MRI-guided Biopsy Research Articles

The role of MRI in muscle-invasive bladder cancer: an update from the last two years.

Muscle invasive bladder cancer (MIBC) is aggressive and requires radical cystectomy and neoadjuvant therapy, yet over 40% of patients face recurrence. The loss of the bladder also significantly reduces quality of life. Accurate staging, crucial for treatment decisions, is typically done through transurethral resection (TURBT), but inconsistencies in pathology affect diagnosis in 25% of cases. MRI is the most precise imaging method for evaluating local tumor invasiveness. This review discusses recent advances in MRI for staging MIBC and predicting responses to neoadjuvant therapy. Vesical imaging - reporting and data system (VI-RADS) accuracy may improve if combined with ADC maps and tumor contact length, while a bi-parametric MRI approach without contrast could reduce side effects without losing diagnostic precision, though evidence is mixed. VI-RADS shows promise in predicting neoadjuvant therapy responses, and the new nacVI-RADS score is in development. Non-Gaussian diffusion-weighted imaging techniques and machine learning could enhance accuracy but need more integration with mpMRI. VI-RADS may assist in evaluating responses in bladder-sparing regimens. Urodrill, an MRI-guided biopsy, aims to replace diagnostic TURBT but needs more accuracy data. MRI in MIBC is evolving, offering potential for accurate local staging and reduced side effects by avoiding TURBT. Predicting neoadjuvant treatment response could guide personalized treatment and bladder preservation. Larger trials are needed to validate these findings.

Clinical value of contralateral biopsies in men with unilateral MRI foci undergoing targeted biopsy.

To evaluate the additional prostate cancer detection yield and clinical implications of performing contralateral systematic biopsies in men with unilateral suspicious magnetic resonance imaging (MRI) findings undergoing MRI-guided transperineal (TP) biopsies in an outpatient clinic. A prospective study of 655 consecutive men with unilateral MRI suspicious findings undergoing office-based MRI-guided TP biopsies between May 2022 and December 2023. All men had pre-biopsy MRI followed by MRI-guided TP fusion biopsies with at least four targeted cores per lesion plus five contralateral systematic biopsies. The primary objective was the clinically significant prostate cancer (csPCa) detection rate of contralateral systematic biopsies in men with no or insignificant PCa on targeted biopsies. Secondary objectives included the impact of contralateral biopsies on PCa grade upgrading, additional insignificant PCa diagnoses, and the clinical implications of multifocal csPCa detected on both targeted and contralateral cores. Any and csPCa (Gleason Grade Group [GG] ≥2) was detected in 564/655 (85%) and 471/655 (71%) men with a median age of 66 years and PSA level of 7.6 ng/mL. Overall, seven of 655 (1%) men had csPCa detected by contralateral systematic biopsies missed on MRI-targeted biopsy, all of whom had low-volume Gleason GG 2 PCa eligible for active surveillance. Furthermore, 70/464 (15%) men with csPCa on MRI-targeted biopsy had matching Gleason GG 2-5 PCa on contralateral biopsy, and another seven had higher Gleason GG. However, the additional information from contralateral biopsies did not seem to influence whole-gland treatment allocation and nerve-sparing during surgery. Contralateral systematic biopsies in men with unilateral MRI findings undergoing MRI-guided TP targeted biopsies have limited value for csPCa detection and risk assessment for whole-gland treatment but may be important for determining PCa multifocality considering focal therapy eligibility.

The Value of Second-look Ultrasound and Mammography for Assessment and Biopsy of MRI-detected Breast Lesions

Rationale and ObjectivesSuspicious lesions detected in multiparametric breast MRI can be further analyzed with second-look ultrasound (SLUS) and/or mammography. This study aims to assess the value of second-look imaging in selecting the appropriate biopsy method for different lesion characteristics. Materials and MethodsBetween January 2021 and December 2023, 212 women underwent contrast-enhanced multiparametric breast MRI at 3.0 Tesla. A total of 241 suspicious lesions (108 malignancies, 44.8%) were further assessed with SLUS and second-look mammography. Subsequent image-guided biopsy of each lesion was performed using the most suitable modality. Size-dependent lesion detection rates in SLUS and mammography were compared by means of the McNemar test. ResultsLesions referred to MRI-guided biopsy were predominantly ≤ 10 mm in size (52.8%). SLUS displayed higher detection rates than mammography for mass lesions (55.6% [95% confidence interval 46.4–64.4%] versus 16.7% [10.6–24.3%]; p<0.001) with a particularly high sensitivity for malignant mass lesions > 10 mm (88.5 % [69.9–97.6%]). In contrast, the detection rate for malignant non-mass lesions was lower in SLUS than in second-look mammography (22.0% [11.5–36.0%] versus 38.0% [24.7–52.8%]; p<0.001). The malignancy rates in ultrasound-, mammography-, and MRI-guided biopsies were 53.7%, 55.2%, and 35.0%, respectively. ConclusionSLUS is an excellent tool for further assessment and biopsy of suspicious mass lesions > 10 mm without associated calcifications. In contrast, supplemental ultrasound is of limited value in the evaluation and biopsy guidance of suspicious non-mass lesions compared to second-look mammography.

