significant disease was defined as grade group ≥2. The primary objective was to evaluate the detection of clinically significant disease according to access route. The secondary outcomes were to compare the respective detection rates of random and targeted biopsies stratified per access route and to evaluate micro-US for its potential added value. 47 men undergoing TR-B and 88 undergoing TP-B were matched for age, PSA, clinical stage, prostate volume, PIRADS score, number of mpMRI-visible lesions and indication to biopsy. The detection rates of clinically significant and of any prostate cancer did not differ between the two groups (45% TR-B vs 42% TP-B; p = 0.8, and 57% TR-B vs 59% TP-B; p = 0.9, respectively). Detection rates also did not differ significantly between random (p = 0.4) and targeted biopsies (p = 0.7) stratified per access route. Micro-US targeted biopsy detected 36 MRI-invisible lesions in 33 patients; 19% of these lesions were positive for clinically significant disease. Overall, micro-US targeted biopsies upgraded 2% of patients to clinically significant disease that would have been missed otherwise. MR-micro-US-fusion TR-B and TP-B have similar diagnostic yields in terms of detection rates of clinically significant prostate cancer. Micro-US targeted biopsy appears to have an additional diagnostic value over systematic and MRI-targeted biopsies.

Comparison of TransPerineal Prostate Biopsy Using Novel Affordable VY Probe (TPPB-VY) and TransRectal Prostate Biopsy (TRPB) in Detection of Prostate Cancer on Hypoechoic Lesions.

Introduction:Prostate cancer is one of the most commonly encountered urologic malignancy. Biopsy samples may be attained using TPPB-VY or TRPB; both of the approaches are relatively comparable in terms of accuracy. Transperineal Access System revolutionizes the methodology for obtaining prostate biopsies. But in Indonesia this device is not available and expensive, we developed VY probe mounted needle guide device. The study was aimed to compare cancer detection rate and rates of cancer detection in Grade Groups (GG) between these two approaches, particularly in prostate cancer patients. Methods:A cross-sectional study with retrospective data from patients diagnosed with prostate cancer in Hasan Sadikin General Hospital in 2019 – 2020 was performed. Ethical approval of this study was sought from the hospital authorities (IRB number: LB.02.01/X.6.5/ 55/2020). The patient was included to the study if PSA ≥ 4 ng/ml, DRE results suggestive of prostate cancer. The diagnostic accuracy of both approaches was compared using histopathological analysis. Results:There were 44 patients included in the study; 22 patients had received TRPB and 22 patients had TPPB-VY. Higher degree of cancer detection rates was found in patients receiving TPPB-VY. Patient with Prostatic adenocarcinoma were all found having hypoechoic lesion in TPPB-VY. On the other hand, half of the patient with Prostatic adenocarcinoma shown having no lesion in TRPB. Prostate cancer with hypoechoic lesion can be detected better by TPPB-VY than TRPB. Cancer detection rates on TPPB-VY were significantly higher than on TRPB for each grade group. Conclusion:Among patient with hypoechoic lesions, TPPB-VY led to more detectionof prostate cancer, it provides detection of all grade groups and high-grade prostate cancer, this showed a non-inferior TPPB-VY compared to TRPB. TPPB-VY should be considered as an option for all men in whom a prostate biopsy is indicated.

Saturation target biopsy can overcome the learning curve of magnetic resonance imaging/ultrasound fusion biopsy of the prostate

