Detection of prostate cancer by MR-ultrasound fusion guided biopsy

Detection of prostate cancer by MR-ultrasound fusion guided biopsy Poster No.: C-0761 Congress: ECR 2014 Type: Scientific Exhibit Authors: T. Durmus, C. Stephan, T. Slowinski, A. Thomas, A. Maxeiner, B. Hamm, T. Fischer; Berlin/DE Keywords: Genital / Reproductive system male, Contrast agents, Pelvis, MR-Diffusion/Perfusion, Ultrasound-Power Doppler, Ultrasound, Contrast agent-intravenous, Biopsy, Cancer DOI: 10.1594/ecr2014/C-0761 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 16

Aims and objectives Objectives: Men with an elevated serum level of prostate specific antigen (PSA) or suspicious findings 1 on digital rectal examination (DRE) are examined by transrectal ultrasound (TRUS). For histological confirmation and therapeutic planning, US-guided systematic biopsy of the prostate is performed. 2 However, in a subgroup of patients with elevated serum 3-4 PSA levels, no malignancy is detected by systematic biopsy. Some patients underwent repeat biopsies due to remaining cancer suspicoun up to four times and more until 5 cancer can be detected. A negative biopsy therefore does not exclude prostate cancer. Consequently, healthy men are subjected to the risks of repeated, unnecessary biopsies. Aim: Multiparametric magnetic resonance imaging (MRI) of the prostate is highly sensitive and specific for clinically relevant prostate cancer. The aim of this study is to evaluate whether prostate cancer detection rates of transrectal ultrasound (TRUS)-guided biopsy Fig. 2 on page 2 may be improved by image fusion of ultrasound and MRI Fig. 3 on page 3. Images for this section: Page 2 of 16

Fig. 2: TRUS biopsy Page 3 of 16

Fig. 3: T2 TSE axial image of the prostate of young patient. Notice the differentiability of the peripheral zone (PZ), transition zone (TZ), as well as the central zone (ZZ). Exemplary B-mode axial image of another patient allwos for discrimination of the peripheral and transitional zone only. Page 4 of 16

Methods and materials A total of 68 consecutive patients with elevated PSA levels and at least one prior negative TRUS guided biopsy were included into this study. All patients had a clinical indication for systematic rebiopsy due to remaining cancer suspicoun. All inclded patients underwent multiparametric 3T MRI Fig. 4 on page 5 including T2w, diffusion weighted and dynamic contrast enhanced imaging. MR data (T2w) were uploaded into two modern sonography systems (Hitachi Preirus and Toshiba Aplio 500) Fig. 5 on page 5, and images were fused in real-time mode during biopsy. Targeted biopsies were performed in MR/US-fusion mode and followed by systematic standard TRUS guided biopsy Fig. 6 on page 6 with removal of 10 to 15 cores Fig. 7 on page 7. Detection rates of both methods were calculated and compared using the Chi2 test. Images for this section: Fig. 4: MRI parameters Page 5 of 16

Fig. 5: US protocoll Page 6 of 16

Fig. 6: Biplane TRUS biopsy enabling simultanous visualisation of the target and biopsy needle in transversal and sagittal section. Page 7 of 16

Fig. 7: Exemplary scheme for TRUS biopsy and targeted biopsies based on MR/US fusion Page 8 of 16

Results Age was not significantly different in patients with and without histologically confirmed prostate cancer. PSA values were significantly higher in patients with prostate cancer compared with patients without cancer. The proportion of histologically confirmed cancers in the group of MR/US fusion biopsy (35%) Fig. 8 on page 9, Fig. 9 on page 10, Fig. 11 on page 11 was significantly higher than in the systematic TRUS biopsy group (19%), (p<0.05). Table 1: Detection rate of MR/US fusion biopsy was significantly higher compared to systematic TRUS biopsy alone. References: Humboldt-Universität zu Berlin, Institut für Radiologie, Charité - Berlin/DE Images for this section: Page 9 of 16

Fig. 8: mp MRI with ventral tumor Fig. 9: mp MRI Page 10 of 16

Fig. 10: MR/US Fusion technique Table 1: Detection rate of MR/US fusion biopsy was significantly higher compared to systematic TRUS biopsy alone. Page 11 of 16

Fig. 11: Histology result after fusion biopsy Page 12 of 16

Conclusion Real time MR/US image fusion enhances prostate cancer detection rates compared with TRUS-guided biopsy alone in patients with remaining cancer suspicioun after negative systematic biopsy. Further studies need to clarify whether fusion biopsy also enhances Gleason score matching when compared to prostatectomy specimens. Fig. 13 References: Humboldt-Universität zu Berlin, Institut für Radiologie, Charité - Berlin/DE Images for this section: Page 13 of 16

Fig. 12: Conclusion with workeflow Page 14 of 16

Fig. 13 Page 15 of 16

Personal information References 1. Colombo T, Schips L, Augustin H, et al. Value of transrectal ultrasound in preoperative staging of prostate cancer. Minerva Urol Nefrol. 1999;51:1-4. 2. Greenlee RT, Hill-Harmon MB, Murray T, Thun M. Cancer statistics, 2001. CA Cancer J Clin. 2001;51:15-36. 3. Keetch DW, Catalona WJ, Smith DS. Serial prostatic biopsies in men with persistently elevated serum prostate specific antigen values. J Urol. 1994;151:1571-1574. 4. Ellis WJ, Brawer MK. Repeat prostate needle biopsy: who needs it? J Urol. 1995;153:1496-1498. 5. Nagata M, Sato T, Un-no T, et al. Repeat prostate biopsy in patients with previous negative biopsies. Hinyokika Kiyo. 2002;48:589-592. Page 16 of 16