title: Magnetic resonance imaging-ultrasound fusion biopsy for prediction of final prostate pathology.
abstract: OBJECTIVE
  We explored the impact of magnetic resonance imaging-ultrasound fusion prostate biopsy on the prediction of final surgical pathology.
  
  
  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.
authors.affiliation: Department of Urology, University of California, Los Angeles, California.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Le
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, California.
authors.forename: Samuel
authors.initials: S
authors.lastname: Stephenson
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, California.
authors.forename: Michelle
authors.initials: M
authors.lastname: Brugger
authors.affiliation: Department of Pathology, University of California, Los Angeles, California.
authors.forename: David Y
authors.initials: DY
authors.lastname: Lu
authors.affiliation: Department of Urology, University of California, Los Angeles, California.
authors.forename: Patricia
authors.initials: P
authors.lastname: Lieu
authors.affiliation: Department of Urology, Stanford University, Stanford, California.
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Sonn
authors.affiliation: Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, California.
authors.forename: Shyam
authors.initials: S
authors.lastname: Natarajan
authors.affiliation: Department of Urology, University of California, Los Angeles, California.
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Dorey
authors.affiliation: Department of Pathology, University of California, Los Angeles, California.
authors.forename: Jiaoti
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Radiology, University of California, Los Angeles, California.
authors.forename: Daniel J A
authors.initials: DJ
authors.lastname: Margolis
authors.affiliation: Department of Urology, University of California, Los Angeles, California.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Reiter
authors.affiliation: Department of Urology, University of California, Los Angeles, California. Electronic address: lmarks@mednet.ucla.edu.
authors.forename: Leonard S
authors.initials: LS
authors.lastname: Marks
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D012007:Rectum; D015203:Reproducibility of Results
keywords: biopsy; magnetic resonance imaging; prostatectomy; prostatic neoplasms; ultrasonography