Background: Magnetic resonance imaging (MRI) has emerged as a promising tool for diagnosing prostate cancer. Magnetic resonance imaging/ultrasound (MRI/US) fusion target biopsy (TB) can increase the detection rate of clinically significant prostate cancer (csPC) and decrease the detection rate of clinically insignificant PC (ciPC) compared with systematic biopsy (SB). However, the MRI/US fusion biopsy had a steep learning curve. A new biopsy template, saturation TB (sTB), was reported to provide a cancer detection rate comparable to that of the combination of TB and SB. This study reports our experience with MRI/US fusion prostate biopsy and investigates the role of sTB in MRI/US fusion biopsy. Methods: We prospectively enrolled males with elevated prostate-specific antigen or abnormal digital rectal examination (DRE) and Prostate Imaging Reporting &amp; Data System (PI-RADS) score ≥3 who underwent MRI/US fusion prostate biopsy in a tertiary referral center. We compared cancer detection rates among different biopsy templates, including TB, SB, sTB, and the combination of TB and SB. The biopsy results and complications were recorded. Results: The detection rate of csPC by sTB was significantly higher than that of TB (53% vs. 44%; p = 0.008) or SB (53% vs. 43%; p = 0.002). The median biopsy cores were 6, 15, and 26 for TB, sTB, and the combination of TB and SB, respectively. In other words, sTB could decrease 11 biopsy cores without compromising the cancer detection rate compared with the combination of TB and SB. There were no Clavien-Dindo score of ≥3 complications in any of the patients. Conclusion: The sTB template can overcome targeting errors during MRI/US fusion biopsy, offering a cancer detection rate equal to the combination of TB and SB with reduced biopsy cores.

A Prospective Study Comparing Cancer Detection Rates of Transperineal Prostate Biopsies Performed by Junior Urologists versus a Senior Consultant in a Real-World Setting

Introduction: Prostate biopsy (PB) is a typical daily practice method for the diagnosis of prostate cancer (PCa). This study aimed to compare the PCa detection rates and peri- and postoperative complications of PB among 3 residents and a consultant. Patients and Methods: A total of 343 patients who underwent PB between August 2018 and July 2019 were involved in this study. Residents were systematically trained for 2 weeks by a consultant for performing systematic biopsy (SB) and targeted biopsy (TB). And then, 3 residents and the consultant performed PB independently every quarter due to routine rotation in daily practice. The peri- and postoperative data were collected from a prospectively maintained database (www.pc-follow.cn). The primary outcome and secondary outcome were to compare the PCa detection rates and complications between the residents and consultant, respectively. Results: There was no significant difference between the residents and consultant in terms of overall PCa detection rates of SB and TB or further stratified by prostate-specific antigen value and prostate imaging reporting and data system (PI-RADS) scores. We found the consultant had more TB cores (175 cores vs. 86–114 cores, p = 0.043) and shorter procedural time (mean 16 min vs. 19.7–20.1 min, p < 0.001) versus the residents. The complication rate for the consultant was 6.7% and 5%–8.2% for the residents, respectively (p = 0.875). Conclusions: The residents could get similar PCa detection and complication rates compared with that of the consultant after a 2-week training. However, the residents still need more cases to shorten the time of the biopsy procedure.

MP05-15 TRANSPERINEAL VS TRANSRECTAL MICRO-ULTRASOUND AND MPMRI TARGETED PROSTATE BIOPSIES: PROPENSITY SCORE-MATCHED STUDY

