MRI-guided Biopsy Research Articles

Office-Based, Single-Sided, Low-Field MRI-Guided Prostate Biopsy.

This paper describes the workflow of transperineal prostate biopsy (TBx) using the single-sided, low-field Promaxo MRI system (Promaxo Inc., Oakland, California, United States) operating at a field strength ranging between 58 and 74 millitesla (mT). Prostate cancer (PCa) is the leading cause of cancer-related death and the second most frequently diagnosed cancer in men. Systematic biopsy (SBx) with 12-14 cores is the preferred standard of care procedure. The blinded approach of SBx, however, results in several shortcomings, including high rates of false negatives and increased infection rates due to the transrectal approach. The evolution of clinical use and scientific research using different prostate biopsy modalities is discussed, including the potential for the Promaxo MRI system to mitigate logistical constraints often associated with standard magnetic resonance (MR)-guided biopsy through the utilization of an office-based, low-field MRI.

Fusion versus cognitive MRI-guided prostate biopsies in diagnosing clinically significant prostate cancer

Objective: This study assesses whether fusion or cognitive magnetic resonance imaging (MRI)-guided prostate targeted and systematic transperineal biopsies (TPB) increase detection of clinically significant prostate cancer (csPCa). Materials and Methods: A retrospective analysis was completed of patients (2018–2020) undergoing 3-Tesla multiparametric prostate MRI informing targeted (either cognitive or MIM software fusion approach) and systematic TPB. ISUP (International Society of Urological Pathology) grade group ⩾ 2 was considered csPCa. Results: A total of 355 cases from 4 urologists were included; 131 were fusion and 224 were cognitive MRI-guided biopsies. Of all csPCa found, 86.8% ( n = 171) of cases were confirmed to be at the MRI-indicated location and 11.6% were found as part of active surveillance. In all, 45.0% of the fusion group were found to have csPCa, compared to 62.05% ( n = 139) in the cognitive group ( p = 0.002). csPCa detection rates varied between urologists (41% to 78%, p < 0.001), so a subgroup analysis was performed on Urologist A; 45.0% of fusion and 41.3% of cognitive biopsies had csPCa ( p = 0.644). Multinomial logistic regression analysis showed that biopsy type, being on active surveillance, number of biopsy cores, iPSA (initial Prostate Specific Antigen) value or PIRADS (Prostate Imaging-Reporting and Data System) score made no significant difference in whether csPCa was found. Conclusion: Cognitive and fusion targeting had similar csPCa detection rates. Further prospective studies would be beneficial to validate these findings. Level of evidence: 2b (according to Oxford Centre for Evidence-Based Medicine)

Combined miR-486 and GP88 (Progranulin) Serum Levels Are Suggested as Supportive Biomarkers for Therapy Decision in Elderly Prostate Cancer Patients.

Our study aimed to assess the applicability of miR-486 in combination with soluble GP88 protein as a diagnostic and/or predictive biomarker for prostate cancer (PCa) patients. miR-486 and GP88 levels in serum samples from 136 patients undergoing MRI-guided biopsy of the prostate were assessed by qRT–PCR and ELISA, respectively. Of these, 86 patients received a histologically confirmed diagnosis of PCa. Neither marker showed an association with the diagnosis of cancer. PCa patients were separated based on (i) treatment into patients with active surveillance or patients with any type of curative treatment and (ii) age into elderly (>68 years) patients and younger patients (≤68 years). In elderly patients (N = 41) with the intention of curative treatment at optimized cut-off values, significantly higher GP88 levels (p = 0.018) and lower miR-486 levels (p = 0.014) were observed. The total PSA level and ISUP biopsy grade were used in a baseline model for predicting definitive therapy. The baseline model exhibited an area under the curve (AUC) of 0.783 (p = 0.005). The addition of the serum biomarkers miR-486 and GP88 to the baseline model yielded an improved model with an AUC of 0.808 (p = 0.002). Altogether, combined miR-486 and GP88 serum levels are associated with and are therefore suggested as supportive biomarkers for therapy decisions, particularly in elderly PCa patients.

Ex Vivo Fluorescence Confocal Microscopy (FCM) of Prostate Biopsies Rethought: Opportunities of Intraoperative Examinations of MRI-Guided Targeted Biopsies in Routine Diagnostics.

