MRI-targeted Biopsy Cores from Prostate Index Lesions: Assessment and Prediction of the Number Needed

Overview

Journal Prostate Cancer Prostatic Dis

Specialties Oncology
Urology

Date 2022 Oct 8

PMID 36209237

Authors

Nick Lasse Beetz

Franziska Drager

Charlie Alexander Hamm

Seyd Shnayien

Madhuri Monique Rudolph

Konrad Frobose

Sefer Elezkurtaj

Matthias Haas

Patrick Asbach

Bernd Hamm

Samy Mahjoub

Frank Konietschke

Maximilian Wechsung

Felix Balzer

Hannes Cash

Sebastian Hofbauer

Tobias Penzkofer

Affiliations

Soon will be listed here.

Abstract

Background: Magnetic resonance imaging (MRI) is used to detect the prostate index lesion before targeted biopsy. However, the number of biopsy cores that should be obtained from the index lesion is unclear. The aim of this study is to analyze how many MRI-targeted biopsy cores are needed to establish the most relevant histopathologic diagnosis of the index lesion and to build a prediction model.

Methods: We retrospectively included 451 patients who underwent 10-core systematic prostate biopsy and MRI-targeted biopsy with sampling of at least three cores from the index lesion. A total of 1587 biopsy cores were analyzed. The core sampling sequence was recorded, and the first biopsy core detecting the most relevant histopathologic diagnosis was identified. In a subgroup of 261 patients in whom exactly three MRI-targeted biopsy cores were obtained from the index lesion, we generated a prediction model. A nonparametric Bayes classifier was trained using the PI-RADS score, prostate-specific antigen (PSA) density, lesion size, zone, and location as covariates.

Results: The most relevant histopathologic diagnosis of the index lesion was detected by the first biopsy core in 331 cases (73%), by the second in 66 cases (15%), and by the third in 39 cases (9%), by the fourth in 13 cases (3%), and by the fifth in two cases (<1%). The Bayes classifier correctly predicted which biopsy core yielded the most relevant histopathologic diagnosis in 79% of the subjects. PI-RADS score, PSA density, lesion size, zone, and location did not independently influence the prediction model.

Conclusion: The most relevant histopathologic diagnosis of the index lesion was made on the basis of three MRI-targeted biopsy cores in 97% of patients. Our classifier can help in predicting the first MRI-targeted biopsy core revealing the most relevant histopathologic diagnosis; however, at least three MRI-targeted biopsy cores should be obtained regardless of the preinterventionally assessed covariates.

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