title: Quantification of prostate deformation due to needle insertion during TRUS-guided biopsy: comparison of hand-held and mechanically stabilized systems.
abstract: OBJECTIVE
  Prostate biopsy is the clinical standard for the definitive diagnosis of prostate cancer. To overcome the limitations of 2D TRUS-guided biopsy systems when targeting preplanned locations, systems have been developed with 3D guidance to improve the accuracy of cancer detection. Prostate deformation due to needle insertion and biopsy gun firing is a potential source of error that can cause target misalignments during biopsies.
  
  
  METHODS
  The authors used nonrigid registration of 2D TRUS images to quantify the deformation that occurs during the needle insertion and the biopsy gun firing procedure and compare this effect in biopsies performed using a hand-held TRUS probe to those performed using a mechanically assisted 3D TRUS-guided biopsy system. The authors calculated a spatially varying 95% confidence interval on the prostate tissue motion and analyzed this motion both as a function of distance to the biopsy needle and as a function of distance to the lower piercing point of the prostate. The former is relevant because biopsy targets lie along the needle axis, and the latter is of particular importance due to the reported high concentration of prostate cancer in the peripheral zone, a substantial portion of which lies on the posterior side of the prostate where biopsy needles enter the prostate after penetrating the rectal wall during transrectal biopsy.
  
  
  RESULTS
  The results show that for both systems, the tissue deformation is such that throughout the length of the needle axis, including regions proximal to the lower piercing point, spherical tumors with a radius of 2.1 mm or more can be sampled with 95% confidence under the assumption of zero error elsewhere in the biopsy system. More deformation was observed in the direction orthogonal to the needle axis compared to the direction parallel to the needle axis; this is of particular importance given the long, narrow shape of the biopsy core. The authors measured lateral tissue motion proximal to the needle axis of not more than 1.5 mm, with 95% confidence. The authors observed a statistically significant and clinically insignificant maximum difference of 0.38 mm in the deformation, resulting from the hand-held and mechanically assisted systems along the needle axis, and the mechanical system resulted in a lower relative increase in deformation proximal to the needle axis during needle insertion, as well as lower variability of deformation during biopsy gun firing.
  
  
  CONCLUSIONS
  Given the clinical need to biopsy tumors of volume greater than or equal to 0.5 cm3, corresponding to spherical tumors with a radius of 5 mm or more, the tissue motion induced by needle insertion and gun firing is an important consideration when setting the design specifications for TRUS-guided prostate biopsy systems.
authors.affiliation: Imaging Research Laboratories, Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 5K8, Canada. tdesilva@imaging.robarts.ca
authors.forename: Tharindu
authors.initials: T
authors.lastname: De Silva
authors.forename: Aaron
authors.initials: A
authors.lastname: Fenster
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Bax
authors.forename: Cesare
authors.initials: C
authors.lastname: Romagnoli
authors.forename: Jonathan
authors.initials: J
authors.lastname: Izawa
authors.forename: Jagath
authors.initials: J
authors.lastname: Samarabandu
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Ward
mesh_terms: D016477:Artifacts; D001707:Biopsy, Needle / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D055595:Mechanical Phenomena; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D012007:Rectum; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D014463:Ultrasonography