Background: The diagnosis of prostate carcinoma (PCa) requires time- and material-consuming histopathological examinations. Ex vivo fluorescence confocal microscopy (FCM) can detect carcinoma foci in diagnostic biopsies intraoperatively. Methods: MRI-guided and systematic biopsies were identified in a dataset of our previously published study cohort. Detection rates of clinically relevant tumors were determined in both groups. A retrospective blinded trial was performed to determine how many tumors requiring intervention were detectable via FCM analysis of MRI-guided targeted biopsies alone. Results: MRI-guided targeted biopsies revealed tumors more frequently than systematic biopsies. Carcinomas in need of intervention were reliably represented in the MRI-guided biopsies and were identified in intraoperative FCM microscopy. Combined with serum PSA levels and clinical presentation, 91% of the carcinomas in need of intervention were identified. Conclusions: Intraoperative FCM analysis of MRI-guided biopsies is a promising approach for the efficient diagnosis of PCa. The method allows a timely assessment of whether a tumor disease requiring intervention is present and can reduce the psychological stress of the patient in the waiting period of the histological finding. Furthermore, this technique can lead to reduction of the total number of biopsies needed for the diagnosis of PCa.

MP09-20 PROSTATE BIOPSY TARGETED TO PROSTATE SPECIFIC MEMBRANE ANTIGEN (PSMA) FOCI

You have accessJournal of UrologyCME1 May 2022MP09-20 PROSTATE BIOPSY TARGETED TO PROSTATE SPECIFIC MEMBRANE ANTIGEN (PSMA) FOCI David Kuppermann, Jeremie Calais, Wayne Brisbane, Elizabeth Tran, Lorna Herbert, Matthias Benz, Johannes Czernin, and Leonard Marks David KuppermannDavid Kuppermann More articles by this author , Jeremie CalaisJeremie Calais More articles by this author , Wayne BrisbaneWayne Brisbane More articles by this author , Elizabeth TranElizabeth Tran More articles by this author , Lorna HerbertLorna Herbert More articles by this author , Matthias BenzMatthias Benz More articles by this author , Johannes CzerninJohannes Czernin More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002531.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PSMA PET imaging is the most accurate imaging method known for detection of metastatic PCa. PSMA PET may also reveal intra-prostatic cancer. 68Ga-PSMA scanning was approved by FDA in December 2020 for pre-op staging of PCa and to detect possible recurrence. MRI-guided biopsy (MRGB) is the preferred method for diagnosis of prostate cancer (PCa), but PCa may be MRI-invisible (≈15-20%). Herein we study intra-prostatic PSMA focal uptake as a target for biopsy detection of PCa using PET/CT-US fusion (PSMA-guided biopsy, PSMA-GB). METHODS: In a prospective trial, 13 men underwent PSMA PET/CT imaging prior to fusion biopsy at UCLA. Subjects are men with negative prior biopsy (10 MRGB), but continued clinical suspicion of PCa and focal uptake of PSMA in the prostate. Method of PSMA-GB is identical to MRGB (PMID 26749141) but employs US fusion with PET/CT instead of MRI, as detailed previously (PMID: 28607878). Method of Ga-PSMA image acquisition via PET/CT scanning has been reported (PMID: 30920593). Contouring of intra-prostatic foci of PSMA positivity was via Profuse software by co-author J.C. Image fusion & trans-rectal targeted biopsy was via Artemis device (LSM). Detection rate of csPCa ( >GG2) by PSMA-GB was primary endpoint. RESULTS: To date, 13 men have completed study. Median age=71 yrs.; prostate volume=27.7 cc (IQR 22.1, 38.3); PSA density=0.25 ng/ml/cc (IQR 0.10, 0.45 PSMA-GB was successfully completed in all 13 with no more difficulty than usual MRI-GB. Overall detection rate was 9/13 (70%): GG2 in 1, GG3 in 6, and GG4 in 2. Max Cancer Core Length was 4 mm median (IQR 3, 9). 4 PSMA foci were anterior; all 4 contained csPCa. Median SUVmax (standardized uptake value) was 6 in PSMA lesions returning <GG1 findings vs 8.2 in men with csPCa. Median PSAD (density) was higher in men with csPCa (0.25) than others (0.20). Of 5 men with prior radiation, 4 had csPCa on PSMA-GB. CONCLUSIONS: Prostate biopsy, which targets PSMA “hot spots” via PET/CT-US fusion, may lead to detection of clinically significant cancers missed by MRI-guided biopsy. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e144 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Kuppermann More articles by this author Jeremie Calais More articles by this author Wayne Brisbane More articles by this author Elizabeth Tran More articles by this author Lorna Herbert More articles by this author Matthias Benz More articles by this author Johannes Czernin More articles by this author Leonard Marks More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD11-11 A URINARY EXOSOME ASSAY INTERROGATING SMALL NON-CODING RNAS ACCURATELY IDENTIFIES AND STRATIFIES PROSTATE CANCER INTO LOW- INTERMEDIATE- OR HIGH-RISK DISEASE

