title: Gleason Score Determination with Transrectal Ultrasound-Magnetic Resonance Imaging Fusion Guided Prostate Biopsies--Are We Gaining in Accuracy?
abstract: OBJECTIVE
  We evaluated the accuracy of prostate magnetic resonance imaging- transrectal ultrasound targeted biopsy for Gleason score determination.
  
  
  METHODS
  We selected 125 consecutive patients treated with radical prostatectomy for a clinically localized prostate cancer diagnosed on magnetic resonance imaging-transrectal ultrasound targeted biopsy and/or systematic biopsy. On multiparametric magnetic resonance imaging each suspicious area was graded according to PI-RADS™ score. A correlation analysis between multiparametric magnetic resonance imaging and pathological findings was performed. Factors associated with determining the accuracy of Gleason score on targeted biopsy were statistically assessed.
  
  
  RESULTS
  Pathological analysis of radical prostatectomy specimens detected 230 tumor foci. Multiparametric magnetic resonance imaging detected 151 suspicious areas. Of these areas targeted biopsy showed 126 cancer foci in 115 patients, and detected the index lesion in all of them. The primary Gleason grade, secondary Gleason grade and Gleason score of the 126 individual tumors were determined accurately in 114 (90%), 75 (59%) and 85 (67%) cases, respectively. Maximal Gleason score was determined accurately in 80 (70%) patients. Gleason score determination accuracy on targeted biopsy was significantly higher for low Gleason and high PI-RADS score tumors.
  
  
  CONCLUSIONS
  Magnetic resonance imaging-transrectal ultrasound targeted biopsy allowed for an accurate estimation of Gleason score in more than two-thirds of patients. Gleason score misclassification was mostly due to a lack of accuracy in the determination of the secondary Gleason grade.
authors.affiliation: Department of Urology, Cochin Hospital, Paris Descartes University, Paris, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Lanz
authors.affiliation: Department of Radiology, Cochin Hospital, Paris Descartes University, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Cornud
authors.affiliation: Department of Pathology, Cochin Hospital, Paris Descartes University, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Beuvon
authors.affiliation: Department of Radiology, Cochin Hospital, Paris Descartes University, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Lefèvre
authors.affiliation: Department of Radiology, Cochin Hospital, Paris Descartes University, Paris, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Legmann
authors.affiliation: Department of Urology, Cochin Hospital, Paris Descartes University, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Zerbib
authors.affiliation: Department of Urology, Cochin Hospital, Paris Descartes University, Paris, France; Inserm U1154, Institut Necker-Enfants Malades, Paris Descartes University, Paris, France.
authors.forename: Nicolas Barry
authors.initials: NB
authors.lastname: Delongchamps
mesh_terms: D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D060787:Neoplasm Grading; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D012007:Rectum; D015203:Reproducibility of Results; D014463:Ultrasonography
keywords: biopsy; magnetic resonance imaging; neoplasm grading; prostatic neoplasms