Pathologic prostate cancer grade concordance among high-resolution micro-ultrasound, systematic transrectal ultrasound and MRI fusion biopsy

Background and ObjectiveComparative studies among biopsy strategies have not been conducted evaluating pathologic concordance at radical prostatectomy(RP), especially with novel micro-ultrasound (micro-US) image-guided biopsy. MethodsA retrospective study among patients with PCa who underwent RP following TRUS, MRI-TRUS fusion, microUS, or MRI-microUS fusion biopsy in a multi-site single institution. We compared GG-upgrade from biopsy to RP based on highest GG in any biopsy core and examined clinical/pathologic factors associated with pathologic upgrading using descriptive statistics, and multivariable logistic-regression analysis. Results429 patients between 1/2021 and 6/2023 including 10 (25.6%) who underwent systematic TRUS, 237 (55.2%) MRI-TRUS, 67 (15.6%) MRI-microUS and 15 (3.5%) micoUS-alone biopsy prior to RP. 78 (18.2%) were upgraded on final pathology (TRUS 31 (28.2%), MRI-TRUS 31 (13.1%), MRI-microUS 10 (14.9%), microUS: 6 (40%)) and 99 downgraded. 14 (3.5%) experienced a major upgrade (≥2 GG increase). On multivariable-analysis both MRI-TRUS (odds ratio, OR: 0.31,95% CI:0.17–0.56, P < 0.001) and MRI-microUS (OR: 0.43,95%CI: 0.19–0.98, P = 0.044) were associated with lower odds pathological-upgrade compared with TRUS biopsy alone. No significant differences in the odds of upgrade between TRUS and microUS alone (P > 0.05), or between MRI-microUS and MRI-TRUS(P = 0.696) on pairwise comparisons. MRI-microUS was associated with lower upgrade compared with microUS (OR: 0.26,95% CI:0.08–0.90, P = 0.034). No difference among the biopsy strategies in pathologic downgrading or overall GG concordance. Limitations include retrospective analysis, inter-clinician experience and lesion selection in varying biopsy techniques. ConclusionBoth MRI-microUS and MRI-TRUS fusion were associated with similarly improved GG concordance compared with TRUS biopsy. No significant differences between microUS-alone and TRUS or between MRI-microUS and MRI-TRUS fusion approaches, may suggest similar accuracy performance for disease sampling. What does the study addTo our knowledge, this is the first study to investigate GG concordance based on type of biopsy, especially microUS related GG upgrading after RP. In a moderately sized cohort this is the first to investigate pathologic concordance in MRI-microUS fusion compared to MRI-TRUS fusion biopsy. Our study may help urologists in counseling patients after biopsy and choosing the ideal image guided biopsy technique, however randomized controlled trials are needed to validate our results. Patient SummaryWe performed a study to see if the type of prostate biopsy, including use of MRI assistance as well as a new image-guided biopsy using a more advanced ultrasound, was better able to identify the aggressiveness of prostate cancer patients had. We found that the new biopsy type when fused with MRI and the existing MRI-guided biopsy type were similar in predicting the type of prostate cancer found at prostate surgery. These were both more accurate than the conventional ultrasound only biopsy.

Performance of breast MRI for high-risk screening during lactation.