You have accessJournal of UrologyCME1 May 2022PD11-11 A URINARY EXOSOME ASSAY INTERROGATING SMALL NON-CODING RNAS ACCURATELY IDENTIFIES AND STRATIFIES PROSTATE CANCER INTO LOW- INTERMEDIATE- OR HIGH-RISK DISEASE Laurence Klotz, Winnie Wang, Alvin Lopez Pujals, Deepak Kapoor, Rebecca DeVaux, Greg DiRienzo, Federico Corica, Ann Anderson, Carl Olsson, Alberto Corica, James Libby, and Martin Tenniswood Laurence KlotzLaurence Klotz More articles by this author , Winnie WangWinnie Wang More articles by this author , Alvin Lopez PujalsAlvin Lopez Pujals More articles by this author , Deepak KapoorDeepak Kapoor More articles by this author , Rebecca DeVauxRebecca DeVaux More articles by this author , Greg DiRienzoGreg DiRienzo More articles by this author , Federico CoricaFederico Corica More articles by this author , Ann AndersonAnn Anderson More articles by this author , Carl OlssonCarl Olsson More articles by this author , Alberto CoricaAlberto Corica More articles by this author , James LibbyJames Libby More articles by this author , and Martin TenniswoodMartin Tenniswood More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002537.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The miR Sentinel® Test measures the expression of 442 small non-coding RNAs (sncRNAs) extracted from urinary exosomes to differentiate patients with No Molecular Evidence of Prostate Cancer (NMEPCa) from those with Molecular Evidence of Prostate Cancer (MEPCa). The test further classifies men with MEPCa into low-, intermediate- or high-risk disease. We compared the results of the miR Sentinel® PCC4 Test to systematic and MRI-guided core needle biopsy in men at risk for prostate cancer. METHODS: 763 biopsy naïve men in whom a prostate biopsy was indicated, were recruited. sncRNAs were isolated from urinary exosomes and interrogated by RT-qPCR on a custom designed OpenArray platform. RESULTS: The validation cohort consisted of 763 biopsy naïve patients undergoing systematic or systematic plus targeted biopsy. The molecular classification was compared to the Gleason Grade Group (GG) (Table 1). Sensitivity for the classification of {NPEPC or GG1} versus {GG2-5} was 75+18+4+105=203)/221=92.2% and the negative predictive value for absence of CS PCa was (221+64+12+123=420)/(238+200=420)= 96%. The apparent false positive rate for CS cancer was (34+35+32+22=(123)/(543) = 23%. 208 of the patients had discordant systematic and targeted biopsies. 29 of these had a negative systematic biopsy and a positive targeted biopsy. The molecular test predicted the targeted biopsy outcome in 27/29=93.1% overall, and in 14/15 (93%) of the cases with clinically significant cancer. In the 18 patients with positive systematic and negative MRI targeted biopsies, the test result predicted the positive biopsy in 100%. CONCLUSIONS: The miR Sentinel Test offers an accurate non-invasive means to accurately identify the presence or absence of prostate cancer and classify risk status predict pathological grade on biopsy. The high predictive accuracy of the test in patients whose systematic and targeted biopsy were discordant suggests that the 23% discordance between negative biopsy results and positive Sentinel Test results was in most cases due to false negative biopsies. Source of Funding: The study was funded by miR Scientific © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e194 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laurence Klotz More articles by this author Winnie Wang More articles by this author Alvin Lopez Pujals More articles by this author Deepak