Skip to main content
SpringerLink
Log in

Targeted MRI/TRUS fusion-guided biopsy in men with previous prostate biopsies using a novel registration software and multiparametric MRI PI-RADS scores: first results

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate a novel system for MRI/TRUS fusion-guided biopsy for detection of prostate cancer (PCa) in patients with previous negative prostate biopsy and determine diagnostic accuracy when using the Prostate Imaging Reporting and Data System (PI-RADS) for multiparametric magnetic resonance imaging (mpMRI) as proposed by the European Society of Urogenital Radiology.

Methods

Thirty-nine men with clinical suspicion of PCa and history of previous prostate biopsy underwent mpMRI on a 3-T MRI. In total, 72 lesions were evaluated by the consensus of two radiologists. PI-RADS scores for each MRI sequence, the sum of the PI-RADS scores and the global PI-RADS were determined. MRI/TRUS fusion-guided targeted biopsy was performed using the BioJet™ software combined with a transrectal ultrasound system. Image fusion was based on rigid registration. PI-RADS scores of the dominant lesion were compared with histopathological results. Diagnostic accuracy was determined using receiver operating characteristic curve analysis.

Results

MRI/TRUS fusion-guided biopsy was reliable and successful for 71 out of 72 lesions. The global PI-RADS score of the dominant lesion was significantly higher in patients with PCa (4.0 ± 1.3) compared to patients with negative histopathology (2.6 ± 0.8; p = 0.0006). Using a global PI-RADS score cut-off ≥4, a sensitivity of 85 %, a specificity of 82 % and a negative predictive value of 92 % were achieved.

Conclusions

The described fusion system is dependable and efficient for targeted MRI/TRUS fusion-guided biopsy. mpMRI PI-RADS scores combined with a novel real-time MRI/TRUS fusion system facilitate sufficient diagnosis of PCa with high sensitivity and specificity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gosselaar C, Roobol MJ, van den Bergh RC, Wolters T, Schroder FH (2009) Digital rectal examination and the diagnosis of prostate cancer–a study based on 8 years and three screenings within the European Randomized Study of Screening for Prostate Cancer (ERSPC) Rotterdam. Eur Urol 55(1):139–146. doi:10.1016/j.eururo.2008.03.079

    Article  PubMed  Google Scholar 

  2. Freedland SJ, Kane CJ, Amling CL, Aronson WJ, Terris MK, Presti JC Jr, Group SDS (2007) Upgrading and downgrading of prostate needle biopsy specimens: risk factors and clinical implications. Urology 69(3):495–499. doi:10.1016/j.urology.2006.10.036

    Article  PubMed Central  PubMed  Google Scholar 

  3. Suardi N, Capitanio U, Chun FK, Graefen M, Perrotte P, Schlomm T, Haese A, Huland H, Erbersdobler A, Montorsi F, Karakiewicz PI (2008) Currently used criteria for active surveillance in men with low-risk prostate cancer: an analysis of pathologic features. Cancer 113(8):2068–2072. doi:10.1002/cncr.23827

    Article  PubMed  Google Scholar 

  4. Ukimura O, Coleman JA, de la Taille A, Emberton M, Epstein JI, Freedland SJ, Giannarini G, Kibel AS, Montironi R, Ploussard G, Roobol MJ, Scattoni V, Jones JS (2013) Contemporary role of systematic prostate biopsies: indications, techniques, and implications for patient care. Eur Urol 63(2):214–230. doi:10.1016/j.eururo.2012.09.033

    Article  PubMed  Google Scholar 

  5. Djavan BOB, Ravery V, Zlotta A, Dobronski P, Dobrovits M, Fakhari M, Seitz C, Susani M, Borkowski A, Boccon-Gibod L, Schulman CC, Marberger M (2001) Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop? J Urol 166(5):1679–1683. doi:10.1016/S0022-5347(05)65652-2

    Article  CAS  PubMed  Google Scholar 

  6. Shariat SF, Roehrborn CG (2008) Using biopsy to detect prostate cancer. Rev Urol 10(4):262–280

    PubMed Central  PubMed  Google Scholar 

  7. Roehrborn CG, Pickens GJ, Sanders JS (1996) Diagnostic yield of repeated transrectal ultrasound-guided biopsies stratified by specific histopathologic diagnoses and prostate specific antigen levels. Urology 47(3):347–352

    Article  CAS  PubMed  Google Scholar 

  8. Nam RK, Saskin R, Lee Y, Liu Y, Law C, Klotz LH, Loblaw DA, Trachtenberg J, Stanimirovic A, Simor AE, Seth A, Urbach DR, Narod SA (2010) Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol 183(3):963–968. doi:10.1016/j.juro.2009.11.043

