title: Accuracy of real-time magnetic resonance imaging-transrectal ultrasound fusion image-guided transperineal target biopsy with needle tracking with a mechanical position-encoded stepper in detecting significant prostate cancer in biopsy-naïve men.
abstract: To evaluate the accuracy of real-time elastic fusion image-guided transperineal prostate biopsy with needle tracking involving a mechanical position-encoded stepper in detecting clinically significant prostate cancer for biopsy-naïve men.
  
  
  
  We prospectively recruited patients with serum prostate-specific antigen levels of 4.0-20 ng/mL and suspicious of prostate cancer on multiparametric magnetic resonance imaging. They underwent targeted biopsies for cancer-suspicious lesions and 12-core systematic biopsies. Pathological findings from biopsy cores and whole-mount specimens (for those who underwent radical prostatectomy) were analyzed.
  
  
  
  A total of 250 patients were included, in whom targeted and systematic biopsies detected significant cancers in 55% and 25%, respectively (P < 0.001). The targeted biopsy cores (n = 527) showed significantly greater biopsy-proven significant cancer detection rates (P < 0.001), cancer core length (P < 0.0001), cancer core percentage (P < 0.001) and Gleason scores (P < 0.001) than did the systematic biopsies. The significant cancer detection rate for targeted lesions (those with Prostate Imaging and Reporting and Data System classification scores of 5) was 80%. Biopsy-proven significant cancer detection rates for targeted lesions ≤10 mm and >10 mm were similar for Prostate Imaging and Reporting and Data System scores of 4 (P = 0.707) and 5 (P = 0.386). In whole-mount specimens (n = 30), locations for 95% of significant cancers were diagnosed preoperatively. Targeted biopsies alone diagnosed 79% of significant cancers.
  
  
  
  Although targeted biopsies are superior to systematic biopsies in detecting significant cancers, systematic biopsies maintain an important role in the diagnosis of prostate cancer in biopsy-naïve men.
authors.affiliation: Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Sunao
authors.initials: S
authors.lastname: Shoji
authors.affiliation: Department of Pathology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Hiraiwa
authors.affiliation: Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ogawa
authors.affiliation: Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Kawakami
authors.affiliation: Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Mayura
authors.initials: M
authors.lastname: Nakano
authors.affiliation: Department of Radiology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Hashida
authors.affiliation: Imaging-based Computational Biomedicine Laboratory, Graduate School of Information Science, Nara Institute of Science and Technology, Ikoma, Nara, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Radiology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Terumitsu
authors.initials: T
authors.lastname: Hasebe
authors.affiliation: Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Uchida
authors.affiliation: Department of Pathology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Tajiri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000379:methods; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D061705:Image-Guided Biopsy / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010502:Perineum / Q000601:surgery; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: cancer detection; fusion image-guided biopsy; magnetic resonance imaging; prostate cancer; significant cancer