Kapoor More articles by this author Rebecca DeVaux More articles by this author Greg DiRienzo More articles by this author Federico Corica More articles by this author Ann Anderson More articles by this author Carl Olsson More articles by this author Alberto Corica More articles by this author James Libby More articles by this author Martin Tenniswood More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP58-19 COMPARISON OF URONAV TRUS AND COGNITIVE FUSION TP BIOPSY IN DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022MP58-19 COMPARISON OF URONAV TRUS AND COGNITIVE FUSION TP BIOPSY IN DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER Amanda Sherman, Daneil Kuftinec, Lori Lyn Price, Alireza Moinzadeh, and William Faust Amanda ShermanAmanda Sherman More articles by this author , Daneil KuftinecDaneil Kuftinec More articles by this author , Lori Lyn PriceLori Lyn Price More articles by this author , Alireza MoinzadehAlireza Moinzadeh More articles by this author , and William FaustWilliam Faust More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002641.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transperineal (TP) prostate biopsy is a safe and effective technique to sample the prostate gland with less risk of infection and bleeding. Targeting of abnormal lesions on MRI at time of biopsy can be performed with cognitive fusion or software-based platforms. The success of TP MRI-guided biopsy, particularly cognitive fusion, remains unclear. This study compares cancer detection rates between software-based transrectal US (TRUS)/MRI fusion biopsy and cognitive fusion TP prostate biopsy. METHODS: Biopsies (n=495) taken between 2019 and 2021 were performed using either TRUS with UroNav (TRUSUN) guidance, or via TP approach with cognitive fusion (TPCF) to target MRI lesion. Demographic characteristics, PSA, prostate volume, DRE status, highest PIRADS lesion on MRI and final biopsy pathology were collected. Cancer Detection Rate (CDR), clinically significant Cancer Detection Rate (csCDR), and clinically significant cancer detection rate in target only (csCDRt) were compared by technique type. Statistical analysis was performed using Chi-squared, Fisher's exact, and t-tests as appropriate. RESULTS: A total of 377 TRUSUN and 118 TPCF prostate biopsies were performed. TPCF detected more cancers of any grade (p=0.02), but there was no difference in csCDR or csCDRt. When stratified by lesion, there was no difference in cancer detection except in the PIRADS 5 group, where TPCF outperformed TRUSUN biopsy in detecting clinically significant prostate cancer (p=0.006). Further analysis of the PIRADS 5 group found no difference in baseline characteristics except for age (mean age 72.2y in TP group, 68.7y in TRUS p=0.008). CONCLUSIONS: TPCF prostate biopsy showed similar rates of csCDR and csCDRt as TRUSUN prostate biopsy. When analyzed by PI-RADS score, TPCF was found to have similar or, in the case of PI-RADS 5 lesion, superior csCDRt. Subgroup analysis did not find significant group differences, aside from age, to explain this finding. This data suggests that TPCF is as effective at detecting clinically significant prostate cancer as TRUSUN. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e999 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Sherman More articles by this author Daneil Kuftinec More articles by this author Lori Lyn Price More articles by this author Alireza Moinzadeh More articles by this author William Faust More articles by this author Expand All Advertisement PDF DownloadLoading ...