To assess the diagnostic performance of breast MRI during lactation in the setting of high-risk breast cancer screening. Screening breast MRIs performed between April 2008 and March 2024 were retrospectively reviewed. Background parenchymal enhancement (BPE) grade was compared between lactating patients and patients who recently stopped lactating using the Mann-Whitney test. Breast Imaging Reporting and Data System (BI-RADS) scores prevalence rates were compared between lactating patients and controls encompassing young non-lactating patients using the Chi-square test. Diagnostic performance was calculated for patients with a biopsy reference or a 1-year radiologic follow-up. One-hundred forty-two screening breast MRIs were performed in lactating patients (n = 104, median age, 36.0 ± 6.0 years). Marked BPE appeared in 82% of cases (116/142), with a higher BPE grade in exams performed during lactation as compared with those performed in patients who had recently ceased lactating (p < 0.001). Screening MRIs performed during lactation had a higher rate of BI-RADS 3 scores (40/142, 28% vs. 683/8922, 7%, p < 0.001) and a lower rate of BI-RADS 1/2 scores (88/142, 62% vs. 7549/8922, 84.6%, p = 0.002) compared with those performed in controls (n = 8922). One pregnancy-associated breast cancer was detected, and one interval-cancer occurred. All MRI-guided biopsies were negative (n = 13). Screening breast MRI during lactation had 50% sensitivity (1/2), 60% specificity (72/120), 2.0% positive predictive value (1/49), and 98.6% negative predictive value (71/82). The efficacy of breast MRI for high-risk screening during lactation is limited by prominent BPE, leading to an increased rate of BI-RADS 3 categorization and diminished overall specificity. Question Studies on breast MRI during lactation were solely focused on studies conducted in patients with known cancer but not in the screening setting. Findings Screening breast MRI during lactation usually results in marked background parenchymal enhancement, negatively impacting its diagnostic performance. Clinical relevance Despite the lower performance, and amidst the significant risk of pregnancy-associated breast cancer, this screening approach remains relevant for lactating patients with high-risk profiles, such as BReast Cancer (BRCA) carriers. Radiologists should be familiar with the normal appearance of breast MRI duringlactation.

The efficacy of different biomarkers and endpoints to refine referrals for suspected prostate cancer: the TARGET study (Tiered integrAted tests for eaRly diaGnosis of clinically significant ProstatE Tumours).

The majority of men referred with a raised PSA for suspected prostate cancer will receive unnecessary tertiary investigations including MRI and biopsy. Here, we compared different types of biomarkers to refine tertiary referrals and when different definitions of clinically significant cancer were used. Data and samples from 798 men referred for a raised PSA (≥ 3ng/mL) and investigated through an MRI-guided biopsy pathway were accessed for this study. Bloods were acquired pre-biopsy for liquid biomarkers and germline DNA. Variables explored included PSA + Age (base model), free/total PSA (FTPSA), Prostate Health Index (phi), PSA density (PSAd), polygenic risk score (PRS) and MRI (≥ LIKERT 3). Different diagnostic endpoints for significant cancer (≥ grade group 2 [GG2], ≥ GG3, ≥ Cambridge Prognostic Group 2 [CPG2], ≥ CPG3) were tested. The added value of each biomarker to the base model was evaluated using logisticregression models, AUC and decision curve analysis (DCA) plots. The median age and PSA was 65years and 7.13ng/mL respectively. Depending on definition of clinical significance, ≥ grade group 2 (GG2) was detected in 57.0% (455/798), ≥ GG3 in 27.5% (220/798), ≥ CPG2 in 61.6% (492/798) and ≥ CPG3 in 42.6% (340/798). In the pre-MRI context, the PSA + Age (base model) AUC for prediction of ≥ GG2, ≥ GG3, ≥ CPG2 and ≥ CPG3 was 0.66, 0.68, 0.70 and 0.75 respectively. Adding phi and PSAd to base model improved performance across all diagnostic endpoints but was notably better when the composite CPG prognostic score was used: AUC 0.82, 0.82, 0.83, 0.82 and AUC 0.74, 0.73, 0.79, 0.79 respectively. In contrast, neither FTPSA or PRS scores improved performance especially in detection of ≥ GG3 and ≥ CPG3 disease. Combining biomarkers did not alter results. Models using phi and PSAd post-MRI also improved performances but again benefit varied with diagnostic endpoint. In DCA analysis, models which incorporated PSAd and phi in particular were effective at reducing use of MRI and/or biopsies especially for ≥ CPG3 disease. Incorporating phi or PSAd can refine and tier who is referred for tertiary imaging and/or biopsy after a raisedPSA test. Incremental value however varied depending on the definition of clinical significance and was particularly useful when composite prognostic endpoints are used.

