title: Targeted MRI-guided prostate biopsy: are two biopsy cores per MRI-lesion required?
abstract: OBJECTIVE
  This study evaluates the feasibility of performing less than two core biopsies per MRI-lesion when performing targeted MR-guided in-bore prostate biopsy.
  
  
  METHODS
  Retrospectively evaluated were 1545 biopsy cores of 774 intraprostatic lesions (two cores per lesion) in 290 patients (66 ± 7.8 years; median PSA 8.2 ng/ml) regarding prostate cancer (PCa) detection, Gleason score, and tumor infiltration of the first (FBC) compared to the second biopsy core (SBC). Biopsies were acquired under in-bore MR-guidance.
  
  
  RESULTS
  For the biopsy cores, 491 were PCa positive, 239 of 774 (31 %) were FBC and 252 of 771 (33 %) were SBC (p = 0.4). Patient PCa detection rate based on the FBC vs. SBC were 46 % vs. 48 % (p = 0.6). For clinically significant PCa (Gleason score ≥4 + 3 = 7) the detection rate was 18 % for both, FBC and SBC (p = 0.9). Six hundred and eighty-seven SBC (89 %) showed no histologic difference. On the lesion level, 40 SBC detected PCa with negative FBC (7.5 %). Twenty SBC showed a Gleason upgrade from 3 + 3 = 6 to ≥3 + 4 = 7 (2.6 %) and 4 to ≥4 + 3 = 7 (0.5 %).
  
  
  CONCLUSIONS
  The benefit of a second targeted biopsy core per suspicious MRI-lesion is likely minor, especially regarding PCa detection rate and significant Gleason upgrading. Therefore, a further reduction of biopsy cores is reasonable when performing a targeted MR-guided in-bore prostate biopsy.
  
  
  CONCLUSIONS
  • Higher PI-RADS overall score (IV-V) correlated well with PCa detection rate • In more than 80 % SBC was concordant regarding overall PCa detection • In almost 90 % there was no Gleason upgrading by the SBC • Only 2/54 (3.7 %) csPCa was missed when the SBC was omitted • For IB-GB a further reduction of biopsy cores is reasonable.
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Schimmöller
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany. Michael.Quentin@med.uni-duesseldorf.de.
authors.forename: M
authors.initials: M
authors.lastname: Quentin
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Blondin
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Dietzel
authors.affiliation: Medical Faculty, Department of Urology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hiester
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schleich
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Medical Faculty, Department of Urology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Rabenalt
authors.affiliation: Medical Faculty, Department of Pathology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany.
authors.forename: H E
authors.initials: HE
authors.lastname: Gabbert
authors.affiliation: Medical Faculty, Department of Urology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Albers
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Antoch
authors.affiliation: Medical Faculty, Department of Urology, University Dusseldorf, Moorenstr. 5, D-40225, Dusseldorf, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Arsov
mesh_terms: D000368:Aged; D062005:Biopsy, Large-Core Needle / Q000379:methods*; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D060787:Neoplasm Grading; D011467:Prostate / Q000000981:diagnostic imaging*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: Biopsy cores; Gleason score; MRI-guided biopsy; Prostate MRI; Prostate cancer