    Article  PubMed  Google Scholar 

  9. Ahmed HU, Kirkham A, Arya M, Illing R, Freeman A, Allen C, Emberton M (2009) Is it time to consider a role for MRI before prostate biopsy? Nat Rev Clin Oncol 6(4):197–206. doi:10.1038/nrclinonc.2009.18

    Article  PubMed  Google Scholar 

  10. Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, Mottet N, Schmid HP, van der Kwast T, Wiegel T, Zattoni F, European Association of U (2011) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 59(1):61–71. doi:10.1016/j.eururo.2010.10.039

    Article  PubMed  Google Scholar 

  11. Mazaheri Y, Shukla-Dave A, Muellner A, Hricak H (2008) MR imaging of the prostate in clinical practice. MAGMA 21(6):379–392. doi:10.1007/s10334-008-0138-y

    Article  PubMed  Google Scholar 

  12. Dickinson L, Ahmed HU, Allen C, Barentsz JO, Carey B, Futterer JJ, Heijmink SW, Hoskin PJ, Kirkham A, Padhani AR, Persad R, Puech P, Punwani S, Sohaib AS, Tombal B, Villers A, van der Meulen J, Emberton M (2011) Magnetic resonance imaging for the detection, localisation, and characterisation of prostate cancer: recommendations from a European consensus meeting. Eur Urol 59(4):477–494. doi:10.1016/j.eururo.2010.12.009

    Article  PubMed  Google Scholar 

  13. Dickinson L, Ahmed HU, Allen C, Barentsz JO, Carey B, Futterer JJ, Heijmink SW, Hoskin P, Kirkham AP, Padhani AR, Persad R, Puech P, Punwani S, Sohaib A, Tombal B, Villers A, Emberton M (2013) Scoring systems used for the interpretation and reporting of multiparametric MRI for prostate cancer detection, localization, and characterization: could standardization lead to improved utilization of imaging within the diagnostic pathway? J Magn Reson Imaging 37(1):48–58. doi:10.1002/jmri.23689

    Article  PubMed  Google Scholar 

  14. Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G, Rouviere O, Logager V, Futterer JJ, European Society of Urogenital R (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22(4):746–757. doi:10.1007/s00330-011-2377-y

    Article  PubMed Central  PubMed  Google Scholar 

  15. Siddiqui MM, Rais-Bahrami S, Truong H, Stamatakis L, Vourganti S, Nix J, Hoang AN, Walton-Diaz A, Shuch B, Weintraub M, Kruecker J, Amalou H, Turkbey B, Merino MJ, Choyke PL, Wood BJ, Pinto PA (2013) Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy. Eur Urol 64(5):713–719. doi:10.1016/j.eururo.2013.05.059

    Article  PubMed  Google Scholar 

  16. Moore CM, Robertson NL, Arsanious N, Middleton T, Villers A, Klotz L, Taneja SS, Emberton M (2013) Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review. Eur Urol 63(1):125–140. doi:10.1016/j.eururo.2012.06.004

    Article  PubMed  Google Scholar 

  17. Roethke MC, Kuru TH, Schultze S, Tichy D, Kopp-Schneider A, Fenchel M, Schlemmer HP, Hadaschik BA (2014) Evaluation of the ESUR PI-RADS scoring system for multiparametric MRI of the prostate with targeted MR/TRUS fusion-guided biopsy at 3.0 Tesla. Eur Radiol 24(2):344–352. doi:10.1007/s00330-013-3017-5

    Article  CAS  PubMed  Google Scholar 

  18. Kuru TH, Saeb-Parsy K, Cantiani A, Frey J, Lombardo R, Serrao E, Gaziev G, Koo B, Roethke M, Gnanapragasam V, Warren A, Doble A, Hadaschik B, Kastner C (2014) Evolution of repeat prostate biopsy strategies incorporating transperineal and MRI-TRUS fusion techniques. World J Urol 32(4):945–950. doi:10.1007/s00345-014-1334-1

    Article  PubMed  Google Scholar 

  19. Marks L, Young S, Natarajan S (2013) MRI-ultrasound fusion for guidance of targeted prostate biopsy. Curr Opin Urol 23(1):43–50. doi:10.1097/MOU.0b013e32835ad3ee

    Article  PubMed Central  PubMed  Google Scholar 

  20. D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, Tomaszewski JE, Renshaw AA, Kaplan I, Beard CJ, Wein A (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280(11):969–974

    Article  PubMed  Google Scholar 

  21. Shoji S, Hiraiwa S, Endo J, Hashida K, Tomonaga T, Nakano M, Sugiyama T, Tajiri T, Terachi T, Uchida T (2014) Manually controlled targeted prostate biopsy with real-time fusion imaging of multiparametric magnetic resonance imaging and transrectal ultrasound: an early experience. Int J Urol: Off J Jpn Urol Assoc. doi:10.1111/iju.12643