You have accessJournal of UrologyProstate Cancer: Detection & Screening I (MP05)1 Sep 2021MP05-15 TRANSPERINEAL VS TRANSRECTAL MICRO-ULTRASOUND AND MPMRI TARGETED PROSTATE BIOPSIES: PROPENSITY SCORE-MATCHED STUDY Arnas Rakauskas, Max Peters, Paul Martel, Stefano La Rosa, Jean-Yves Meuwly, Beat Roth, and Massimo Valerio Arnas RakauskasArnas Rakauskas More articles by this author , Max PetersMax Peters More articles by this author , Paul MartelPaul Martel More articles by this author , Stefano La RosaStefano La Rosa More articles by this author , Jean-Yves MeuwlyJean-Yves Meuwly More articles by this author , Beat RothBeat Roth More articles by this author , and Massimo ValerioMassimo Valerio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001972.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Micro-ultrasound (micro-US) is a novel US-based imaging modality that allows real-time targeted prostate biopsies with mpMRI fusion. Its high resolution relying on a 29 MHz transducer allows real-time visualisation of prostate cancer (PCa) lesions. Micro-US integrate a transperineal and a transrectal hardware which allows the operator to tailor the biopsy approach to each patient. We aimed to compare cancer detection rates in patients who underwent transrectal (TRUS-PB) versus transperineal MRI fusion guided micro-ultrasound biopsy (TPB). METHODS: Out of 322 biopsy procedures, 56 TRUS-PB and 266 TPB were carried-out. All prostate biopsies were performed using ExactVuTM system (Exact Imaging, Markham, Canada) with mpMRI image fusion. Systematic biopsies were performed in addition to targeted biopsy in both modalities. 1:2 propensity score match-pairing was performed prior to statistical comparison. Men with anterior lesions were excluded as it has already been shown that in this subgroup TPB perform better than TRUS-PB. Clinically significant disease (csPCa) was defined as Gleason pattern 4 or higher. Potential predictors for detection of csPCa were analysed by univariable and multivariable logistic regression. Detection rate of csPCa according to micro-US findings was also evaluated. RESULTS: 47 men undergoing TRUS-PB and 88 undergoing TPB were matched in terms of age, PSA, clinical stage, mpMRI score, number of mpMRI visible lesions, prostate volume, and indication to biopsy. The detection of csPCa was not different between two groups (44% TPB vs. 43% TRUS-PB, p=0.8). There was no statistically significant difference in likelihood to detect any PCa as well (55% TPB vs 57% TRUS-PB p = 0.7). Both approaches were equal in csPCa detection rates in targeted biopsies only (31% TPB vs 28% TRUS-PB, p=0.6). Micro-US detected non-MR visible csPCa and insignificant disease in 13 (10%) and 12 (9%) men, respectively. In univariable analysis age, prostate volume and previous biopsy status were all associated with clinically significant PCa. In multivariate analysis only age and prostate volume remained independent predictors. CONCLUSIONS: In our initial experience, the detection rate of csPCa was high at 55-57% regardless the biopsy approach. TRUS-PB seems to be as precise as TPB, at least in sampling posterior areas. These findings might be related to the high resolution of micro-US allowing real-time visualisation of regions of interest and/or to the selected study population. These findings should be validated in a larger more homogeneous cohort. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e84-e84 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arnas Rakauskas More articles by this author Max Peters More articles by this author Paul Martel More articles by this author Stefano La Rosa More articles by this author Jean-Yves Meuwly More articles by this author Beat Roth More articles by this author Massimo Valerio More articles by this author Expand All Advertisement Loading ...

The Added Value of Supplemental Breast Ultrasound Screening for Women With Dense Breasts: A Single Center Canadian Experience.

We evaluated the contribution to cancer detection of supplemental breast ultrasound screening in women with dense breasts based on a single center experience by comparing our results with similar programs elsewhere. We performed a retrospective review of handheld sonographer-performed screening ultrasound exams at our academic breast imaging center, from January 1st to December 31st, 2019. Breast density, breast cancer risk factors, BI-RADS assessment, and lesion pathology were reviewed and tallied, followed by derivation of the biopsy rate, breast cancer detection rate, PPV3 and average tumor size. These values were compared to published results of breast screening programs elsewhere. 695 screening breast ultrasounds for women with dense breasts and negative mammograms were performed in 2019. The biopsy rate was 1.3%, breast cancer detection rate was 7 in 1000, PPV3 was 42%, and the average tumor size was 9.0 ± 1.4 mm. The first-year data of the breast screening ultrasound program at our practice are promising, demonstrating comparable cancer detection rate, higher PPV3, and similar biopsy rate in those with dense breasts compared with similar programs elsewhere. Longitudinal analysis and larger sample size are required for validation. Comparison of incidence and prevalence screening data is also warranted to elucidate the true value of this program.

Abbreviated Breast MRI for Screening High-risk Women: Comparison with the Full Clinical Protocol.

