title: Can transrectal needle biopsy be optimised to detect nearly all prostate cancer with a volume of ≥0.5 mL? A three-dimensional analysis.
abstract: OBJECTIVE
  To investigate whether transrectal needle biopsy can be optimised to detect nearly all prostate cancer with a tumour volume (TV) of ≥0.5 mL.
  
  
  METHODS
  Retrospectively analysed 109 whole-mounted and entirely submitted radical prostatectomy specimens with prostate cancer. All tumours in each prostate were outlined on whole-mount slides and digitally scanned to produce tumour maps. Tumour map images were exported to three-dimensional (3D) slicer software (http://www.slicer.org) to develop a 3D-prostate cancer model. In all, 20 transrectal biopsy schemes involving two to 40 cores and two to six anteriorly directed biopsy (ADBx) cores (including transition zone, TZ) were simulated, as well as models with various biopsy cutting lengths. Detection rates for tumours of different volumes were determined for the various biopsy simulation schemes.
  
  
  RESULTS
  In 109 prostates, 800 tumours were detected, 90 with a TV of ≥0.5 mL (mean TV 0.24 mL). Detection rate for tumours with a TV of ≥0.5 mL plateaued at 77% (69/90) using a 12-core (3 × 4) scheme, standard 17-mm biopsy cutting length without ADBx cores. In all, 20 of 21 (95%) tumours with a TV of ≥0.5 mL not detected by this scheme originated in the anterior peripheral zone or TZ. Increasing the biopsy cutting length and depth/number of ADBx cores improved the detection rate for tumours with a TVof ≥0.5 mL in the 12-core scheme. Using a 22-mm cutting length and a 12-core scheme with additional volume-adjusted ADBx cores, 100% of ≥0.5 mL tumours in prostates ≤ 50 mL in volume and 94.7% of ≥0.5 mL tumours in prostates > 50 mL in volume were detected.
  
  
  CONCLUSIONS
  Our 3D-prostate cancer model analysis suggests that nearly all prostate cancers with a TV of ≥0.5 mL can be detected by 14-18 transrectal needle-biopsy cores. Using longer biopsy cutting lengths and increasing the depth and number of ADBx cores (including TZ) according to prostate volume are necessary as well.
authors.affiliation: Department of Pathology, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Kent
authors.initials: K
authors.lastname: Kanao
authors.forename: James A
authors.initials: JA
authors.lastname: Eastham
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
authors.forename: Victor E
authors.initials: VE
authors.lastname: Reuter
authors.forename: Samson W
authors.initials: SW
authors.lastname: Fine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods* / Q000592:standards; D003198:Computer Simulation; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000473:pathology*; D012007:Rectum; D012189:Retrospective Studies; D047368:Tumor Burden
keywords: anterior; biopsy; prostate cancer; simulation; transition zone