title: Multiparametric Magnetic Resonance/Ultrasound Fusion Prostate Biopsy: Number and Spatial Distribution of Cores for Better Index Tumor Detection and Characterization.
abstract: We evaluated the minimum core number for better index tumor detection to determine the best core site as well as biopsy Gleason score heterogeneity in the same index lesion. The aim was to optimize the highest Gleason score detection.
  
  
  
  A total of 327 patients with negative digital rectal examination underwent magnetic resonance imaging/transrectal ultrasound fusion targeted biopsy for elevated/rising prostate specific antigen and/or 1 or more detectable lesions on multiparametric magnetic resonance imaging after a previous negative standard biopsy. Depending on the diameter of each index lesion (8 or less, or greater than 8 mm) 4 or 6 cores, respectively, were taken according to a well determined sequence.
  
  
  
  Of the patients 166 (50.7%) had prostate cancer, including 79 (47.6%) with an 8 mm or less index lesion and 87 (52.4%) with a greater than 8 mm index lesion. Of patients with an index tumor 8 mm or less 7 (8.9%) had 1, 31 (39.2%) had 2, 27 (34.2%) had 3 and 14 (17.7%) had 4 positive cores. Similarly, of patients with a lesion greater than 8 mm 8 (9.2%) had 1, 30 (34.5%) had 2, 13 (14.9%) had 3, 14 (16.1%) had 4, 12 (13.8%) had 5 and 10 (11.5%) had 6 positive cores. The major prevalence of positive cores was observed in the center of the target. Gleason score heterogeneity was found in 12.6% of those with an 8 mm or less target vs 26.4% with a target greater than 8 mm. In the center of the target there was a slight prevalence of Gleason pattern 4 or greater, or a lesser pattern.
  
  
  
  Approaching magnetic resonance imaging/transrectal ultrasound fusion targeted biopsy with a single core might be inadequate. Rather, taking 2 cores in the center of the index lesion may provide more accurate cancer detection and optimize the chances of finding the highest Gleason pattern.
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Italy; University of Turin, Orbassano, Italy. Electronic address: porpiglia@libero.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: De Luca
authors.affiliation: University of Turin, Orbassano, Italy; Division of Nuclear Medicine, San Giovanni Battista Hospital, Perugia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Passera
authors.affiliation: Division of Radiology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Italy.
authors.forename: Agostino
authors.initials: A
authors.lastname: De Pascale
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Amparore
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cattaneo
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Checcucci
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: De Cillis
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Italy.
authors.forename: Diletta
authors.initials: D
authors.lastname: Garrou
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Manfredi
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Mele
authors.affiliation: Division of Pathology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Bollito
authors.affiliation: Division of Urology, San Luigi Gonzaga Hospital and University of Turin, Orbassano, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Fiori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D061705:Image-Guided Biopsy; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D018084:Ultrasonography, Interventional
keywords: biopsy; high-intensity focused; magnetic resonance imaging; prognosis; prostatic neoplasms; transrectal; ultrasound