To compare cancer detection rate (CDR), patient recall, and interpretation time of a full protocol MRI (fpMRI) to an abbreviated MRI protocol (abMRI) in high-risk women. This retrospective study was approved by the IRB. All sequential high-risk screening MRI examinations performed between January 1, 2013, and December 31, 2016, were included. Breast radiologists reviewed patient history, prior images, and abMRI images and recorded their interpretation. Time for interpretation reflected review of the MRI study but not dictation or report generation. Following a minimum 30-day washout period, radiologists interpreted the fpMRI, with interpretation and timing recorded. Data collected included CDR, interpretation time, and patient recall rate. Statistical analyses utilized were Cohen's kappa coefficient, Student's t-test, and McNemar's test. Included were 334 MRI examinations of 286 women. Interpretation time was 60.7 seconds for the abMRI compared to 99.4 seconds for the fpMRI, with an average difference of 38.7 ± 5.4 seconds per patient (P < 0.0001). Recall rates were comparable: the abMRI recall rate was 82/334 (24.6%) and the fpMRI 81/334 (24.3%). All five cancers included were detected by both protocols with equal recall rate. However, there were more recommendations for biopsy with the fpMRI, although this difference was not statistically significant. The abMRI demonstrated comparable CDR to fpMRI, with shortened interpretation time and similar recall rates. Implementing an abMRI to screen high-risk women reduces imaging and interpretation time, thereby improving cost-effectiveness and the patient experience without reduction in cancer detection.

Survival Outcomes of Screening with Breast MRI in Women at Elevated Risk of Breast Cancer.

To determine survival outcomes in women with breast cancer detected at combined screening with breast MRI and mammography versus screening mammography alone. This is an institutional review board-approved retrospective study, and the need for informed consent was waived. A total of 3002 women with an increased risk of breast cancer were screened between 2001 and 2004. Of the 3002 women, 1534 (51.1%) had 2780 combined screenings (MRI and mammography) and 1468 (48.9%) had 4811 mammography-only screenings. The Χ 2 test and the Kaplan-Meier method were used to compare cancer detection rates and survival rates. The overall cancer detection rate was significantly higher in the MRI plus mammography group compared with the mammography-only group (1.4% [40 of 2780] vs 0.5% [23 of 4811]; P < 0.001). No interval cancers occurred in the MRI plus mammography group, whereas 9 interval cancers were found in the mammography-only group. During a median follow-up of 10.9 years (range: 0.7 to 15.2), a total of 11 recurrences and 5 deaths occurred. Of the 11 recurrences, 6 were in the MRI plus mammography group and 5 were in the mammography-only group. All five deaths occurred in the mammography-only group. Disease-free survival showed no statistically significant difference between the two groups (P = 0.32). However, overall survival was significantly improved in the MRI plus mammography group (P = 0.002). Combined screening with MRI and mammography in women at elevated risk of breast cancer improves cancer detection and overall survival.

Comparison of prostate cancer detection rates of various prostate biopsy methods for patients with prostate-specific antigen levels of &lt;10.0 ng/mL in real-world practice

PurposeSeveral strategies of prostate biopsy (PBx) have been introduced to improve prostate cancer (PCa) detection rates. However, studies comparing cancer detection rates (CDRs) according to biopsy methods in real-world practice are scarce. This study aimed to investigate CDRs according to the biopsy methods for patients with prostate-specific antigen (PSA) <10.0 ng/mL.Materials and MethodsFrom 2006 to 2015, patients who underwent PBx were initially selected. All patients were categorized according to the biopsy methods performed (magnetic resonance imaging targeted biopsy [MR-TBx], 12+2 hypoechoic lesion target biopsy, saturation biopsy [sPBx], extended biopsy, and 12-core PBx). The CDR of MR-TBx was compared to that of sPBx and other protocols. Volume per core (VPC) was defined as prostate volume divided by the number of biopsy cores. Patients previously diagnosed with PCa were excluded.ResultsOf the 1,598 patients (median PSA, 5.41 ng/mL), 401 (25.1%) were diagnosed with PCa. Among the biopsy methods, MR-TBx has the highest CDR and proportion of Gleason score ≥7 (3+4). Biopsy methods, VPC, age, prostate volume, and PSA were associated with PCa detection. In the sub-analysis for initial biopsy, MR-TBx had no significant difference with sPBx, but had higher CDR than the other biopsy protocols. For repeat biopsy, VPC, rather than the biopsy method, was associated with CDR.ConclusionsThis study reaffirmed the efficacy of MR-TBx on CDR in real-world practice. In cases with barriers to performing magnetic resonance imaging, VPC might be useful for adjusting the optimal number of biopsy cores in repeat biopsy.

