title: Magnetic resonance/transrectal ultrasound fusion biopsy of the prostate compared to systematic 12-core biopsy for the diagnosis and characterization of prostate cancer: multi-institutional retrospective analysis of 389 patients.
abstract: To determine the incremental diagnostic value of targeted biopsies added to an extended sextant biopsy scheme on a per-patient, risk-stratified basis in 2 academic centers using different multiparametric magnetic resonance imaging (MRI) protocols, a large group of radiologists, multiple biopsy systems, and different biopsy operators.
  
  
  
  All patients with suspected prostate cancer (PCa) who underwent multiparametric MRI of the prostate in 2 academic centers between February 2013 and January 2015 followed by systematic and targeted MRI-transrectal ultrasound fusion biopsy were reviewed. Risk-stratified detection rate using systematic biopsies was compared with targeted biopsies on a per-patient basis. The McNemar test was used to compare diagnostic performance of the 2 approaches.
  
  
  
  A total of 389 men met eligibility criteria. PCa was diagnosed in 47% (182/389), 52%(202/389), and 60%(235/389) of patients using the targeted, systematic, and combined (targeted plus systematic) approach, respectively. Compared with systematic biopsy, targeted biopsy diagnosed 11% (37 vs. 26) more intermediate-to-high risk (P<0.0001) and 16% (10 vs. 16) fewer low-risk tumors (P<0.0001). These results were replicated when data from each center, biopsy-naïve patients, and men with previous negative biopsies were analyzed separately.
  
  
  
  Targeted MRI-transrectal ultrasound fusion biopsy consistently improved the detection of clinically significant PCa in a large patient cohort with diverse equipment, protocols, radiologists, and biopsy operators as can be encountered in clinical practice.
authors.affiliation: Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Guilherme C
authors.initials: GC
authors.lastname: Mariotti
authors.affiliation: Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: Daniel.Costa@UTSouthwestern.edu.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Costa
authors.affiliation: Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Ivan
authors.initials: I
authors.lastname: Pedrosa
authors.affiliation: Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Priscila M
authors.initials: PM
authors.lastname: Falsarella
authors.affiliation: Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Martins
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Claus G
authors.initials: CG
authors.lastname: Roehrborn
authors.affiliation: Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Neil M
authors.initials: NM
authors.lastname: Rofsky
authors.affiliation: Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Yin
authors.initials: Y
authors.lastname: Xi
authors.affiliation: Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Thais C
authors.initials: TC
authors.lastname: M Andrade
authors.affiliation: Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Marcos R
authors.initials: MR
authors.lastname: Queiroz
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.affiliation: Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Rodrigo G
authors.initials: RG
authors.lastname: Garcia
authors.affiliation: Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Gustavo C
authors.initials: GC
authors.lastname: Lemos
authors.affiliation: Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Ronaldo H
authors.initials: RH
authors.lastname: Baroni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014463:Ultrasonography
keywords: Biopsy; Early detection of cancer; Magnetic Resonance Imaging; Prostatic Neoplasms; Risk assessment