MP46-03 MRI-US FUSION BIOPSY FOR IMPROVED PREDICTION OF WHOLE-ORGAN PROSTATE PATHOLOGY (2014)

You have accessJournal of UrologyProstate Cancer: Localized IV1 Apr 2014MP46-03 MRI-US FUSION BIOPSY FOR IMPROVED PREDICTION OF WHOLE-ORGAN PROSTATE PATHOLOGY Jesse Le, Samuel Stephenson, Michelle Brugger, David Lu, Geoffrey Sonn, Patricia Lieu, Shyam Natarajan, Frederick Dorey, Jiaoti Huang, Daniel Margolis, Robert Reiter, and Leonard Marks Jesse LeJesse Le More articles by this author , Samuel StephensonSamuel Stephenson More articles by this author , Michelle BruggerMichelle Brugger More articles by this author , David LuDavid Lu More articles by this author , Geoffrey SonnGeoffrey Sonn More articles by this author , Patricia LieuPatricia Lieu More articles by this author , Shyam NatarajanShyam Natarajan More articles by this author , Frederick DoreyFrederick Dorey More articles by this author , Jiaoti HuangJiaoti Huang More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , Robert ReiterRobert Reiter More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1436AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Accurate prediction of whole-organ pathology is an important unmet need in men with prostate cancer (CaP). Conventional biopsy may under-estimate final pathology in as many as 50% of cases. Targeted biopsy using MRI-ultrasound (MRI-US) fusion improves detection of clinically significant CaP (J.Urol. 189: 86, 2013). Thus, we studied the use of fusion biopsy in the prediction of whole-organ pathology. Methods All 57 men undergoing radical prostatectomy (RP) at UCLA (1/10 – 7/13) who had fusion biopsy were included in this prospective IRB-approved study. Biopsy was performed within 3 months prior to RP. The Artemis fusion device (Eigen, Grass Valley, CA) was used by a single urologist (LM) to obtain cores from a 12-point systematic grid (mapping biopsy, MBx) and from any regions of interest on multi-parametric MRI (targeted biopsy, TBx). A single radiologist (DM) read all MRIs, and a single pathologist (DL) independently re-reviewed all biopsy and whole mount pathology, blinded to prior interpretation and matched specimen. Gleason score (GS) concordance between biopsy and whole mount was the primary endpoint; concordance was calculated using three measures: highest Gleason pattern overall (max GG); sum of primary and secondary Gleason pattern (G1, G2); sum of G1 and tertiary Gleason pattern (G3) if >G2. The Goodman-Kruskal gamma statistic (γ) was used as a measure of agreement. Results Median age was 65 years (51-78) with median PSA 8.2 ng/ml (1.7-53). Final GS was 6 (14%), 7 (68%), and 8-9 (18%); a G3 was assigned in 18 (32%) men. In the 57 men, 107 MRI targets for biopsy were identified, 60/107 (56%) of which were CaP positive; Tbx yielded CaP in more men than MBx (84% versus 70%). Max GG was detected by Mbx in 52%, by Tbx in 60%, and by the combination in 82% of cases. The upgrading rate was 16% when both the Mbx and Tbx were combined. One case was downgraded on final pathology (2%). The combination of Tbx (γ=0.43-0.48) and Mbx (γ=0.56-0.68) were needed to obtain the best predictive accuracy (γ=0.89-0.97) (table). Conclusions Use of MR-US fusion biopsy allows for prediction of final prostate pathology with greater accuracy than that reported using conventional methods. Accurate knowledge of whole-organ pathology, provided by fusion biopsy, has important clinical implications. Table. Predictive accuracy of Gleason grade with MRI-US fusion biopsy Mapping biopsy, n (%) Targeted biopsy, n (%) Combined, n (%) Max GG Concordant 25 (52) 34 (60) 47 (82) Upgraded 23 (48) 22 (39) 9 (16) Downgraded 0 (0) 1 (2) 1 (2) GS Concordant 24 (50) 33 (58) 41 (72) Upgraded 19 (40) 16 (28) 4 (7) Downgraded 5 (10) 8 (14) 12 (21) GS with G3 Concordant 21 (44) 33 (58) 44 (77) Upgraded 27 (56) 23 (40) 12 (21) Downgraded 0 (0) 1 (2) 1 (2) Max GG (highest Gleason grade pattern); GS (Gleason score with primary and secondary pattern); GS with G3 (tertiary pattern used in score if higher than secondary Gleason pattern). © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e510-e511 Advertisement Copyright & Permissions© 2014Metrics Author Information Jesse Le More articles by this author Samuel Stephenson More articles by this author Michelle Brugger More articles by this author David Lu More articles by this author Geoffrey Sonn More articles by this author Patricia Lieu More articles by this author Shyam Natarajan More articles by this author Frederick Dorey More articles by this author Jiaoti Huang More articles by this author Daniel Margolis More articles by this author Robert Reiter More articles by this author Leonard Marks More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...