Three-dimensional greyscale transrectal ultrasound-guidance and biopsy core preembedding for detection of prostate cancer: Dutch clinical cohort study

BackgroundTo overcome the limitations regarding two dimensional (2D) greyscale (GS) transrectal ultrasound (TRUS)-guided biopsy in prostate cancer (PCa) detection and tissue packaging in biopsy processing, there is an ongoing focus on new imaging and pathology techniques. A three-dimensional (3D) model of the prostate with biopsy needle guidance can be generate by the Navigo™ workstation (UC-care, Israel). The SmartBX™ system (UC-care, Israel) provides a prostate biopsy core preembedding method. The aim of this study was to compare cancer detection rates between the 3D TRUS-guidance and preembedding method with conventional 2D GS TRUS-guidance among patients undergoing prostate biopsies.MethodsWe retrospectively analyzed the records of all patients who underwent prostate biopsies for PCa detection at our institution from 2007 to 2016. The cohort was divided into a 2D GS TRUS-guidance cohort (from 2007 to 2013, n = 1149) and a 3D GS TRUS-guidance with preembedding cohort (from 2013 to 2016, n = 469). Effect of 3D GS TRUS-guidance with preembedding on detection rate of PCa and clinically significant PCa (Gleason score ≥ 7 or > 2 biopsy cores with a Gleason score 6) was compared to 2D GS TRUS-guidance using regression models.ResultsDetection rate of PCa and clinically significant PCa was 39.0 and 24.9% in the 3D GS TRUS cohort compared to 33.5 and 19.0% in the 2D GS TRUS cohort, respectively. On multivariate regression analysis the use of 3D GS TRUS-guidance with preembedding was associated with a significant increase in detection rate of PCa (aOR = 1.33; 95% CI: 1.03–1.72) and clinically significant PCa (aOR = 1.47; 95% CI: 1.09–1.98).ConclusionOur results suggest that 3D GS TRUS-guidance with biopsy core preembedding improves PCa and clinically significant PCa detection compared to 2D GS TRUS-guidance. Additional studies are needed to justify the application of these systems in clinical practice.

MRI for prostate cancer: can computed high b-value DWI replace native acquisitions?

To compare computed high b-value diffusion-weighted images (c-DWI) derived from low b-value DWI images and acquired high b-value DWI (a-DWI), in overall image quality and prostate cancer detection rate. A total of 124 consecutive men with suspected prostate cancer (PCa) underwent diagnosis prostate MRI on a 3.0T MR system using a 32-channel phased-array torso coil. Among them, 63 underwent prostate biopsy. MRI protocol included 3DT2w images, high resolution Fov Optimized and Constrained Undistorted Single-Shot (FOCUS™) DWI images with b-values of 100, 400, 800, and 2000s/mm2 and dynamic contrast enhanced images. C-DWI images (2000 and 2500s/mm2) were derived from the three lower acquired b-value DWI images using a mono-exponential diffusion decay. C-DWI and acquired high b-value DWI (a-DWI) (2000s/mm2) were compared for image quality (background signal suppression, anatomic clarity, ghosting, distortion) and tumor conspicuity by four radiologists. C-DWIs demonstrated higher rating than a-DWIs for overall image quality despite worsened ghosting. In patients with a biopsy, similar detection rate was observed while conspicuity was better with c-DWI (p < 0.001). Non-acquisition of high b-value a-DWI reduced total acquisition time by 220s per patient. C-DWI provides a substantial reduction in acquisition time while maintaining comparable prostate cancer detection rate and improving global image quality. • Computed DWI improves global quality of prostate MRI. • Computed DWI improves analysis of DWI images with decrease acquisition time. • Computed DWI provides greater background suppression of parenchyma and improves conspicuity of suspicious lesion.