An integrated navigation system based on a dedicated breast support device for MRI-guided breast biopsy.

Breast cancer is currently the cancer type with the highest incidence in the world, and it is extremely harmful to women's health. MRI-guided breast biopsy is a common method in clinical examination of breast cancer. However, traditional breast biopsy is less accurate and takes a long time. In this study, an integrated navigation system (INS) based on a dedicated breast support device (DBSD) was proposed to assist doctors in biopsy. The grid-shaped DBSD can reduce the displacement and deformation of the breast during the biopsy operation and is convenient for puncture. The robot system based on the DBSD is designed to assist doctors in performing puncture action. The software system has functions such as registration, path planning, and real-time tracking of biopsy needles based on the DBSD, which can assist doctors in completing the entire biopsy procedure. A series of experiments are designed to verify the feasibility and accuracy of the system. Experiments prove that the robot system has reasonable structure and meets the requirements of MR compatibility. The latency of the INS during intraoperative navigation is 0.30 ± 0.03s. In the phantom puncture experiment, the puncture error under the navigation of the INS is 1.04 ± 0.15mm. The INS proposed in this paper can be applied to assist doctors in breast biopsy in MR environment, improve the accuracy of biopsy and shorten the time of biopsy. The experimental results show that the system is feasible and accurate.

Comparison between second-look ultrasound and second-look digital breast tomosynthesis in the detection of additional lesions with presurgical CESM.

To compare second-look ultrasound (SL-ultrasound) with second-look digital breast tomosynthesis (SL-DBT) in the detection of additional lesions (ALs) with presurgical contrast-enhanced spectral mammography (CESM). We retrospectively included 121 women with 128 ALs from patients who underwent CESM for presurgical staging at our centre from September 2016 to December 2018. These ALs underwent SL-ultrasound and a retrospective review of DBT (SL-DBT) performed 1-3 weeks prior to CESM to evaluate the performance of each technique individually and in combination. ALs in CESM images were evaluated according to enhancement type (focus, mass, or non-mass), size (<10 mm or >10 mm) and level of suspicion (BI-RADS 2, 3, 4 or 5). Our gold-standard was post-biopsy histology, post-surgical specimen or >24 month negative follow-up. McNemar's test was used for the statistical analysis. Out of the 128 ALs, an imaging correlate was found for 71 (55.5 %) with ultrasound, 79 (61.7%) with DBT, 53 (41.4 %) with DBT and ultrasound, and 97 (75.8%) with ultrasound and/or DBT. SL-DBT demonstrated a higher detection rate vs SL-ultrasound in non-mass enhancement (NME) pattern (p: 0.0325) and ductal carcinoma in situ histological type (p: 0.0081). Adding SL-DBT improved the performance vs SL-ultrasound alone in the overall sample (p: <0.0001) and in every subcategory identified; adding SL-ultrasound to SL-DBT improved the detectability of ALs in the overall sample and in every category except for NME (p: 0.0833), foci (p: 0.0833) and B3 lesions (p: 0.3173). Combined second-look imaging (SL-DBT+ SL-ultrasound) for CESM ALs is superior to SL-DBT alone and SL-ultrasound alone. In B3 lesions, NME, and foci, the analysis of a larger sample could determine whether adding SL-ultrasound to SL-DBT is necessary or not. Thanks to its high sensitivity, CESM is a useful tool in presurgical staging to detect the extent of the disease burden and identify ALs not detected with conventional imaging. Since CESM-guided biopsy systems are still scarcely available in clinical practice, it is necessary to look for other approaches to histologically characterize ALs detected with CESM. In our study, combined second-look imaging (SL-DBT + SL-ultrasound) showed better performance in terms of detectability of ALs, than either SL-DBT or SL-ultrasound alone, and allowed us to identify 91.2% of ALs that turned out to be malignant at final histology; for the remaining 8.8% it was still necessary to perform MRI or MRI-guided biopsy. However, this issue could be solved once CESM-guided biopsies spread in clinical practice. SL-DBT demonstrated a higher detection rate than SL-ultrasound in NME and ductal carcinoma in situ histology.

Evaluating the diagnostic role of in-bore magnetic resonance imaging guided prostate biopsy: a single-centre study.

BackgroundTo evaluate the role of in‐bore MRI‐guided biopsy (IB‐MRGB) in the diagnosis of clinically significant prostate cancer (csPCa).MethodsIn this tertiary single centre study, a total of 125 consecutive patients receiving IB‐MRGB over a three‐year period were evaluated, including 73 patients who had prior biopsies and 52 biopsy‐naïve patients. We assessed cancer detection rate of patients according to the degree of suspicion based on mpMRI findings. Histopathological data were reviewed by experienced uropathologists.ResultsThe mpMRI was suspicious for PCa (PI‐RADS 4/5) in 77% (96/125) and equivocal (PI‐RADS 3) in 23% (29/125). The detection rate for csPCa was 54.2% (52/96) and 20.7% (6/29) for suspicious lesions (PI‐RADS 4/5) and equivocal lesions (PI‐RADS 3), respectively. In subgroup analysis, patients with previous negative biopsy, overall positive biopsy rate and csPCa detection rate were 48.3% (19/35) and 34.5% (13/35), respectively. In patients on AS, 36/44 (81.8%) and 21/44 (47.8%) had PCa and csPCa respectively. In biopsy‐naïve patients 34/52 (65.4%) and 27/52 (51.92%) had PCa and csPCa respectively. Of the patients on AS, 18/44 (41.6%) upgraded from ISUP 1 to ISUP 2 PCa, and 4/44 (9.1%) upgraded from ISUP 1 to ISUP 3 PCa on IB‐MRGB. A total of 14 Clavien‐Dindo≤2 complications occurred in 14 patients (11.2%) that were directly related to the biopsy. No Clavien‐Dindo≥3 complications occurred.ConclusionMRI‐targeted biopsy is suitable for assessment of csPCa. Given the favourable complications profile, its use may be considered in both the initial biopsy and re‐biopsy settings.

