TRUS Biopsy. Richard Hindley

Transcription

1 TRUS Biopsy Richard Hindley

2 TRUS Biopsy Random Blind to Location of Disease Poor repeatability Miss disease Over sample clinically insignificant disease Geometric evaluation of systematic transrectal ultrasound guided prostate biopsy. M Han, D Chan, C Kim et al. J Urol

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4 Progression or re-classification? CCLmax 3mm Core length 12mm Gleason pattern 3 Gleason pattern 4 CCLmax 8mm First biopsy Second biopsy 4

5 Targeted biopsies Advantages Fewer cores Less discomfort?la Less side effects Less OR/path time Better risk classification Grade Volume Location Warnings Under-calling on mpmri Missing with targeted biopsies.. Less insignificant disease 5

6 PROMIS: Prostate MRI Imaging Study Evaluation of Multi-Parametric Magnetic Resonance Imaging in the Diagnosis and Characterisation of Prostate Cancer Chief Investigator: Mark Emberton, UCL (Sponsor) Co- CI: Hashim Ahmed, Richard Hindley and Christopher Parker MRC Clinical Trials Unit Programme Lead: Richard Kaplan, Project Lead: Louise Brown Clinical Operations Manager: Yolanda Collaco-Moraes Trial Manager: Cybil Kwakye, Data Manager: Sophie Stewart This project was funded by the NIHR Health Technology Assessment programme (project number 09/22/67) and will be published in full in Health Technology Assessment. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health. 6

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8 Advantages of the new pathway Less over-diagnosis and overtreatment Improved detection of clinically significant cancers Better treatment allocation as a result of better sampling Reduced side-effects of biopsy 8

9 MRI / US Fusion Process of aligning one imaging modality with another Rigid or Elastic Transperineal or Transrectal Multiple systems now available 9

10 Fusion targeted biopsy MRI Rigid Overlay TRUS Elastic 10

11 Manufacturers UroNav (In vivo/philips) Artemis (Eigen) Urostation (Koelis) BiopSee (PiMedical/BK) Virtual Navigator (Esoate) HI RVS/Real time virtual sonography MIMS (Nuada) Bioject (BK medical) WCE London

12 A Collaborative Suite for Radiology and Urology 12

13 MIM software 13

14 MRI scoring systems: What lies behind a 3/5 (equivocal) score 140 men undergoing MIM fusion targeted biopsy 69 men scored as 3/5 103 distinct lesions 67 of 103 benign (34 cancer) 22 low volume had pattern 4 (12% Intermediate risk) Of those scored as 5/5 only 4% benign 14

15 Abstract Context: The current standard for diagnosing prostate cancer in men at risk relies on a transrectal ultrasound guided test that is blind Platinum Priority Collaborativebiopsy Review Prostate Cancerto the location of the cancer. To increase theby accuracy diagnostic pathway, a software-based magnetic resonance Editorial Stacy Loebof on this pp of this issue imaging ultrasound (MRI-US) fusion targeted biopsy approach has been proposed. Objective: Our of main objective was to compare Prostate the detection rate of clinically significant Detection Clinically Significant Cancer Using Magnetic prostate cancer with software-based MRI-US fusion targeted biopsy against standard Resonance Imaging Ultrasound Fusion Targeted Biopsy: biopsy. The two strategies were also compared in terms of detection of all cancers, sampling utility and efficiency, and rate of serious adverse events. The outcomes of A Systematic Review different targeted approaches were also compared. Evidence acquisition: We performed a systematic review of PubMed/Medline, Embase Massimo Valerio a,b,c,*,y, Ian Donaldson a,b,y, Mark Emberton a,b, Behfar Ehdaie d, (via Ovid), and Cochrane Review databases in December 2013 following the Preferred Boris A. Hadaschik e, Leonard S. Marks f, Pierre Mozer g,h, Ardeshir R. Rastinehad i, Reported Items for Systematic reviews and Meta-analysis statement. The risk of bias was Hashim U. Ahmed a,b evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Evidence synthesis: Fourteen papers reporting the outcomes of 15 studies (n = 2293; Foundation Trust, London, UK; Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Urology Service, Sidney Kimmel range: werecancers, included. We foundcancer that MRI-US detect Center for ) Prostate and Urologic Memorial Sloan-Kettering Center, New York,fusion NY, USA; targeted Department of biopsies Urology, University Hospital Heidelberg, Heidelberg, Germany; Department of Urology, (median: University of California, Los vs Angeles, Los Angeles, CA, USA; % Department of vs Urology, Pitie more clinically significant cancers 33.3% 23.6%; range: 4.8 Salpe trie re Academic Hospital, Pierre et Marie Curie University, Paris, France; Institut des Syste mes Intelligents et de Robotique, l Universite Pierre et Marie 52%) using fewer cores (median: 9.2 vs compared biopsy techniques, EUR OPE A N 37.1) UROLO Y 6 8 ( 2 and 0 1 5Interventional ) with standard Curie, Paris, France; Arthur Smith Institute for Urology and Departments ofgradiology Radiology, Hofstra North Shore-Jewish School of respectively. studies showed a lower detection rate of all cancer (median: 50.5% vs Medicine, New Hyde Some Park, NY, USA 43.4%; range: % vs %). MRI-US fusion targeted biopsy was able to available at detect some clinically significant cancers that would have been missed by using only j o u Article r n a l h oinfo m e p a g e : w w w. e u r o p e a n uabstract rology.com standard biopsy (median: 9.1%; range: %). an It was not possible to determine which When high quality mpmri is available image fusion Context: The current standard for diagnosing prostate cancer in men at risk relies on a ofarticle the history: two biopsy approaches transrectal led most to serious adverse events because standard and ultrasound guided biopsy test that is blind to the location of the cancer. To Accepted October 16, 2014be offered in addition to standard sampling approach might targeted biopsies were performed same session. MRI-US increasein thethe accuracy of this diagnosticsoftware-based pathway, a software-based magneticfusion resonance imaging ultrasound (MRI-US) fusion targeted biopsy approach has been proposed. targeted clinically significant disease than visual targeted biopsy Keywords: biopsy detected moreobjective: Our main objective was to compare the detection rate of clinically significant inimage-guided the only biopsy study reporting onprostate this outcome (20.3% vs 15.1%). cancer with software-based MRI-US fusion targeted biopsy against standard a b c d e f g h i biopsy. The two strategies were also compared in terms of detection of all cancers, Image processing sampling utility and efficiency, and rate of serious adverse events. The outcomes of15 Contributed equally. computer assisted targeted approachescancer were also compared. Platinum Priority Collaborativedifferent Review Prostate * Magnetic resonance imaging y

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