Comparison of cancer detection between 18- and 12-core prostate biopsy in Asian patients with prostate-specific antigen levels of 4–20 ng/mL

BackgroundAlthough prostate biopsy is an accepted option for cancer detection, there is little data regarding the clinical outcome of 18-core transrectal ultrasound (TRUS)-guided biopsy. This retrospective study compared cancer detection rates and biopsy complications between 12- and 18-core TRUS biopsy in Asian patients with prostate-specific antigen (PSA) levels between 4.0 and 20.0 ng/mL. MethodsIn total, 1120 consecutive patients with PSA levels between 4.0 and 20.0 ng/mL were divided into the 12-core (552 patients) and 18-core TRUS biopsy (568 patients) groups. The clinical outcomes of the 12- and 18-core TRUS-biopsy groups were compared. Clinical outcomes were evaluated by comparing the prostate cancer detection rates and post-biopsy complication rates. ResultsThere were no significant group differences in the PSA levels, but the mean age was significantly older in the 12-core biopsy group than in the 18-core biopsy group (mean age, 67.0 vs. 64.0 years, respectively; p = 0.001). The abnormal digital rectal examination rate was higher in the 12-core biopsy group than in the 18-core biopsy group (39.9% vs. 24.5%, respectively; p < 0.001). The prostate cancer detection rate was significantly higher in the 18-core group than in the 12-core group [adjusted odds ratio: 2.75, 95% confidence interval = 2.04–3.01; p < 0.001], especially in patients with age ≥ 50 years, PSA < 10 and cancer clinical stage cT1. (p < 0.001). Moreover, in patients with prostate volumes >30 mL or PSA densities <0.2, the prostate cancer detection rate was significantly higher in the 18-core group than in the 12-core group. There were no differences in the complication rates (e.g., urinary retention, hematuria, urinary tract infection, and urosepsis). ConclusionIn Asian patients with serum PSA levels between 4.0 and 20.0 ng/mL, 18-core biopsy was associated with superior clinical outcomes to those of 12-core biopsy for detecting prostate cancer.

Changes in prostate cancer detection rate of MRI-TRUS fusion vs systematic biopsy over time: evidence of a learning curve.

To determine the effect of urologist and radiologist learning curves and changes in MRI-TRUS fusion platform during 9 years of NCI's experience with multiparametric magnetic resonance imaging (mpMRI)/TRUS fusion biopsy. A prospectively maintained database of patients undergoing mpMRI followed by fusion biopsy (Fbx) and systematic biopsy (Sbx) from 2007 to 2016 was reviewed. The patients were stratified based on the timing of first biopsy. Cohort 1 (7/2007-12/2010) accounted for learning curve. Cohort 2 (1/2011-5/2013) and cohort 3 (5/2013-4/2016) included patients biopsied prior to and after debut of a new software platform, respectively. Clinically significant (CS) disease was defined as Gleason 7 (3+4) or higher. McNemar's test compared cancer detection rates (CDRs) of Sbx and Fbx between time periods. 1528 patients were included in the study with 230, 537 and 761 patients included in three respective cohorts. Median age (interquartile range) was 61.0 (±9.0), 62.0 (±7.3), and 64.0 (±11.0) years in three cohorts, respectively (P<0.001). Fbx and Sbx had comparable CS CDR in cohort 1 (24.8 vs 22.2%, P=0.377). Fbx detected significantly more CS disease compared to Sbx in the following two periods (cohort 2: 31.5 vs 25.0%, P=0.001; cohort 3: 36.4 vs 30.3%, P<0.001) and detected significantly less low risk disease in the same period (cohort 2: 14.5 vs 19.6%, P<0.001; cohort 3: 12.6 vs 16.7%, P<0.001). Even after multivariate adjustment with age, PSA, race, clinical stage and MRI suspicion score, Fbx CS cancer detection increased in successive cohorts (cohort 2: OR 2.23, P=0.043; cohort 3: OR 2.92, P=0.007). In the past 9 years, there has been significant improvement in the accuracy of Fbx. Our results show that after an early learning period, Fbx detected higher rates of CS cancer and lower rates of clinically insignificant cancer than Sbx. Software advances allowed for even greater detection of CS disease.