PSMA PET-targeted Biopsy for Prostate Cancer Diagnosis: Initial Experience From a Multicenter Cohort

Objectivesto describe the initial experience with PSMA-PET/CT - guided biopsy in European referral centres. MethodsThis multicenter observational cohort study was endorsed by the Young Academic Urologist (YAU) Prostate Cancer Group of the EAU and conducted across six tertiary-level European centres. PSMA-guided biopsies were carried out in a cognitive/fusion manner for all the recruited patients with or without MRI-guided biopsies and/or standard biopsy (SB). PCa and clinical significant PCa (csPCA) detection rate (DR) at prostate biopsy were assessed. Uni- and multivariable models were employed to identify features related to csPCA. ResultsOverall, 72 patients were recruited. The topographic location of the dominant lesion depicted by PSMA PET/CT was significantly associated with the location of csPCa, especially in the biopsy naïve cohort. The DR for PCa and csPCa of PSMA-PET/CT-guided biopsies was significantly higher than SB (0.40±0.43 vs. 0.23±0.29, and 0.36±0.44 vs. 0.21±0.30, respectively, both p<0.05) but did not surpass MRI-guided biopsies (0.40±0.43 vs. 0.47±0.44, and 0.36±0.44 vs. 0.47±0.34, respectively, both p>0.05). PSMA-PET/CT-guided biopsy performed better in the biopsy naïve than in the repeated biopsy setting. A SUVmax cut-off value equal to 4.8 provided the best results for detecting csPCa. ConclusionsOur real-world data illustrate the potentialities of PSMA-PET/CT guided biopsy in diagnosing PCa. Specifically, in biopsy naïve patients with suspicion of high-risk disease, the use of PSMA-PET/CT-targeted biopsy can be considered. Additionally, in the context of repeated biopsies, a PSMA-PET/CT target biopsy might be advisable over the SB.

Is YouTube really a source of information on MRI guided prostate biopsy?

Background: The purpose of this review was to evaluate the overall quality of the information in YouTube™ videos about prostate MRI -guided biopsy and whether it describes the procedure. Materials and methods: The terms " MRI -guided biopsy of the prostate" and "MRI targeted prostate biopsy" were searched on YouTube. The first 118 videos of the results were selected, and the written information of the British Association of Urological Surgeons for transrectal ultrasound-guided MRI fusion biopsy was performed. For MRI-guided prostate biopsy, four more questions were added to the MRI-guided prostate biopsy criteria and reviewed by two authors. A qualitative rating was given based on how well they provided information about factors such as preparation for the procedure, the mechanism of the procedure, and possible side effects. In addition, who published the videos (doctor, patient, or YouTuber), target audience (doctors or patients), video duration, upload date, number of daily views, total number of views, number of likes, and comments were recorded. The reliability and quality of the content of these videos included in the study were evaluated using JAMA and GQS scores. Results: A total of 118 videos were reviewed; 3 videos were rated "excellent" and 56 videos were rated "very poor". 91 of the videos (77%) were prepared for physicians, and the remaining videos were prepared by non-physicians. The average duration of the videos was 9.8 minutes, and the average number of daily views was 14.3. The number of views varied between 19 and 710,399 (average: 21). While the average of likes was 62.5, the average of comments was 4.3. The average number of views was 4.3. The score was found to be 3.54 ± 0.5 out of 5. The GQS average was calculated as 4.42 ± 0.56 out of 5. When the videos uploaded by physicians and non-physicians were compared, no statistically significant difference was found in terms of the average duration of the videos, JAMA scores, or number of comments. The number of daily views, number of likes, total number of views, GQS, and scoring criteria were statistically higher in the videos prepared by non-physicians. Conclusion: Information about MRI-guided prostate biopsies on YouTube is not of a high enough standard to allow patients to make informed decisions. Therefore, healthcare professionals must produce high-quality, informative, patient-focused medical YouTube videos.

Beyond the Needle: Understanding Tissue Marker Migration in Breast MRI-Guided Biopsies.

To evaluate the frequency and factors associated with clip migration in MRI-guided breast biopsies. This study was approved by our Institutional Review Board and was compliant with HIPAA. We retrospectively evaluated all MRI-guided biopsies performed between January 2013 and December 2020 in our institution for clip migration. Only patients with follow-up breast MRI showing the clip were included in the study. Migration was defined as movement of the clip of 10mm or more from the target lesion. Migration frequency and directions were recorded. Factors associated with clip migration were analyzed using statistical tests as appropriate. A total of 291 biopsies in 268 women were included in the study with 31 migration events recorded (11%; 95% CI, 7%-15%). All migrations occurred along the biopsy tract; 97% (30/31) of them displaced distal to the needle entry site. More than 50% regional fat (around the target lesion) was the strongest factor associated with migration, seen in 21/141 women (15%), compared to 10/150 (7%) with 50% or less local fat (P = .023). Global fatty breast was more loosely associated with migration, showing borderline significance (P = .06). Other factors did not correlate with clip migration, including lesion size, depth, or location; pathology result; breast thickness; or biopsy approach. Although clip migration after breast MRI-guided biopsy is an uncommon event, it occurs more often when the target lesion is surrounded by fat, with the clip usually displaced away from the needle entry site.