Distribution of NCCN risk classifications using MRI-ultrasound fusion versus systematic 12 core biopsies.

283 Background: The widely-used National Comprehensive Cancer Network (NCCN) risk criteria for prostate cancer are impactful for patient and clinicians, particularly when assessing suitability for initial active surveillance. However, in the era of MRI-guided biopsy, fewer patients may meet stringent “very-low risk” criteria due to improved sampling, which may lead to over-treatment of non-lethal cancers. We evaluated the distribution of prostate cancer risk classification obtained using MRI-ultrasound fusion versus systematic 12 core biopsy. Methods: We performed a retrospective study of patients who underwent prostate MRI-ultrasound fusion biopsy at a single institution from January 2017 to July 2021. The primary study objective was to characterize the proportion of patients meeting NCCN “very-low risk” designation within a contemporary biopsy cohort. We calculated NCCN risk classifications (very low, low, favorable intermediate, unfavorable intermediate, high, and very high) based on constituent components (PSA, PSA density, number of biopsy cores positive, greatest extent of core positivity). We conducted comparisons within patients based on findings obtained through MRI-ultrasound fusion biopsy versus systematic biopsy only. Results: We identified 1,132 patients, including 1,014 (89.5%) and 118 (10.5%) who underwent first-time biopsy and surveillance biopsies. The median PSA was 7.15 (interquartile range: 5.2-10.8). Using data obtained through systematic biopsy alone, 123 (10.9%) and 242 (21.4%) were classified as very-low and low NCCN risk, respectively. Incorporating data from MRI-ultrasound fusion biopsy, 86 (7.6%) and 255 (22.5%) were classified as very-low and low NCCN risk, respectively. Among patients initially electing active surveillance as management, 7.4%, 60.2%, 26.9% met very-low, low, and favorable-intermediate risk criteria, respectively. Conclusions: A small proportion of patients undergoing MRI-ultrasound fusion biopsy will be classified as ‘very-low risk’ by the NCCN definition, and the majority of patients managed initially with active surveillance fall outside of this criteria. These findings imply a need to broaden support for active surveillance outside of “very-low risk” criteria to promote greater uptake.[Table: see text]

Efficacy of MRI-Directed Breast Ultrasound and Lesion Characteristics Affecting Visualization on Breast Ultrasound

