title: Effect of targeted biopsy guided by elastic image fusion of MRI with 3D-TRUS on diagnosis of anterior prostate cancer.
abstract: OBJECTIVE
  To evaluate the effect of targeted biopsy (TB) with elastic fused magnetic resonance imaging (MRI) and 3-dimensional transrectal ultrasound (3D-TRUS) guidance in the diagnosis of anterior prostate cancer (APCa).
  
  
  METHODS
  A retrospective study was performed on patients who underwent TB with elastic fused MRI/3D-TRUS guidance using a 1.5-T MRI with T2- and diffusion-weighted images. APCa was defined as TB-proven cancer whose MR-imaged center was located anteriorly according to standardized MRI reporting schema. Prostate Imaging Reporting and Data System was used to quantify MRI suspicion. Maximum cancer core length (MCCL), cancer core involvement, primary Gleason grade pattern, and Gleason score (GS) on TB were assessed. A clinically significant cancer on TB was MCCL ≥ 5mm of GS 6 or any cancer with GS ≥ 7. Agreement between TB and radical prostatectomy step sections was assessed for all subjects when possible.
  
  
  RESULTS
  A total of 211 consecutive subjects were included. APCa was found in 81% (170/211). Median (range) of TB per patient, MCCL, and cancer core involvement were 2 (1-5), 10mm (4-23), and 57% (10%-100%), respectively. According to the level of MRI suspicion, positive rate for any cancer vs. clinically significant cancer was 96% (114/119) vs. 86% (102/119) for highly suspicious, 80% (46/57) vs. 68% (39/57) for likely, and 29% (10/35) vs. 20% (7/35) for equivocal, respectively (P = 0.016 and<0.001). Step-section analysis was possible for 70 patients. Concordance of primary Gleason grade pattern and GS between TB and radical prostatectomy was 90% (κ = 0.7) and 77% (κ = 0.64), respectively.
  
  
  CONCLUSIONS
  TB with elastic fused MRI/3D-TRUS guidance significantly enhanced accuracy in diagnosing clinically significant APCa.
authors.affiliation: USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA. Electronic address: Eduard.Baco@medisin.uio.no.
authors.forename: Eduard
authors.initials: E
authors.lastname: Baco
authors.affiliation: Department of Radiology, Oslo University Hospital Aker, Oslo, Norway.
authors.forename: Erik
authors.initials: E
authors.lastname: Rud
authors.affiliation: USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Osamu
authors.initials: O
authors.lastname: Ukimura
authors.affiliation: Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Vlatkovic
authors.affiliation: Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
authors.forename: Aud
authors.initials: A
authors.lastname: Svindland
authors.affiliation: USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Toru
authors.initials: T
authors.lastname: Matsugasumi
authors.affiliation: Chirurgie Urologique et Transplantation rénale-CHU Bordeaux, INSERM U1029-Université Bordeaux I, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Bernhard
authors.affiliation: USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: John C
authors.initials: JC
authors.lastname: Rewcastle
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Heidi B
authors.initials: HB
authors.lastname: Eggesbø
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011786:Quality Control; D012189:Retrospective Studies; D014463:Ultrasonography; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000379:methods*
keywords: Clinically significant prostate cancer; Elastic image fusion; Magnetic resonance imaging; Targeted prostate biopsy; Transrectal ultrasound