Cognitive target MRI-TRUS fusion biopsies of MRI detected PIRADS 4 and 5 lesions Poster No.: B-0704 Congress: ECR 2015 Type: Scientific Paper Authors: P. P. van Westerveld, J. Vriesema, J. H. W. van den Hout, E. Cornel, J. Veltman; Almelo/NL Keywords: DOI: Genital / Reproductive system male, MR, Ultrasound, Biopsy, Cancer 10.1594/ecr2015/B-0704 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 6
Purpose Prostate cancer is the most frequently diagnosed type of cancer in adult men. In the Netherlands alone, 11.000 and more cases are diagnosed and 2500 deaths are caused by it each year. Usually, men with an increased PSA value are referred to a urologist for routine trans rectal ultra sonography (TRUS) guided biopsies in standard pattern (10-12 cores). A diagnostic tool with a low detection grade. More and more, the Multiparametric MRI is becoming a widely used diagnostic tool for the detection of (significant) prostate cancer. Significant lesions detected on prostate-mri need to be evaluated by histological biopsy. MRI guided target biopsies are limitedly available, time consuming, uncomfortable and costly. TRUS guided target biopsies based on MRI findings are a logical first diagnostic step. Our purpose was to evaluate the performance of cognitive target MRI-TRUS fusion biopsies of MRI detected PIRADS 4 and 5 lesions. Methods and materials 52 consecutive patients in the period from 12/2013-06/2014 with increased PSA and a PIRADS 4 or 5 lesion on MRI (3T Siemens-skyra, protocol according to ESUR guidelines (1)) were included. All patients target biopsies using TRUS were performed by the same urologist and radiologist, in consensus, with MRI images and structured report available. The procedure length was 15 minutes, with the patient in lithotomy position in leg supports. A standard ultrasound device, also used for normal standard pattern TRUS guided biopsy, was used (BK Medical, Flexfocus 800). This method is also called cognitive based MRI/TRUS guided target biopsy, and is the simplest form of fusion target biopsy available. In patients with a negative biopsy, MRI-guided target biopsy was advised. Images for this section: Page 2 of 6
Fig. 1: Impression of cognitive MRI/TRUS Fusion biopsy procedure Page 3 of 6
Results A total of 52 patients were included (16 PIRADS 4 and 36 PIRADS 5 lesions). Mean PSA and PSA-density value was respectively 9,88 (SD 6,1) and 0.20 (SD 0.11). Mean lesion size was 13.95mm (SD 6.26mm). 9 PIRADS 4 lesions (56%) were found positive for prostate cancer, 26 PIRADS 5 (72%). Overall 67% of the patients were diagnosed with prostate cancer using cognitive target MRI-TRUS fusion biopsies. The additional MRI-guided-biopsies that were performed from the negative cases proved in 50% to be malignant (0/2 biopsies were positive of the Pirads 4 and 3/4 of the Pirads 5 lesions). Images for this section: Table 1: Descriptives of patient population Page 4 of 6
Fig. 2: Graph 1: Gleason values compared to PIRADS score; cumulative count Page 5 of 6
Conclusion Cognitive target MRI-TRUS fusion biopsies are an effective first step in the evaluation of PIRADS 4 and 5 MRI detected lesions. Additional MRI-Guided-Biopsies of negative results are mandatory. Personal information PP van Westerveld, 2nd year Radiology resident at ZGT Almelo E-mail: p.vwesterveld@zgt.nl References [1] Barentsz JO, Richenberg J, Clements R, et al. ESUR prostate MR guidelines 2012. European Radiology2012;22(4):746-757. doi:10.1007/s00330-011-2377-y. Page 6 of 6