ObjectiveTo assess the efficacy of magnetic resonance imaging (MRI)-directed ultrasound (US) in further characterizing lesions detected on MRI and to evaluate the correlation between lesion characteristics and their visibility on US. MethodsA retrospective review was performed of the records of patients with breast abnormalities detected on MRI between May 2018 and December 2020. All patients who were given a Breast Imaging-Reported and Data System Assessment Category 4 or 5 on breast MRI and sent to breast US for assessment of the MRI abnormality were included. Patients lost to follow-up or those who did not get their subsequent ultrasound at our institution were excluded. The following factors were recorded for all lesions described on the MRI reports: breast density, degree of background parenchymal enhancement, type of MRI finding (mass, areas of non-mass enhancement [NME], enhancing focus), largest dimension, T2 signal intensity, kinetics, shape, margins, enhancement pattern, and presence of ipsilateral breast malignancy. For the subset of the lesions that were identified on MRI-directed US, we recorded the following sonographic features: largest dimension, shape, and margin. The chi-square or Fisher exact tests of association were used to compare categorical characteristics. ResultsTwo hundred and thirty-three MRI-detected breast lesions were included in the study, which consisted of 171 masses, 7 enhancing foci, and 55 NME lesions. Of all lesions, 52% (89/171) of masses, 29% (16/55) of areas of NME, and 29% (2/7) of foci were seen on US. Moreover, 43 per 63 (68%) of malignant, 18 per 47 (38%) of high-risk and 46 per 123 (37%) of benign lesions were seen on MRI-directed US. Of the invasive malignant lesions, 77% (36/47) had a sonographic correlate. For masses, the average size on MRI was 1.1 cm, and MRI size had a statistically significant association with US visibility (P value 0.01). Similarly, spiculated margins on MRI for masses had a significant association with US visibility (P value 0.0006). Linear, segmental, and regional distributions of areas of NME were associated with decreased likelihood of sonographic visibility (P = 0.049). ConclusionMRI-directed US is a useful tool in the management of MRI-detected breast lesions. Our study indicates that masses, particularly those with spiculated margins on MRI, should be sent to US for further assessment. Additionally, masses are more likely to be seen under US as their size increases. MRI-directed US is less likely to visualize areas of NME and enhancing foci, which may be managed with MRI follow-up or MRI-guided biopsy depending on their level of suspicion.

MRI-guided Breast Biopsy Case-based Review: Essential Techniques and Approaches to Challenging Cases.

MRI-guided Breast Biopsy Case-based Review: Essential Techniques and Approaches to Challenging Cases.

Imaging of clinically silent rectoprostatic hematoma in MRI guided in-bore prostate biopsy

MR imaging provides awareness for rectoprostatic hematomas as a complication in prostate biopsy. We evaluated the frequency and size of clinically silent bleeding after in-bore MRI-guided prostate biopsy according to documentation in MRI. From 2007 until 2020 in-bore MRI-guided prostate biopsy was performed in 283 consecutive patients with suspected prostate cancer. Interventional image documentation was reviewed for rectoprostatic hematomas and rectal blood collections in this retrospective observational single-center study. Correlation to patient characteristics was analyzed using a multivariable logistic regression model. 283 consecutive patients with a mean age of 66 ± 8 years were included. We diagnosed bleeding complications in 41 (14.5%) of the patients. Significant rectoprostatic hematomas were found in 24 patients. Intra-rectal blood collections were observed in 16 patients and one patient showed bleeding in the urinary bladder. The volume of rectoprostatic hematomas was determined with a median of 7.5 ml (range 2–40 ml, IQR 11.25). We found no correlation between the presence of a rectoprostatic hematoma and malignant findings, patient position in biopsy, number of cores, age, prostate volume nor PSA density (p > 0.05). Rectoprostatic hematomas and rectal blood collections are rare complications after in-bore MR-guided prostate biopsy. MR imaging provides benefits not only for lesion detection in prostate biopsy but also for the control of bleeding complications, which can be overlooked in standard TRUS biopsy. Their significance in pain, erectile dysfunction, and urinary retention remains to be investigated.

A0624 - Role of PSA density in prediction of significant prostate cancer among Asian men with MRI-guided biopsies: A multicenter evaluation

A0624 - Role of PSA density in prediction of significant prostate cancer among Asian men with MRI-guided biopsies: A multicenter evaluation

Reducing Number of Patient Visits and Time to Biopsy After Suspicious Breast MRI

The annual volume of breast MRI examinations at our institution increased from 395 in 2014 to 766 in 2018. Accordingly, the annual volume of MRI-guided breast biopsies increased from 41 in 2014 to 102 in 2018. These increases paralleled trends in the community setting over the past 15 years [1]. At our institution, a suspicious breast MRI finding would proceed to MRI-directed ultrasound, followed by ultrasound- or MRI-guided core biopsy at a separate appointment, requiring three separate visits.

A0465 - MRI-guided biopsy for prostate cancer diagnosis: Less is more

A0465 - MRI-guided biopsy for prostate cancer diagnosis: Less is more

Contrast-enhanced spectral mammography (CESM)-guided breast biopsy as an alternative to MRI-guided biopsy.