Incorporation of mpMRI before prostate biopsy shall be universal or selective: A prospective observational study

Purpose: The aim of this study is to evaluate the role of multiparametric magnetic resonance imaging (mpMRI) as a triage workup in the diagnostic pathway of suspected prostate cancer (PCa) in our population. Material and methods: This prospective observational study was conducted at lesser than details of site are removed for blinded peer review &gt; on biopsy-naive patients from May 2021 to December 2022. We included patients aged 40 to 80 years with clinical suspicion of PCa, prostate-specific antigen (PSA) level &gt;4 ng/mL, abnormal digital rectal examination (DRE), or all the above. All patients first underwent 1.5-T mpMRI and transrectal ultrasound-guided biopsy using the cognitive biopsy technique. Results: A total of 95 patients were included, with the majority of them (64.21%) being ≥66 years old. Of these, 69 patients had abnormal DRE findings, 89 had PSA ≥4 ng/mL, and 64 had both elevated PSA and abnormal DRE findings. PCa was detected in 6.25%, 54.84%, 71.43%, and 96.43% of patients with lesions of Prostate Image Reporting and Data System scores of 2, 3, 4, and 5, respectively. Using Prostate Image Reporting and Data System score of 3 as a biopsy threshold resulted in high sensitivity (98.31%) and low specificity (41.67%) for PCa detection. The proportion of Gleason score of ≥7 cancer-detected cores in the magnetic resonance imaging-guided cognitive biopsy was significantly higher than that in the standard 12-core biopsy (86.54% versus 61.45%; P &lt; 0.001). Conclusion: The incorporation of prebiopsy mpMRI could be used as a diagnostic pathway for suspected PCa before transrectal ultrasound-guided biopsy.

Lesion size may affect diagnostic capabilities of MRI-guided ultrasound fusion biopsy and cognitive targeted biopsy for clinically significant prostate cancer

MRI-guided targeted biopsy (MRGB) was recommended as part of biopsy paradigm of prostate cancers by current guidelines. This study aimed to analyze the diagnostic efficacy of MRGB and systemic biopsy (SB), and to compare diagnostic capabilities within subgroups of MRGB: MRI-cognitive biopsy (MRCB) and MRI-fusion biopsy (MRFB). We retrospectively enrolled patients who underwent MRGB for suspicious malignant lesion(s) identified on MRI in a single tertiary center, sample size was 74 patients. An mpMRI was performed prior to biopsy and reviewed by an experienced radiologist specialized in prostate cancer. Per-person results of MRGB and each concomitant SB were analyzed as independent biopsies for its positive biopsy rate and positive core percentage. Per-lesion results of MRFB and MRCB were compared for the detection rate. Variables of interest were analyzed with t-test, chi-squared test, and logistic regression analysis. Statistical analyses were performed with IBM Statistical Product and Service Solutions (SPSS), Version 23 (IBM, Armonk, New York). Total of 74 patients fulfilled the inclusion criteria and were enrolled. MRFB had higher PCa detection rate comparing to both MRCB and SB (56.1%, 30.3%, and 33.9% respectively, p value = 0.036); clinically significant prostate cancer (csPCa) detection rate was also significantly higher in MRFB group (43.9%, 24.2%, and 16.9% in each group respectively, p value = 0.011). In per-lesion analysis, MRCB and MRFB had no significant difference in PCa and csPCa detection rate (41.0% vs. 26.2% and 29.5% vs. 16.7% respectively, p value = 0.090 and 0.103). In the lesion ≦ 1.3 cm group, MRFB could achieve higher PCa detection rate, comparing to MRCB (36.4% vs. 14.3%, p value = 0.047); there were also higher positive rates for PCa and csPCa per biopsied cores (22.1% vs. 6.8% and 15.6% vs. 2.7%, p value = 0.029 and 0.028, respectively). Further logistic regression of multi-variate analysis in subgroup of lesion ≦ 1.3 cm revealed that PIRADS score and biopsy method were significant predictors of positive biopsy result for PCa (p value = 0.045 and 0.026, respectively) and for csPCa (p value = 0.043 and 0.025, respectively). In patients receiving trans-perineal prostate biopsy, MRFB had higher cancer detection rate than MRCB and SB. In per lesion comparison, MRFB and MRCB had similar diagnostic accuracy. However, in lesions with diameter less than 1.3 cm, MRFB can provided better diagnose value for PCa and csPCa than MRCB.

