MRI–Ultrasound Fused Approach for Prostate Biopsy—How It Is Performed
Abstract
:Simple Summary
Abstract
1. Introduction
2. mpMRI and Identification of Lesions
3. Current Indications
4. Overview of mpMRI-Guided Biopsy Techniques
4.1. Cognitive Fusion
4.2. mpMRI–TRUS Fusion
4.3. Direct In-Bore/In-Gantry
5. Comparative Effectiveness
5.1. mpMRI-Guided versus Systematic TRUS Biopsy
5.2. Comparison across mpMRI-Guided Biopsy Techniques
5.3. TP vs. TR Approach
5.4. Case Presentation
5.5. Future Directions
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Society—Guideline | Statement(s) | Recommendation (Grade) |
---|---|---|
AUA/SUO— Early Detection of Prostate Cancer | Clinicians may use MRI prior to initial biopsy to increase the detection of GG2+ | Conditional Recommendation; Evidence Level (Grade B) |
For biopsy-naïve patients who have a suspicious lesion on MRI, clinicians should perform targeted biopsies of the suspicious lesion and may also perform a systematic template biopsy. | Moderate Recommendation [targeted biopsies]/Conditional Recommendation [systematic template biopsy]; Evidence Level (Grade C) | |
In patients undergoing repeat biopsy with no prior prostate MRI, clinicians should obtain a prostate MRI prior to biopsy. | Strong Recommendation; Evidence Level: Grade C) | |
In patients undergoing repeat biopsy and who have a suspicious lesion on MRI, clinicians should perform targeted biopsies of the suspicious lesion and may also perform a systematic template biopsy. | Moderate Recommendation [targeted biopsies]/Conditional Recommendation [systematic template biopsy] Evidence Level: Grade C | |
Clinicians may use software registration of MRI and ultrasound images during fusion biopsy, when available. | Expert Opinion | |
Clinicians should obtain at least 2 needle biopsy cores per target in patients with suspicious prostate lesion(s) on MRI. | Moderate Recommendation; Evidence Level: Grade C | |
European Association of Urology/European Association of Nuclear Medicine/European Society for Radiotherapy and Oncology/European Society of Urogenital Radiology/International Society of Urological Pathology/International Society of Geriatric Oncology (EAU/EANM/ESTRO/ESUR/ISUP/SIOG)— Guidelines on Prostate Cancer | Guidelines for MRI in biopsy decision Recommendations in biopsy-naïve patients | |
Perform MRI before prostate biopsy. | Strong | |
When MRI is positive (i.e., PI-RADS ≥ 3), combine targeted and systematic biopsy | Strong | |
Recommendations in patients with prior negative biopsy | ||
Perform MRI before prostate biopsy | Strong | |
When MRI is positive (i.e., PI-RADS ≥ 3), perform targeted biopsy only. | Weak | |
Guidelines for first-line treatment of various disease stages Active Surveillance | ||
Perform MRI before a confirmatory biopsy if no MRI has been performed before the initial biopsy | Strong | |
Take both targeted biopsy (of any PI-RADS ≥ 3 lesion) and systematic biopsy if a confirmatory biopsy is performed. | Weak | |
If a patient has had upfront MRI followed by systematic and targeted biopsies there is no need for confirmatory biopsies | Weak | |
NCCN—Prostate Cancer Early Detection | Further evaluation and indications for biopsy | |
mpMRI if available High suspicion for clinically significant cancer: Image-guided biopsy via TR or TP approach with MRI targeting (preferred) or without MRI targeting | It is strongly recommended that image-guided biopsy techniques be employed routinely | |
Management of biopsy results | ||
Atypical intraductal proliferation (AIP) without invasive carcinoma Repeat biopsy using MRI targeting and systematic biopsy to look for invasive carcinoma | AIP is potentially considered a marker of unsampled cancer, and it is associated with an increased risk (50%) of invasive carcinoma and/or intraductal carcinoma on repeat biopsy |
Vendor/Device | Ultrasound | Tracking Mechanism | Biopsy Route | FDA 510(k) |
---|---|---|---|---|
Invivo(Philips) UroNav | Manual sweep | Electromagnetic | Transrectal, ṗ transperineal | 2005 |
Eigen Artemis | Manual rotation | Articulated arm | Transrectal | 2008 |
Koelis Urostation | Automatic rotation | Image-based | Transrectal | 2010 |
Pi Medical BiopSee | Biplane probe on stepper | Stepper with encoders | Transperineal | N/A |
Esaote Virtual Navigator | Manual sweep/rotation | Electromagnetic | Transrectal | 2014 |
BK Ultrasound BioJet Fusion | Biplane probe on stepper | Stepper with encoders | Transrectal or transperineal | 2012 |
Hitachi/Real-Time Virtual Sonography | Real-time biplanar | Electromagnetic | Transrectal or transperineal | 2010 |
MIM Software Symphony Bx | Biplane probe on stepper | Stepper with encoders | Transperineal | 2014 |
Focal Healthcare Fusion Bx | Manual rotation | Articulated arm | Transrectal | 2016 |
UC-Care Navigo | Manual sweep | Electromagnetic | Transrectal | 2016 |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Lang, J.; McClure, T.D.; Margolis, D.J.A. MRI–Ultrasound Fused Approach for Prostate Biopsy—How It Is Performed. Cancers 2024, 16, 1424. https://doi.org/10.3390/cancers16071424
Lang J, McClure TD, Margolis DJA. MRI–Ultrasound Fused Approach for Prostate Biopsy—How It Is Performed. Cancers. 2024; 16(7):1424. https://doi.org/10.3390/cancers16071424
Chicago/Turabian StyleLang, Jacob, Timothy Dale McClure, and Daniel J. A. Margolis. 2024. "MRI–Ultrasound Fused Approach for Prostate Biopsy—How It Is Performed" Cancers 16, no. 7: 1424. https://doi.org/10.3390/cancers16071424