Comparison between automated breast volume scanner (ABVS) versus hand-held ultrasound as a second look procedure after magnetic resonance imaging.

To evaluate the agreement between automated breast volume scanner (ABVS) and conventional ultrasound (US) as a second-look (SL) tool for assessing additional findings found on MRI. Over a 7-month period, we prospectively assigned to SL-US and SL-ABVS all patients undergoing 1.5T breast MRI in whom additional findings were found. Five experienced breast radiologists independently interpreted SL-US and SL-ABVS in blinded sessions to evaluate the detection rate of MRI findings and assign them to BI-RADS categories. We calculated the agreement between the two methods in assessing MRI findings as significant (BI-RADS 3-5) versus not significant (BI-RADS 1-2), as well as their cancer detection rate. In a population of 131 patients, SL-ABVS and SL-US showed a comparable detection rate of MRI findings (69.3 vs. 71.5%) (p > 0.05; McNemar test), with an almost perfect agreement in assessing them as significant or not (k = 0.94). This translated into a comparably high cancer detection rate (83.8% for SL-ABVS vs. 87.0% for SL-US). Only 1/31 cancers was missed by SL-ABVS. SL-ABVS and SL-US are nearly equivalent in assessing the significance of MRI findings, leading to a comparable cancer detection rate. SL-ABVS has the potential to replace SL-US in the SL scenario. • SL-ABVS shows almost perfect agreement with SL-US in assessing MRI findings. • SL-ABVS shows a comparably high cancer detection rate with respect to SL-US. • SL-ABVS has the potential to replace SL-US in evaluating additional MRI findings.

Comparing cancer detection rates of patients undergoing short term follow-up vs routine follow-up after benign breast biopsies, is follow-up needed?

PurposeTo compare cancer rates after benign breast biopsies between patients with short term imaging follow-up (STFU) and those with routine follow-up (RFU). Materials & methodsRetrospective review of benign stereotactic, US or DCE-MRI breast biopsies. ResultsOf 580 lesions, 192 (33%) had STFU, and 388 (67%) had RFU. For US and mammographic detected lesions, there is no difference in cancer rates between the STFU (1 cancer, n=148) and the RFU group (0 cancer, n=365) (p=0.29). There were 2 cancers in the STFU group versus 0 in the RFU DCE-MRI group (p=0.54). ConclusionOur results support RFU after benign ultrasound and stereotactic breast biopsies.

Does an asymmetric lobe in digital rectal examination include any risk for prostate cancer? results of 1495 biopsies.

ABSTRACTIntroduction:Despite the well-known findings related to malignity in DRE such as nodule and induration, asymmetry of prostatic lobes, seen relatively, were investigated in a few studies as a predictor of prostate cancer so that there is no universally expected conclusion about asymmetry. We aimed to compare cancer detection rate of normal, asymmetric or suspicious findings in DRE by using biopsy results.Materials and Methods:Data of 1495 patients underwent prostate biopsy between 2006-2014 were searched retrospectively. Biopsy indications were abnormal DRE and or elevated PSA level(>4ng/mL). DRE findings were recorded as Group 1: Benign DRE, Group 2: Asymmetry and Group 3: Nodule/induration. Age, prostatic volume, biopsy results and PSA levels were recorded.Results:Mean age, prostate volume and PSA level were 66.72, 55.98 cc and 18.61ng/ mL respectively. Overall cancer detection rate was 38.66 % (575 of 1495). PSA levels were similar in group 1 and 2 but significantly higher in group 3. Prostatic volume was similar in group 1 and 2 and significantly lower in Group 3.Malignity detection rate of group 1,2 and 3 were 28.93%, 34.89% and 55.99% respectively. Group 1 and 2 were similar (p=0.105) but 3 had more chance for cancer detection.Conclusion:Nodule is the most important finding in DRE for cancer detection. Only an asymmetric prostate itself does not mean malignity.

