title: Accuracy of cognitive MRI-targeted biopsy in hitting prostate cancer-positive regions of interest.
abstract: OBJECTIVE
  Prostate cancer (PCa) diagnosis relies on clinical suspicion leading to systematic transrectal ultrasound-guided biopsy (TRUSGB). Multiparametric magnetic resonance imaging (mpMRI) allows for targeted biopsy of suspicious areas of the prostate instead of random 12-core biopsy. This method has been shown to be more accurate in detecting significant PCa. However, the precise spatial accuracy of cognitive targeting is unknown.
  
  
  METHODS
  Consecutive patients undergoing mpMRI-targeted TRUSGB with cognitive registration (MRTB-COG) followed by robot-assisted radical prostatectomy were included in the present analysis. The regions of interest (ROIs) involved by the index lesion reported on mpMRI were subsequently targeted by two experienced urologists using the cognitive approach. The 27 ROIs were used as spatial reference. Mapping on radical prostatectomy specimen was used as reference to determine true-positive mpMRI findings. Per core correlation analysis was performed.
  
  
  RESULTS
  Forty patients were included. Overall, 40 index lesions involving 137 ROIs (mean ROIs per index lesion 3.43) were identified on MRI. After correlating these findings with final pathology, 117 ROIs (85 %) were considered as true-positive lesions. A total of 102 biopsy cores directed toward such true-positive ROIs were available for final analysis. Cognitive targeted biopsy hit the target in 82 % of the cases (84/102). The only identified risk factor for missing the target was an anterior situated ROI (p = 0.01).
  
  
  CONCLUSIONS
  In experienced hands, cognitive MRTB-COG allows for an accuracy of 82 % in hitting the correct target, given that it is a true-positive lesion. Anterior tumors are less likely to be successfully targeted.
authors.affiliation: Department of Urology, Jewish General Hospital, McGill University Health Center, Cote Ste Catherine Rd, Montreal, QC, H3T1E2, Canada.|Department of Urology, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Cerantola
authors.affiliation: Department of Urology, Jewish General Hospital, McGill University Health Center, Cote Ste Catherine Rd, Montreal, QC, H3T1E2, Canada.
authors.forename: Eléonore
authors.initials: E
authors.lastname: Haberer
authors.affiliation: Department of Pathology, Jewish General Hospital, Montreal, QC, Canada.
authors.forename: Jose
authors.initials: J
authors.lastname: Torres
authors.affiliation: Department of Pathology, Jewish General Hospital, Montreal, QC, Canada.
authors.forename: Mona
authors.initials: M
authors.lastname: Alameldin
authors.affiliation: Department of Urology, Jewish General Hospital, McGill University Health Center, Cote Ste Catherine Rd, Montreal, QC, H3T1E2, Canada.
authors.forename: Samuel
authors.initials: S
authors.lastname: Aronson
authors.affiliation: Department of Radiology, Jewish General Hospital, Montreal, QC, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Levental
authors.affiliation: Department of Urology, Jewish General Hospital, McGill University Health Center, Cote Ste Catherine Rd, Montreal, QC, H3T1E2, Canada.
authors.forename: Franck
authors.initials: F
authors.lastname: Bladou
authors.affiliation: Department of Urology, Jewish General Hospital, McGill University Health Center, Cote Ste Catherine Rd, Montreal, QC, H3T1E2, Canada. manidjar@jgh.mcgill.ca.
authors.forename: Maurice
authors.initials: M
authors.lastname: Anidjar
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000368:Aged; D062005:Biopsy, Large-Core Needle / Q000379:methods*; D003071:Cognition; D019160:Endosonography; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D012680:Sensitivity and Specificity
keywords: Accuracy; Cognitive targeted biopsy; Correlation; Index lesion; MRI; Prostate cancer