Accuracy of Sampling PI-RADS 4-5 Index Lesions Alone by MRI-guided In-bore Biopsy in Biopsy-naive Patients Undergoing Radical Prostatectomy.

Kilic M., Vural M., Coskun B., Acar Ö., Saglican Y., Akpek S., ...More

European urology focus, vol.6, pp.249-254, 2020 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 6
  • Publication Date: 2020
  • Doi Number: 10.1016/j.euf.2019.04.010
  • Journal Name: European urology focus
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED)
  • Page Numbers: pp.249-254
  • Keywords: Prostate cancer, Magnetic resonance imaging-guided in-bore biopsy, Prostate biopsy, Radical prostatectomy, VERSION 2, MULTIPARAMETRIC MRI, TARGETED BIOPSIES, CANCER, PERFORMANCE, DIAGNOSIS, OUTCOMES, FUSION, SYSTEM
  • Acibadem Mehmet Ali Aydinlar University Affiliated: Yes


Background: Targeting multiparametric magnetic resonance imaging (MP-MRI)-suspicious regions alone in biopsy-naive patients is not common practice, since it may miss clinically significant prostate cancer (PCa).

Objective: To investigate the accuracy of in-bore MRI-guided biopsy of Prostate Imaging Reporting and Data System (PI-RADS) 4 and 5 index lesions alone in biopsy-naive patients undergoing radical prostatectomy (RP).

Design, Setting, And Participants: A total of 170 patients underwent MRI-guided in-bore biopsy for PI-RADS 4 and 5 index lesions alone between 2013 and 2018, of whom 136 patients were diagnosed with PCa. Fifty-two patients without prior biopsy who underwent RP were included in this study. MP-MRI findings, biopsy results, and whole-mount step-section specimen evaluation were retrospectively analyzed.

Outcome Measurements And Statistical Analysis: Continuous variables were reported as mean (standard deviation) or median (range). Differences in parametric variables were calculated by Student t test.

Results And Limitations: Overall International Society of Urological Pathology grade group (GG) up- and downgrading rates were 23.0% and 7.6% per patient and 24.5% and 6.5% per focus, respectively. Ten of 12 biopsy-detected GG 1 foci were upgraded in the final pathology. In 30 patients, a total of 43 different tumor foci were identified outside the sampled index lesion. Average biopsied and nonbiopsied tumor volumes were found to be 2.02 and 0.45 cm³, respectively (p <  0.001). The index lesion was the largest focus of tumor in all patients' final histopathological examination; upgrading was identified in only one nonbiopsied focus in a single patient. Limitations include retrospective design and nonstandard indications of in-bore MRI biopsy.

Conclusions: In-bore MRI-guided biopsy of PI-RADS 4-5 index lesions alone in biopsy-naive patients is a safe and accurate diagnostic modality allowing appropriate patient selection for individualized treatment.

Patient Summary: In-bore magnetic resonance imaging-guided prostate biopsy of suspicious lesions alone allows accurate risk stratification of patients and reduces the detection of insignificant prostate cancer.