title: The addition of a sagittal image fusion improves the prostate cancer detection in a sensor-based MRI /ultrasound fusion guided targeted biopsy.
abstract: BACKGROUND
  To explore the diagnostic benefit of an additional image fusion of the sagittal plane in addition to the standard axial image fusion, using a sensor-based MRI/US fusion platform.
  
  
  METHODS
  During July 2013 and September 2015, 251 patients with at least one suspicious lesion on mpMRI (rated by PI-RADS) were included into the analysis. All patients underwent MRI/US targeted biopsy (TB) in combination with a 10 core systematic prostate biopsy (SB). All biopsies were performed on a sensor-based fusion system. Group A included 162 men who received TB by an axial MRI/US image fusion. Group B comprised 89 men in whom the TB was performed with an additional sagittal image fusion.
  
  
  RESULTS
  The median age in group A was 67 years (IQR 61-72) and in group B 68 years (IQR 60-71). The median PSA level in group A was 8.10 ng/ml (IQR 6.05-14) and in group B 8.59 ng/ml (IQR 5.65-12.32). In group A the proportion of patients with a suspicious digital rectal examination (DRE) (14 vs. 29%, p = 0.007) and the proportion of primary biopsies (33 vs 46%, p = 0.046) were significantly lower. The rate of PI-RADS 3 lesions were overrepresented in group A compared to group B (19 vs. 9%; p = 0.044). Classified according to PI-RADS 3, 4 and 5, the detection rates of TB were 42, 48, 75% in group A and 25, 74, 90% in group B. The rate of PCa with a Gleason score ≥7 missed by TB was 33% (18 cases) in group A and 9% (5 cases) in group B; p-value 0.072. An explorative multivariate binary logistic regression analysis revealed that PI-RADS, a suspicious DRE and performing an additional sagittal image fusion were significant predictors for PCa detection in TB. 9 PCa were only detected by TB with sagittal fusion (sTB) and sTB identified 10 additional clinically significant PCa (Gleason ≥7).
  
  
  CONCLUSIONS
  Performing an additional sagittal image fusion besides the standard axial fusion appears to improve the accuracy of the sensor-based MRI/US fusion platform.
authors.affiliation: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Günzel
authors.affiliation: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany. hannes.cash@charite.de.
authors.forename: Hannes
authors.initials: H
authors.lastname: Cash
authors.affiliation: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: John
authors.initials: J
authors.lastname: Buckendahl
authors.affiliation: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Königbauer
authors.affiliation: Departement of Radiology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Asbach
authors.affiliation: Departement of Radiology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Haas
authors.affiliation: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Neymeyer
authors.affiliation: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hinz
authors.affiliation: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Kurt
authors.initials: K
authors.lastname: Miller
authors.affiliation: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Kempkensteffen
mesh_terms: D000368:Aged; D006801:Humans; D007091:Image Processing, Computer-Assisted; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D012189:Retrospective Studies; D014463:Ultrasonography
keywords: MRI/US fusion biopsy; Multiparametric magnetic resonance imaging; Prostate cancer detection; Targeted biopsy