title: Reproducibility of Multiparametric Magnetic Resonance Imaging and Fusion Guided Prostate Biopsy: Multi-Institutional External Validation by a Propensity Score Matched Cohort.
abstract: As the adoption of magnetic resonance imaging/ultrasound fusion guided biopsy expands, the reproducibility of outcomes at expert centers becomes essential. We sought to validate the comprehensive NCI (National Cancer Institute) experience with multiparametric magnetic resonance imaging and fusion guided biopsy in an external, independent, matched cohort of patients.
  
  
  
  We compared 620 patients enrolled in a prospective trial comparing systematic biopsy to fusion guided biopsy at NCI to 310 who underwent a similar procedure at Long Island Jewish Medical Center. The propensity score, defined as the probability of being treated outside NCI, was calculated using the estimated logistic regression model. Patients from the hospital were matched 1:1 for age, prostate specific antigen, magnetic resonance imaging suspicion score and prior negative biopsies. Clinically significant disease was defined as Gleason 3 + 4 or greater.
  
  
  
  Before matching we found differences between the cohorts in age, magnetic resonance imaging suspicion score (each p <0.001), the number of patients with prior negative biopsies (p = 0.01), and the overall cancer detection rate and the cancer detection rate by fusion guided biopsy (each p <0.001). No difference was found in the rates of upgrading by fusion guided biopsy (p = 0.28) or upgrading to clinically significant disease (p = 0.95). A statistically significant difference remained in the overall cancer detection rate and the rate by fusion guided biopsy after matching. On subgroup analysis we found a difference in the overall cancer detection rate and the rate by fusion guided biopsy (p <0.001 and 0.003) in patients with prior negative systematic biopsy but no difference in the 2 rates (p = 0.39 and 0.51, respectively) in biopsy naïve patients.
  
  
  
  Improved detection of clinically significant cancer by magnetic resonance imaging and fusion guided biopsy is reproducible by an experienced multidisciplinary team consisting of dedicated radiologists and urologists.
authors.affiliation: Department of Urology and Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Ardeshir R
authors.initials: AR
authors.lastname: Rastinehad
authors.affiliation: Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Abboud
authors.affiliation: Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland.
authors.forename: Arvin K
authors.initials: AK
authors.lastname: George
authors.affiliation: Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Frye
authors.affiliation: Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland.
authors.forename: Richard
authors.initials: R
authors.lastname: Ho
authors.affiliation: Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland.
authors.forename: Raju
authors.initials: R
authors.lastname: Chelluri
authors.affiliation: Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland.
authors.forename: Michele
authors.initials: M
authors.lastname: Fascelli
authors.affiliation: Biometric Research Branch, National Institutes of Health, Bethesda, Maryland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Shih
authors.affiliation: Department of Radiology, North Shore-Long Island Jewish Hofstra School of Medicine, New Hyde Park, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Villani
authors.affiliation: Department of Radiology, North Shore-Long Island Jewish Hofstra School of Medicine, New Hyde Park, New York.
authors.forename: Eran
authors.initials: E
authors.lastname: Ben-Levi
authors.affiliation: Department of Pathology, North Shore-Long Island Jewish Hofstra School of Medicine, New Hyde Park, New York.
authors.forename: Oksana
authors.initials: O
authors.lastname: Yaskiv
authors.affiliation: Molecular Imaging Program, National Institutes of Health, Bethesda, Maryland.
authors.forename: Baris
authors.initials: B
authors.lastname: Turkbey
authors.affiliation: Molecular Imaging Program, National Institutes of Health, Bethesda, Maryland.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Choyke
authors.affiliation: Laboratory of Pathology, National Institutes of Health, Bethesda, Maryland.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Merino
authors.affiliation: Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Bradford J
authors.initials: BJ
authors.lastname: Wood
authors.affiliation: Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland. Electronic address: pintop@mail.nih.gov.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Pinto
mesh_terms: D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D015203:Reproducibility of Results; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: adenocarcinoma; biopsy; magnetic resonance imaging; prostate; ultrasound, high-intensity focused, transrectal
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