MP16-07 IMPLICATIONS OF REGIONALIZING FUSION MRI TECHNOLOGY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2015MP16-07 IMPLICATIONS OF REGIONALIZING FUSION MRI TECHNOLOGY Karen Wheeler, Jennifer Lobo, Drew Jensen, Jules Manger, Shawnna Blanchard, Afshan Ornan, Sebastian Feuerlain, and Tracey Krupski Karen WheelerKaren Wheeler More articles by this author , Jennifer LoboJennifer Lobo More articles by this author , Drew JensenDrew Jensen More articles by this author , Jules MangerJules Manger More articles by this author , Shawnna BlanchardShawnna Blanchard More articles by this author , Afshan OrnanAfshan Ornan More articles by this author , Sebastian FeuerlainSebastian Feuerlain More articles by this author , and Tracey KrupskiTracey Krupski More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.814AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Magnetic resonance imaging fusion technology (fusion MRI) is increasingly used to target clinically significant prostate cancer (PCa) over conventional cognitive fusion MRI. There are many ways to disseminate such new technology such as wide dispersion as with CT scanners or regionalization as with lithotripsy. Given the high cost of fusion MRI, we sought to determine the cost and diagnostic implications of using regionalization versus dispersion. METHODS We identified the distribution of prostatectomies at the county level in Virginia using state data from the Department of Health Patient Level Database System via the Thomson Reuters Polaris Suite for the time period 2012–13. Using Mid-Atlantic AUA rosters, we identified Virginia urology practices comprised of more than 2 persons (N = 25). The p-median problem was employed to identify optimal placement of 4 fusion centers to minimize the average patient travel distance from a patient's home county to a fusion center. We compared cancer detection rates (CDRs) in the literature for cognitive fusion and fusion MRI. Cost per additional patient diagnosis was calculated using the number of practices, estimated diagnoses of clinically significant cancer, and published MRI fusion cost of $250,000. Three dissemination models that take into account patient access to technology and the number of centers. RESULTS In 2012–13, 2049 men in Virginia were diagnosed with clinically significant PCa. Based on cognitive fusion CDRs, we estimated that 4360 patients were screened. Published CDRs show 6% higher detection with fusion MRI over cognitive fusion. Table 1 displays diagnosis and cost outcomes for each scenario: every practice having fusion MRI (One for All), and fusion MRI for each of the 4 optimally placed centers using screening for surrounding counties (Proximity Screening) or the entire state (Screening for All). While regional proximity screening reduced costs, the number of additional diagnoses was lower than when every patient was screened with fusion MRI. CONCLUSIONS While it is important to detect clinically relevant PCa, our data highlights that how the technology is disseminated has cost implications. The tradeoffs between cancer detection and cost of technology emphasize the need for thoughtful dissemination of fusion MRI. Dissemination Model One for All Regionalization type: Regionalization type: Proximity Screening Screening for All Fusion Centers 25 4 4 Total cost of technology $6.25 million $1 million $1 million MRI fusion Screened patients 4360 1874 4360 Additional patients diagnosed 262 112 262 Cost per additional diagnosis $23,894 $8,891 $3,823 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e170 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Karen Wheeler More articles by this author Jennifer Lobo More articles by this author Drew Jensen More articles by this author Jules Manger More articles by this author Shawnna Blanchard More articles by this author Afshan Ornan More articles by this author Sebastian Feuerlain More articles by this author Tracey Krupski More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...