Targeted Prostate Biopsy: How, When, and Why? A Systematic Review.

Prostate cancer, the second most diagnosed cancer among men, requires precise diagnostic techniques to ensure effective treatment. This review explores the technological advancements, optimal application conditions, and benefits of targeted prostate biopsies facilitated by multiparametric magnetic resonance imaging (mpMRI). A systematic literature review was conducted to compare traditional 12-core systematic biopsies guided by transrectal ultrasound with targeted biopsy techniques using mpMRI. We searched electronic databases including PubMed, Scopus, and Web of Science from January 2015 to December 2024 using keywords such as "targeted prostate biopsy", "fusion prostate biopsy", "cognitive prostate biopsy", "MRI-guided biopsy", and "transrectal ultrasound prostate biopsy". Studies comparing various biopsy methods were included, and data extraction focused on study characteristics, patient demographics, biopsy techniques, diagnostic outcomes, and complications. mpMRI-guided targeted biopsies enhance the detection of clinically significant prostate cancer while reducing unnecessary biopsies and the detection of insignificant cancers. These targeted approaches preserve or improve diagnostic accuracy and patient outcomes, minimizing the risks associated with overdiagnosis and overtreatment. By utilizing mpMRI, targeted biopsies allow for precise targeting of suspicious regions within the prostate, providing a cost-effective method that reduces the number of biopsies performed. This review highlights the importance of integrating advanced imaging techniques into prostate cancer diagnosis to improve patient outcomes and quality of life.

The Role of Pre-Contrast Sequences of an MRI-Guided Breast Biopsy in Localizing a Target.

Objective: This retrospective study aims to assess the role of pre-contrast sequences of an MRI-guided breast biopsy (MRIB) exam in confident and accurate lesion site localization based on tissue landmarks. Methods: The charts of all consecutives MRIB that were performed between January 2018 and December 2020 were reviewed. The images of the eligible exams were analyzed by 3 breast radiologists. Each radiologist independently attempted to identify lesion site on pre-contrast MRIB sequences, while blinded to the post-contrast MRIB images. Confidence levels (I-confident, II-not confident, and III-unknown) were assigned by each reviewer. A fourth radiologist assessed the accuracy (≤5 mm-accurate, >5 mm-inaccurate) in lesion site localization using the actual biopsied lesion site and the post-contrast MRIB images as reference. Descriptive statistics were used to calculate the percentage of confidence and accuracy categories for each reviewer, with Chi-square tests applied to analyze relationships between categorical variables. Results: There were 174 female patients with 181 lesions eligible for the trial. When the lesion site is confidently identified on the pre-contrast MRIB images (level 1 confidence), mean grade 1 accuracy was 93.8% (P < .001). Accuracy decreased with Level II and III confidence (55.3% and 34.2% respectively). Up to 61.4% improved accuracy was demonstrated when combining the performance of 2 reviewers. No correlation was found between breast density, lesion morphology, or biopsy positioning with confidence level or accuracy grade. Conclusion: Careful review of the pre-contrast MRIB images and familiarization with the surrounding tissue landmarks are important steps in confidently and accurately detecting lesion site.

3D-printing inherently MRI-visible accessories in aiding MRI-guided biopsies

Background3D printers have gained prominence in rapid prototyping and viable in creating dimensionally accurate objects that are both safe within a Magnetic Resonance Imaging (MRI) environment and visible in MRI scans. A challenge when making MRI-visible objects using 3D printing is that hard plastics are invisible in standard MRI scans, while fluids are not. So typically, a hollow object will be printed and filled with a liquid that will be visible in MRI scans. This poses an engineering challenge however since objects created using traditional Fused Deposition Modeling (FDM) 3D-printing techniques are prone to leakage. Digital Light Processing (DLP) is a relatively modern and affordable 3D-printing technique using UV-hardened resin, capable of creating objects that are inherently liquid-tight. When printing hollow parts using DLP printers, one typically requires adding drainage holes for uncured liquid resin to escape during the printing process. If this is not done liquid resin will remain inside the object, which in our application is the desired outcome.PurposeWe devised a method to produce an inherently MRI-visible accessory using DLP technology with low dimensional tolerance to facilitate MRI-guided breast biopsies.MethodsBy hollowing out the object without adding drainage holes and tuning printing parameters such as z-lift distance to retain as much uncured liquid resin inside as possible through surface tension, objects that are inherently visible in MRI scans can be created without further post-processing treatment.ResultsObjects created through our method are simple and inexpensive to recreate, have minimal manufacturing steps, and are shown to be dimensionally exact and inherently MRI visible to be directly used in various applications without further treatment.ConclusionOur proposed method of manufacturing objects that are inherently both MRI safe, and MRI visible. The proposed process is simple and does not require additional materials and tools beyond a DLP 3D-printer. With only an inexpensive DLP 3D-printer kit and basic cleaning and sanitation materials found in the hospital, we have demonstrated the viability of our process by successfully creating an object containing fine structures with low spatial tolerances used for MRI-guided breast biopsies.

