Diagnostic Yield of Incremental Biopsy Cores and Second Lesion Sampling for In-Gantry MRI-Guided Prostate Biopsy.

Seyfried, Nicole; Mahran, Amr; Panda, Ananya; Obmann, Verena C.; Buzzy, Christina A; Jiang, Yun; Wright, Katherine L; Nakamoto, Dean A; Patel, Indravadan J; Conroy, Britt; Ponsky, Lee; Gulani, Vikas (2021). Diagnostic Yield of Incremental Biopsy Cores and Second Lesion Sampling for In-Gantry MRI-Guided Prostate Biopsy. AJR, American journal of roentgenology, 217(4), pp. 908-918. American Roentgen Ray Society 10.2214/AJR.20.24918

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Background: In-gantry MRI-guided biopsy (MRGB) of the prostate has been shown to be more accurate than other targeted prostate biopsy methods. However, the optimal number of cores to obtain during in-gantry MRGB remains undetermined. Objective: To assess the diagnostic yield of incremental cores of the primary lesion and of second lesion sampling during in-gantry MRGB of the prostate. Methods: This retrospective study included 128 men with a total of 163 prostate lesion who underwent in-gantry MRGB between 2016 and 2019. The men had a total of 163 lesions sampled with ≥2 cores, 121 lesions sampled with ≥3 cores, and 52 lesions sampled with ≥4 cores. A total of 40 men underwent sampling of a second lesion. Upgrade on a given core was defined as a greater International Society of Urologic Pathology Grade Group (ISUP-GG) relative to the previously obtained cores. Clinically significant cancer (csPCa) was defined as ISUP-GG 2 or greater. Results: The frequency of any upgrade was 12.9% (21/163) on core 2, versus 10.7% (13/121) on core 3 (p=.29 relative to core 2) and 1.9% (1/52) on core 4 (p=.03 relative to core 3). The frequency of upgrade to csPCa was 7.4% (12/163) on core 2, versus 4.1% (5/121) on core 3 (p=.13 relative to core 2), and 0.0% (0/52) on core 4 (p=.07 relative to core 3). The frequency of upgrade on core 2 was higher for anterior lesions (p <.001) and lesions with a higher PI-RADS score (p= .007); the frequency of upgrade on core 3 was higher for apical lesions (p= .01) and lesions with a higher PI-RADS score (p= .01). Sampling of a second lesion upgraded a single patient (2.5%; 1/40); both lesions were PI-RADS score 4 and contained csPCa. Conclusion: When performing in-gantry MRGB of the prostate, obtaining three cores from the primary lesion is warranted to optimize csPCa diagnosis. Obtaining a 4th core from the primary lesion or sampling a second lesion has very low yield in upgrading cancer diagnoses. Clinical Impact: Operators may refrain from obtaining more than 3 cores or second lesion sampling to reduce patient discomfort and procedure times.

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