Accuracy of MRI-Targeted in-Bore Prostate Biopsy According to the Gleason Score with Postprostatectomy Histopathologic Control—a Targeted Biopsy-Only Strategy with Limited Number of Cores

• Published in: Academic radiology Vol. 22; no. 11; pp. 1409 - 1418
• Main Authors: Garmer, Marietta, MD, Busch, Martin, PhD, Mateiescu, Serban, Dipl.Ing, Fahlbusch, David E., MD, Wagener, Birgit, MD, Grönemeyer, Dietrich H.W., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2015
• Subjects: Aged; Aged, 80 and over; Humans; Image-Guided Biopsy - methods; interventional; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Grading; Prostate - diagnostic imaging; Prostate - pathology; prostate biopsy; Prostatectomy; prostatic neoplasms; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Radiology; Retrospective Studies; Ultrasonography; ADC; transrectal ultrasound; prostate biopsy; MRI; DCE; prostate imaging–reporting and data system; trueFISP; interventional; true fast imaging with steady-state precession; neoplasm grading; apparent diffusion coefficient; radical prostatectomy; Magnetic resonance imaging; diffusion-weighted imaging; PI-RADS; prostatic neoplasms; DWI; TRUS; dynamic contrast enhanced; RP; PSA; prostate-specific antigen
• ISSN: 1076-6332; 1878-4046
• DOI: 10.1016/j.acra.2015.06.020

Rationale and Objectives Accuracy of ultrasound-guided biopsy and Gleason score is limited, and diagnosis of insignificant cancer with Gleason score ≤6 is frequent when extended biopsy schemes are used. We evaluated whether the magnetic resonance imaging (MRI)-targeted in-bore prostate biopsy correctly identifies the Gleason score of prostate cancer in histopathologic correlation after prostatectomy. Simultaneously a targeted concept is expected to keep down the rate of insignificant cancer. Materials and Methods We compared retrospectively the Gleason score of the MRI-targeted in-bore biopsy with prostatectomy specimens in 50 men with prostate cancer. Endorectal MRI included T2-weighted imaging, diffusion-weighted imaging, dynamic contrast-enhanced imaging, and spectroscopy. Lesions with a prostate imaging–reporting and data system (PI-RADS) score ≥3 were considered. Upgrading and downgrading of tumors was evaluated, and significant upgrading was defined as a shift in Gleason score from 6 to 7 or more. Results Gleason score was concordant in 66% of the patients, overall upgraded in 30% of patients, and downgraded in 4% of patients. Significant upgrading of the Gleason score from 6 to 7 occurred in eight patients; upgrading did not exceed one step in the Gleason score. After prostatectomy the Gleason score 6 was found in 20% of patients. The median number of cores obtained was 4 (range 2–6), and the median number of positive cores was 2 (range 1–4). Conclusions In-bore MRI-targeted biopsy offers good accuracy in the Gleason score with postprostatectomy histopathologic control when compared to the literature. A limited number of cores are sufficient to achieve these results. The fraction of insignificant cancer identified by targeted only-biopsy is low. Upgrading is restricted to one step in the Gleason score. Clinicians should be aware of positive findings in MRI and the biopsy technique used when assessing prostate biopsy results.