title: Usefulness of cognitive targeting in multiparametric MRI-guided biopsy to diagnose the dominant lesion in prostate cancer.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of cognitive targeting in multiparametric MRI-guided biopsy to obtain samples of the dominant nodule in prostate cancer.
  
  
  METHODS
  We performed cognitive-targeted biopsy after multiparametric MRI in 53 patients with progressive elevation of PSA. All patients provided written informed consent. Biopsies were done via a transperineal route under ultrasound guidance. The first three samples were obtained by cognitive targeting, with the target lesion determined by multiparametric MRI according to the PI-RADS (prostate imaging, reporting, and data system) criteria. Then 9 cylinders were obtained from the remaining segments of the prostate (systematic biopsies). The pathologist evaluated the 12 cylinders without knowing which ones were obtained by cognitive targeting. In patients with multifocal lesions, we defined the dominant lesion as the one with the highest Gleason score and tumor volume; in patients with unifocal lesions, we defined the dominant lesion as the lesion identified.
  
  
  RESULTS
  We diagnosed 29 prostate tumors. In 89.7% (26/29), the dominant nodule was diagnosed by the cognitive-targeted biopsy. If only cognitive-targeted biopsy had been done, the dominant nodule would not have been diagnosed in two (3.8%, 2/53) patients and only one (1.8%, 1/53) patient, in whom no sample was obtained from the lesion with the highest Gleason score, would have been understaged. The rate of positivity of cognitive-targeted biopsy was 50.9% (27/53) in the entire group of patients and 46.3% (19/41) in the group of patients with previous negative biopsies. No significant immediate or late complications were observed.
  
  
  CONCLUSIONS
  Cognitive targeting is safe and efficacious for detecting the dominant lesion in prostate cancer.
authors.affiliation: Departamento de Radiología, Hospital St Joan de Reus, Reus, España. Electronic address: jrongarcia@yahoo.com.
authors.forename: J
authors.initials: J
authors.lastname: Garcia Bennett
authors.affiliation: Departamento de Radiología, Hospital St Joan de Reus, Reus, España.
authors.forename: A
authors.initials: A
authors.lastname: Conejero Olesti
authors.affiliation: Departamento de Radiología, Hospital St Joan de Reus, Reus, España.
authors.forename: C
authors.initials: C
authors.lastname: Hurtado Salom
authors.affiliation: Departamento de Radiología, Hospital St Joan de Reus, Reus, España.
authors.forename: E
authors.initials: E
authors.lastname: Rebenaque
authors.affiliation: Departamento de Anatomía Patológica, Hospital St Joan de Reus, Reus, España.
authors.forename: D
authors.initials: D
authors.lastname: Parada
authors.affiliation: Facultad de Medicina, Universidad Rovira i Virgili, Reus, España.
authors.forename: E
authors.initials: E
authors.lastname: Serrano Alcalá
authors.affiliation: Departamento de Radiología, Hospital St Joan de Reus, Reus, España.
authors.forename: J A
authors.initials: JA
authors.lastname: Abreu De Con
mesh_terms: D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies
keywords: Biopsia; Biopsy; Cáncer de próstata; Magnetic resonance imaging; Prostate cancer; Resonancia magnética