    Google Scholar 

  22. Rothke M, Blondin D, Schlemmer HP, Franiel T (2013) PI-RADS classification: structured reporting for MRI of the prostate. Rofo 185(3):253–261. doi:10.1055/s-0032-1330270

    Article  CAS  PubMed  Google Scholar 

  23. Schimmoller L, Quentin M, Arsov C, Hiester A, Buchbender C, Rabenalt R, Albers P, Antoch G, Blondin D (2014) MR-sequences for prostate cancer diagnostics: validation based on the PI-RADS scoring system and targeted MR-guided in-bore biopsy. Eur Radiol 24(10):2582–2589. doi:10.1007/s00330-014-3276-9

    Article  PubMed  Google Scholar 

  24. Ashley T (2005) Using predictive value, sensitivity and specificity to interpret laboratory tests: PSA for the diagnosis of prostate cancer. J Insur Med 37(4):261–263

    PubMed  Google Scholar 

  25. Bott SR, Young MP, Kellett MJ, Parkinson MC, Contributors to the UCLHTRPD (2002) Anterior prostate cancer: is it more difficult to diagnose? BJU Int 89(9):886–889

    Article  CAS  PubMed  Google Scholar 

  26. Chun FK, Herrmann TR (2014) Prostate imaging—the future is now: current concepts and future potentials. World J Urol 32(4):843–845. doi:10.1007/s00345-014-1354-x

    Article  PubMed  Google Scholar 

  27. Roethke M, Anastasiadis AG, Lichy M, Werner M, Wagner P, Kruck S, Claussen CD, Stenzl A, Schlemmer HP, Schilling D (2012) MRI-guided prostate biopsy detects clinically significant cancer: analysis of a cohort of 100 patients after previous negative TRUS biopsy. World J Urol 30(2):213–218. doi:10.1007/s00345-011-0675-2

    Article  CAS  PubMed  Google Scholar 

  28. Schimmoller L, Quentin M, Arsov C, Lanzman RS, Hiester A, Rabenalt R, Antoch G, Albers P, Blondin D (2013) Inter-reader agreement of the ESUR score for prostate MRI using in-bore MRI-guided biopsies as the reference standard. Eur Radiol 23(11):3185–3190. doi:10.1007/s00330-013-2922-y

    Article  CAS  PubMed  Google Scholar 

  29. de Rooij M, Crienen S, Witjes JA, Barentsz JO, Rovers MM, Grutters JP (2013) Cost-effectiveness of magnetic resonance (MR) imaging and MR-guided targeted biopsy versus systematic transrectal ultrasound-guided biopsy in diagnosing prostate cancer: a modelling study from a health care perspective. Eur Urol. doi:10.1016/j.eururo.2013.12.012

    PubMed  Google Scholar 

  30. Mowatt G, Scotland G, Boachie C, Cruickshank M, Ford JA, Fraser C, Kurban L, Lam TB, Padhani AR, Royle J, Scheenen TW, Tassie E (2013) The diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localisation of prostate abnormalities for biopsy: a systematic review and economic evaluation. Health Technol Assess 17(20):1–281. doi:10.3310/hta17200

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank “Fritz und Gertrud Stegmeier-Stiftung” for financial support.

Conflict of interest

Dr. Hueper reports grants from DFG outside the submitted work. Dr. Herrmann reports consultancy Karl Storz, LisaLaser, Boston Scientific, and Ipsen outside the submitted word. Mr. Renckly is freelance collaborator for DK Technologies. Dr. Wacker reports grants from BMBF, German Centre for Lung Research (DZL), during the conduct of the study; grants from Promedicus Ltd., grants from DFG, Rebirth-Cluster of Excellence, grants from Siemens Healthcare, outside the submitted work.

Ethical standard

The study has been approved by the local ethic committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients gave their informed consent prior to their inclusion in the study.

Author information

Author notes

    Authors and Affiliations

    1. Institute for Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany

      Susanne Tewes, Katja Hueper, Dagmar Hartung, Juergen Weidemann & Frank Wacker

    2. Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany

      Florian Imkamp, Thomas R. W. Herrmann, Stefan Renckly, Markus A. Kuczyk & Inga Peters

    Authors
    1. Susanne Tewes
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Katja Hueper
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Dagmar Hartung
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Florian Imkamp
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Thomas R. W. Herrmann
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Juergen Weidemann
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Stefan Renckly
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Markus A. Kuczyk
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Frank Wacker
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Inga Peters
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Susanne Tewes.

    Additional information

    Susanne Tewes and Katja Hueper have contributed equally to this manuscript.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Tewes, S., Hueper, K., Hartung, D. et al. Targeted MRI/TRUS fusion-guided biopsy in men with previous prostate biopsies using a novel registration software and multiparametric MRI PI-RADS scores: first results. World J Urol 33, 1707–1714 (2015). https://doi.org/10.1007/s00345-015-1525-4

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00345-015-1525-4

    Keywords

    Search

    Navigation