title: The association of level of practical experience in transrectal ultrasonography guided prostate biopsy with its diagnostic outcome.
abstract: INTRODUCTION The diagnostic yield of transrectal ultrasonography (TRUS) guided prostate biopsy is influenced by many patient and procedure specific factors. However, the role of operator specific factors remains inadequately defined. This study investigated the association of diagnostic outcome of TRUS guided biopsy with operator skill level. METHODS This study looked at a consecutive cohort of 690 men undergoing their first extended pattern TRUS guided prostate biopsy by 27 operators over a 24-month period in a single institution. Logistic regression was used for statistical analysis. RESULTS Biopsies performed by consultants (odds ratio [OR]: 2.35, p=0.004) and senior trainees (OR: 2.37, p=0.002) in patients with prostate specific antigen levels of <10ng/ml were more likely to be positive than those performed by junior trainees (cancer detection rate 50.0%, 50.3% and 29.9% respectively). Furthermore, biopsies performed by junior trainees yielded a significantly higher proportion of prostate cancers with a Gleason score of ≥3+4 than those performed by senior trainees (OR: 2.11, p=0.031) and consultants (OR: 2.40, p=0.013) (81.4%, 67.5% and 64.6% respectively). No significant differences emerged between operator skill groups for complications, rebiopsy rates or the number of prostate cancers found during the follow-up period (median: 34 months) of patients with a negative biopsy. CONCLUSIONS Level of operator experience is associated with the diagnostic outcome of extended pattern TRUS guided biopsy. The findings of this study imply that case selection, self-audit and expert supervision for the duration of the learning curve should form the basis of biopsy training.
authors.affiliation: Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, East and North Hertfordshire NHS Trust , UK.
authors.forename: S
authors.initials: S
authors.lastname: Tadtayev
authors.affiliation: Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, East and North Hertfordshire NHS Trust , UK.
authors.forename: A
authors.initials: A
authors.lastname: Hussein
authors.affiliation: University of Hertfordshire , UK.
authors.forename: L
authors.initials: L
authors.lastname: Carpenter
authors.affiliation: Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, East and North Hertfordshire NHS Trust , UK.|University of Hertfordshire , UK.
authors.forename: N
authors.initials: N
authors.lastname: Vasdev
authors.affiliation: Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, East and North Hertfordshire NHS Trust , UK.
authors.forename: G
authors.initials: G
authors.lastname: Boustead
mesh_terms: D000368:Aged; D062005:Biopsy, Large-Core Needle; D015331:Cohort Studies; D019160:Endosonography; D006801:Humans; D061705:Image-Guided Biopsy; D007610:Kallikreins / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D000072178:Urologists / Q000706:statistics & numerical data*; D014572:Urology / Q000193:education
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Biopsy; Operator effect; Prostate cancer; Prostate specific antigen; Transrectal ultrasonography