Targeted biopsy of the prostate.

Diagnostic multiparametric MRI of the prostate has steadily evolved over the last three decades and can now reliably depict the dominant tumor in most men with prostate cancer. In response, several methods of targeted biopsy to direct tissue sampling of suspected tumor foci seen at multiparametric MRI have been developed and successfully tested in recent years, including software-assisted MRI-ultrasound (US) fusion biopsy and direct MRI-guided in-bore biopsy. These advances are leading to a sea change in the approach to prostate cancer diagnosis, with the traditional approach of blind systematic biopsy increasingly being replaced by MRI directed targeted biopsy. This review aims to describe the current status of targeted biopsy, with an emphasis on the relative accuracy of different techniques. The results of several critical large multicenter trials are presented, while unanswered questions that require more research are highlighted.

MRI-guided in-bore biopsy of the prostate – defining the optimal number of cores needed

BackgroundNumerous studies have shown that magnetic resonance imaging (MRI)-targeted biopsy approaches are superior to traditional systematic transrectal ultrasound guided biopsy (TRUS-Bx). The optimal number of biopsy cores to be obtained per lesion identified on multiparametric MRI (mpMRI) images, however, remains a matter of debate. The aim of this study was to evaluate the incremental value of additional biopsy cores in an MRI-targeted “in-bore”-biopsy (MRI-Bx) setting.Patients and methodsTwo hundred and forty-five patients, who underwent MRI-Bx between June 2014 and September 2021, were included in this retrospective single-center analysis. All lesions were biopsied with at least five biopsy cores and cumulative detection rates for any cancer (PCa) as well as detection rates of clinically significant cancers (csPCa) were calculated for each sequentially labeled biopsy core. The cumulative per-core detection rates are presented as whole numbers and as proportion of the maximum detection rate reached, when all biopsy cores were considered. CsPCa was defined as Gleason Score (GS) ≥ 7 (3 + 4).ResultsOne hundred and thirty-two of 245 Patients (53.9%) were diagnosed with prostate cancer and csPCa was found in 64 (26.1%) patients. The first biopsy core revealed csPCa/ PCa in 76.6% (49/64)/ 81.8% (108/132) of cases. The second, third and fourth core found csPCa/ PCa not detected by previous cores in 10.9% (7/64)/ 8.3% (11/132), 7.8% (5/64)/ 5.3% (7/132) and 3.1% (2/64)/ 3% (4/132) of cases, respectively. Obtaining one or more cores beyond the fourth biopsy core resulted in an increase in detection rate of 1.6% (1/64)/ 1.5% (2/132).ConclusionWe found that obtaining five cores per lesion maximized detection rates. If, however, future research should establish a clear link between the incidence of serious complications and the number of biopsy cores obtained, a three-core biopsy might suffice as our results suggest that about 95% of all csPCa are detected by the first three cores.

Development and Preliminary Evaluation of a Robotic Device for MRI-Guided Needle Breast Biopsy

This study concerns the development and evaluation of a simple and ergonomic robotic system for Magnetic Resonance Imaging (MRI)-guided needle breast biopsy with lateral needle approach. The device comprises two piezoelectrically actuated linear motion stages intended to align a needle supporter with the target for manual needle insertion. The device demonstrated submillimeter accuracy and safe operation within a 3 T clinical MRI scanner. In phantom studies, tumor simulators of varying sizes were successfully targeted in both laboratory and MRI settings.

Transition from Transrectal to Transperineal MRI-Fusion Prostate Biopsy Does Not Comprise Detection Rates of Clinically Significant Prostate Cancer at a Tertiary Care Center.

