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Magnetic resonance imaging-ultrasound fusion biopsy for prediction of final prostate pathology.

Publication ,  Journal Article
Le, JD; Stephenson, S; Brugger, M; Lu, DY; Lieu, P; Sonn, GA; Natarajan, S; Dorey, FJ; Huang, J; Margolis, DJA; Reiter, RE; Marks, LS
Published in: J Urol
November 2014

PURPOSE: We explored the impact of magnetic resonance imaging-ultrasound fusion prostate biopsy on the prediction of final surgical pathology. MATERIALS AND METHODS: A total of 54 consecutive men undergoing radical prostatectomy at UCLA after fusion biopsy were included in this prospective, institutional review board approved pilot study. Using magnetic resonance imaging-ultrasound fusion, tissue was obtained from a 12-point systematic grid (mapping biopsy) and from regions of interest detected by multiparametric magnetic resonance imaging (targeted biopsy). A single radiologist read all magnetic resonance imaging, and a single pathologist independently rereviewed all biopsy and whole mount pathology, blinded to prior interpretation and matched specimen. Gleason score concordance between biopsy and prostatectomy was the primary end point. RESULTS: Mean patient age was 62 years and median prostate specific antigen was 6.2 ng/ml. Final Gleason score at prostatectomy was 6 (13%), 7 (70%) and 8-9 (17%). A tertiary pattern was detected in 17 (31%) men. Of 45 high suspicion (image grade 4-5) magnetic resonance imaging targets 32 (71%) contained prostate cancer. The per core cancer detection rate was 20% by systematic mapping biopsy and 42% by targeted biopsy. The highest Gleason pattern at prostatectomy was detected by systematic mapping biopsy in 54%, targeted biopsy in 54% and a combination in 81% of cases. Overall 17% of cases were upgraded from fusion biopsy to final pathology and 1 (2%) was downgraded. The combination of targeted biopsy and systematic mapping biopsy was needed to obtain the best predictive accuracy. CONCLUSIONS: In this pilot study magnetic resonance imaging-ultrasound fusion biopsy allowed for the prediction of final prostate pathology with greater accuracy than that reported previously using conventional methods (81% vs 40% to 65%). If confirmed, these results will have important clinical implications.

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Published In

J Urol

DOI

EISSN

1527-3792

Publication Date

November 2014

Volume

192

Issue

5

Start / End Page

1367 / 1373

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Reproducibility of Results
  • Rectum
  • Prostatic Neoplasms
  • Prostatectomy
  • Prospective Studies
  • Neoplasm Staging
  • Neoplasm Grading
  • Middle Aged
  • Male
 

Citation

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Le, J. D., Stephenson, S., Brugger, M., Lu, D. Y., Lieu, P., Sonn, G. A., … Marks, L. S. (2014). Magnetic resonance imaging-ultrasound fusion biopsy for prediction of final prostate pathology. J Urol, 192(5), 1367–1373. https://doi.org/10.1016/j.juro.2014.04.094
Le, Jesse D., Samuel Stephenson, Michelle Brugger, David Y. Lu, Patricia Lieu, Geoffrey A. Sonn, Shyam Natarajan, et al. “Magnetic resonance imaging-ultrasound fusion biopsy for prediction of final prostate pathology.J Urol 192, no. 5 (November 2014): 1367–73. https://doi.org/10.1016/j.juro.2014.04.094.
Le JD, Stephenson S, Brugger M, Lu DY, Lieu P, Sonn GA, et al. Magnetic resonance imaging-ultrasound fusion biopsy for prediction of final prostate pathology. J Urol. 2014 Nov;192(5):1367–73.
Le, Jesse D., et al. “Magnetic resonance imaging-ultrasound fusion biopsy for prediction of final prostate pathology.J Urol, vol. 192, no. 5, Nov. 2014, pp. 1367–73. Pubmed, doi:10.1016/j.juro.2014.04.094.
Le JD, Stephenson S, Brugger M, Lu DY, Lieu P, Sonn GA, Natarajan S, Dorey FJ, Huang J, Margolis DJA, Reiter RE, Marks LS. Magnetic resonance imaging-ultrasound fusion biopsy for prediction of final prostate pathology. J Urol. 2014 Nov;192(5):1367–1373.
Journal cover image

Published In

J Urol

DOI

EISSN

1527-3792

Publication Date

November 2014

Volume

192

Issue

5

Start / End Page

1367 / 1373

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Reproducibility of Results
  • Rectum
  • Prostatic Neoplasms
  • Prostatectomy
  • Prospective Studies
  • Neoplasm Staging
  • Neoplasm Grading
  • Middle Aged
  • Male