title: MR-targeted TRUS prostate biopsy using local reference augmentation: initial experience.
abstract: OBJECTIVE
  To evaluate MR-targeted TRUS prostate biopsy using a novel local reference augmentation method.
  
  
  METHODS
  Tracker-based MR-TRUS fusion was applied using local reference augmentation. In contrast to conventional whole gland fusion, local reference augmentation focuses the highest registration accuracy to the region surrounding the lesion to be biopsied. Pre-acquired multi-parametric MR images (mpMRI) were evaluated using PIRADS classification. T2-weighted MR images were imported on an ultrasound machine to allow for MR-TRUS fusion. Biopsies were targeted to the most suspicious lesion area identified on mpMRI. Each target was biopsied 1-5 times. For each biopsied lesion the diameter, PIRADS and Gleason scores, visibility during fusion, and representativeness were recorded.
  
  
  RESULTS
  Included were 23 consecutive patients with 25 MR suspicious lesions, of which 11 patients had a previous negative TRUS-guided biopsy and 12 were biopsy naïve. The cancer detection rate was 64 % (Gleason score ≥6). Biopsy was negative (i.e., no Gleason score) in seven patients confirmed by follow-up in all of them (up to 18 months). After MR-TRUS fusion, 88 % of the lesions could be visualized on TRUS. The cancer detection rate increases with increasing lesion size, being 73 % for lesions larger than 10 mm.
  
  
  CONCLUSIONS
  Tracker-based MR-TRUS fusion biopsy with local reference augmentation is feasible, especially for lesions with an MR maximum diameter of at least 10 mm or PIRADS 5 lesions. If this is not the case, we recommend in-bore MR-guided biopsy.
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Wendy.vandeVen@radboudumc.nl.
authors.forename: Wendy J M
authors.initials: WJ
authors.lastname: van de Ven
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Wulphert
authors.initials: W
authors.lastname: Venderink
authors.affiliation: Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: J P Michiel
authors.initials: JP
authors.lastname: Sedelaar
authors.affiliation: Department of Radiology, ZGT, Hengelo, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Veltman
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Jelle O
authors.initials: JO
authors.lastname: Barentsz
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Jurgen J
authors.initials: JJ
authors.lastname: Fütterer
authors.affiliation: Department of Urology, ZGT, Hengelo, The Netherlands.
authors.forename: Erik B
authors.initials: EB
authors.lastname: Cornel
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Henkjan J
authors.initials: HJ
authors.lastname: Huisman
mesh_terms: D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D019160:Endosonography / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology*; D012007:Rectum; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen
keywords: Biopsy; MR–US fusion; PIRADS; Prostate cancer