A remarkable paradigm shift has emerged regarding the preferred prostate biopsy approach, favoring the transperineal (TP) over the transrectal (TR) approach due to the reduced risk of severe urinary tract infections. However, its impact on the detection of clinically significant prostate cancer (csPCa) remains unclear. We relied on a prospectively maintained tertiary care database to identify patients who underwent either TP or TR prostate biopsy between 01/2014 and 12/2023. Of those, only patients with suspicious magnetic resonance imaging (MRI) PIRADS lesions (Likert-scale: 3,4,5) received MRI-targeted and systematic biopsies. Detection rates of csPCa (International Society of Urological Pathology [ISUP] ≥ 2) were compared between biopsy approach (TP vs. TR) according to index lesion. Subsequently, uni- and multivariable logistic regression models were applied to investigate the predictive status of the biopsy approach within each subcohort. Of 2063 patients, 1118 (54%) underwent combined MRI-guided and systematic prostate biopsy and were included in the final cohort. Of those, 127 (11%) and 991 (89%) underwent TP vs. TR. CsPCa rates, regardless of differences in patients' demographics and distribution of index PIRDAS lesions, did not differ statistically significantly and were 51 vs. 52%, respectively (p = 0.8). CsPCa detection rates for PIRDAS-3, PIRADS-4 and PIRADS-5 did not differ and were 24 vs. 23%, 48 vs. 51% and 72 vs. 76% for PIRADS-3, PIRADS-4 and PIRADS-5 subgroups for TP vs. TR, respectively (all p ≥ 0.9) Conclusions: The current results support the available data indicating that TP biopsy approach is comparable to transrectal biopsy approach regarding csPCa detection rates.

SCOUT® Localization Using MRI Guidance: Initial Experience.

The Food and Drug Administration approved the MRI-compatible wireless SCOUT localization system in April 2022. The purpose of this study was to evaluate feasibility of SCOUT localization under MRI guidance. We present our initial experience adopting MRI-guided SCOUT localization and compare it to MRI-guided wire localization. Electronic medical records and imaging were retrospectively reviewed for all patients who underwent MRI-guided SCOUT or wire localization at our institution between October 2022 and July 2023. Statistical analysis was performed using 2-sample proportion and Wilcoxon rank-sum tests. There were 14 MRI-guided SCOUT and 23 MRI-guided wire localization cases during the study period. All SCOUTs were placed without complication and were considered to be in adequate proximity to the target. There was no significant difference in complication rate (P = .25) or days lapsed from MRI-detected abnormality to surgery (P = .82) between SCOUT and wire cases. SCOUT was placed at time of biopsy for 71% (10/14) of cases. 57% (8/14) of SCOUT cases were used for breast conservation surgery (BCS) compared to 100% (23/23) of wire cases (P <.01), with all 6 SCOUTs not used for BCS placed at time of biopsy. MRI-guided SCOUT localization is feasible and offers an alternative to MRI-guided wire localization, with no SCOUT complications reported. SCOUT placement at time of biopsy obviates the need for an additional procedure, but predicting appropriateness is challenging, with 60% (6/10) of SCOUTs placed at time of MRI-guided biopsy not used for subsequent localization surgery.

Clinical Outcomes of Benign Concordant MRI-Guided Breast Biopsies

IntroductionMRI-guided biopsy is the standard of care for breast imaging findings seen only by MRI. Although a non-zero false-negative rate of MRI-guided breast biopsy has been reported by multiple studies, there are varied practice patterns for imaging follow-up after a benign concordant MRI guided biopsy. This study assessed the outcomes of benign concordant MRI-guided biopsies at a single institution. Patients and MethodsThis IRB-approved, retrospective study included patients with MRI-guided biopsies of breast lesions from November 1, 2014, to August 31, 2020. Only image-concordant breast lesions with benign histopathology and those follow up with MRI imaging or excision were included in the study. ResultsOut of 275 lesions in 216 patients that met the inclusion criteria, 274 lesions were followed with MRI (range, 5-79 months; average, 25.5 months) and showed benign or stable features upon follow-up. One out of 275 lesions (0.4%), a 6 mm focal nonmass enhancement, was ultimately found to represent malignancy after initial MRI-guided biopsy yielded fibrocystic changes. The lesion was stable at a 6-month follow-up MRI but increased in size at 18 months. Repeat biopsy by ultrasound guidance yielded invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS). ConclusionBreast MRI-guided biopsy has a low false-negative rate. Our single malignancy from a total of 275 lesions gives a false negative rate of 0.4%. This data also supports a longer follow-up interval than the commonly performed 6-month follow-up, in order to assess for interval change.