Objective:Contrast-enhanced spectral mammography (CESM) breast biopsy has been recently introduced into clinical practice. This short communication describes the technique and potential as an alternative to MRI-guided biopsy.Methods and materials:An additional abnormality was detected on a breast MRI examination in a patient with lobular carcinoma. The lesion was occult on conventional mammography, tomosynthesis and ultrasound and required histological diagnosis. Traditionally, this would have necessitated an MRI-guided breast biopsy, but was performed under CESM guidance.Results:A diagnostic CESM study was performed to ensure the lesion visibility with CESM and then targeted under CESM guidance. A limited diagnostic study, CESM scout and paired images for stereotactic targeting were obtained within a 10 min window following a single injection of iodinated contrast agent. The time from positioning in the biopsy device to releasing compression after biopsy and marker clip placement was 15 min. The biopsy confirmed the presence of multifocal breast cancer.Conclusion:CESM-guided breast biopsy is a new technique that can be successfully used as an alternative to MRI-guided breast biopsy.Advances in knowledge:CESM-guided biopsy can be used to sample breast lesions which remain occult on standard mammography and ultrasound.

Management of Non-Mass Enhancement at Breast Magnetic Resonance in Screening Settings Referred for Magnetic Resonance-Guided Biopsy.

Rationale and Objectives:According to the Breast Imaging and Reporting Data System (BI-RADS), one of the main limitations of MRI is diagnosing the non-mass enhancement (NME). The NME lesion is challenging since it is unique to the MRI lexicon. This study aims to report our experience with NME lesions diagnosed by MRI referred for MRI-guided biopsies and discuss the management and follow-up of these lesions.Materials and Methods:We retrospectively evaluated all MRI-guide breast biopsies. We included all patients referred for NME breast MRI-guided biopsy in screening settings. All patients had a negative second-look mammography or ultrasonography. We correlated the distribution and internal enhancement pattern (IEP) of the NME lesions with histology. Invasive ductal carcinomas (IDC) of no special type and ductal carcinoma in situ (DCIS) were considered malignant lesions.Results:From January-2018 to July-2021, we included 96 women with a total of 96 lesions in the study. There were 90 benign and 6 malignant lesions with DCIS prevalence (5/6 cancers). The most frequent benign lesion type was fibrocystic changes. There were no NME lesions with diffuse or multiple area distribution features referred to MRI-guided biopsy. The positive-predictive values (PPV) were respectively 0.0%, 2.5%, 9.0%, and 11.0% for linear, focal, regional, and segmental distribution describers, and 0.0, 3.0%, 7.9%, and 50% for homogenous, heterogeneous, clumped, and clustered-ring enhancement patterns.Conclusion:We observe the high potential risk for malignancy in the clustered-ring enhancement followed by the clumped pattern. Segmental distribution presented the highest predictive-positive values.

CURRENT ROLE OF MAGNETIC RESONANCE IMAGING IN THE SCREENING, DIAGNOSIS, AND TREATMENT OF PROSTATE CANCER.

Prostate cancer is the most common cancer in men. Diagnosis of prostate cancer poses a significant challenge, due to several different key parameters that need to be evaluated, such as age, history of prostate specific antigen (PSA), clinical examination and more recently magnetic resonance imaging (MRI). The current diagnostic pathway for prostate cancer has resulted in overdiagnosis and overtreatment as well as underdiagnosis and missed diagnoses in many men. Multiparametric MRI (mp-MRI) of the prostate has been identified as a test that could alleviate these diagnostic errors. Before prostate cancer treatment pathological confirmation is mandatory. Prostate biopsy is an invasive procedure with rare but not negligible potential complications. There are several methods of prostate biopsy of which most common are systemic or planar prostate biopsy and cognitive or targeted MRI-guided prostate biopsy. Multiparametric MRI has demonstrated better accuracy and reproducibility in detecting, locating and evaluating prostate cancer and also sparing some men unnecessary biopsies. Recent studies have shown a mpMRI benefit for better procedure planning regarding prostate cancer location, extent of disease and length of the urethra. There are still some challenges ahead, such as ensuring high-quality execution and reporting of mpMRI and ensuring that this diagnostic pathway is cost-effective. According to the latest urological clinical guidelines mpMRI became fundamental tool in management of prostate cancer. The aim of this study is to give a brief insight in use of mpMRI in prostate cancer diagnosis and treatment.