TY - JOUR
T1 - Targeted Prostate Biopsy
T2 - Umbra, Penumbra, and Value of Perilesional Sampling
AU - Brisbane, Wayne G.
AU - Priester, Alan M.
AU - Ballon, Jorge
AU - Kwan, Lorna
AU - Delfin, Merdie K.
AU - Felker, Ely R.
AU - Sisk, Anthony E.
AU - Hu, Jim C.
AU - Marks, Leonard S.
N1 - Publisher Copyright:
© 2022 European Association of Urology
PY - 2022
Y1 - 2022
N2 - Background: Systematic prostate biopsies add to the cancer detection rate of targeted biopsies, but the explanation for that increased sensitivity is not yet clear. Objective: To determine and quantify the utility of perilesional biopsies in the detection of clinically significant prostate cancer (csPCa). Design, setting, and participants: Participants were 2048 men with magnetic resonance imaging (MRI) lesions (grades 3–5) who underwent targeted and systematic prostate biopsy via MRI/ultrasound fusion at University of California Los Angeles and Cornell between 2011 and 2019. The study is a retrospective examination of prospectively acquired data. Outcome measurements and statistical analysis: All biopsy cores (30 191), locations of which had been stored digitally in the image-fusion device, were analyzed for tissue pathology and relationship with MRI lesions. A validated Matlab script was used to determine the distance between MRI lesions and cores containing csPCa (3552 cores from 927 men). Significance of distance measurements was determined by multilevel, multivariable logistic regression to account for within patient-biopsy correlation and control for patient characteristics. Results and limitations: Overall, 90% (95% confidence interval [CI] = 89–91) of csPCa cores (3206/3552) were located within a radius of 10 mm from the nearest lesion: 65% (95% CI = 63–67) within the region of interest (ROI) and 26% (95% CI = 24–27) outside the ROI but within the 10-mm “penumbra.” The width of the penumbra or concentric band, which enclosed 90% of csPCa, was primarily related to MRI grade of lesion: grade 5, 5 mm; grade 4, 12 mm; grade 3, 16 mm. In 18% (95% CI = 15–20) of patients (166/927), csPCa was diagnosed only by sampling outside the MRI lesion, the yield decreasing with increasing distance. Limitations of MRI interpretation and fusion biopsy performance could affect the utility of these data in individual patients. Conclusions: Perilesional biopsies, that is, samples taken from a band of 10-mm radius outside MRI lesions (the penumbra), contain most cores of csPCa that are not present within the lesion. These data may help increase the performance characteristics of targeted prostate biopsy. Patient summary: We studied the locations of cancer within the prostate in men undergoing magnetic resonance imaging (MRI)-guided biopsy. We found that not all cancers are located within the MRI lesion, but 90% (95% confidence interval = 89–91) of the cancers are within 1 cm of the lesions. Biopsies taken from both within and around MRI lesions provide greater sensitivity for cancer detection than samples taken from the lesion only.
AB - Background: Systematic prostate biopsies add to the cancer detection rate of targeted biopsies, but the explanation for that increased sensitivity is not yet clear. Objective: To determine and quantify the utility of perilesional biopsies in the detection of clinically significant prostate cancer (csPCa). Design, setting, and participants: Participants were 2048 men with magnetic resonance imaging (MRI) lesions (grades 3–5) who underwent targeted and systematic prostate biopsy via MRI/ultrasound fusion at University of California Los Angeles and Cornell between 2011 and 2019. The study is a retrospective examination of prospectively acquired data. Outcome measurements and statistical analysis: All biopsy cores (30 191), locations of which had been stored digitally in the image-fusion device, were analyzed for tissue pathology and relationship with MRI lesions. A validated Matlab script was used to determine the distance between MRI lesions and cores containing csPCa (3552 cores from 927 men). Significance of distance measurements was determined by multilevel, multivariable logistic regression to account for within patient-biopsy correlation and control for patient characteristics. Results and limitations: Overall, 90% (95% confidence interval [CI] = 89–91) of csPCa cores (3206/3552) were located within a radius of 10 mm from the nearest lesion: 65% (95% CI = 63–67) within the region of interest (ROI) and 26% (95% CI = 24–27) outside the ROI but within the 10-mm “penumbra.” The width of the penumbra or concentric band, which enclosed 90% of csPCa, was primarily related to MRI grade of lesion: grade 5, 5 mm; grade 4, 12 mm; grade 3, 16 mm. In 18% (95% CI = 15–20) of patients (166/927), csPCa was diagnosed only by sampling outside the MRI lesion, the yield decreasing with increasing distance. Limitations of MRI interpretation and fusion biopsy performance could affect the utility of these data in individual patients. Conclusions: Perilesional biopsies, that is, samples taken from a band of 10-mm radius outside MRI lesions (the penumbra), contain most cores of csPCa that are not present within the lesion. These data may help increase the performance characteristics of targeted prostate biopsy. Patient summary: We studied the locations of cancer within the prostate in men undergoing magnetic resonance imaging (MRI)-guided biopsy. We found that not all cancers are located within the MRI lesion, but 90% (95% confidence interval = 89–91) of the cancers are within 1 cm of the lesions. Biopsies taken from both within and around MRI lesions provide greater sensitivity for cancer detection than samples taken from the lesion only.
KW - Magnetic resonance imaging
KW - Prostate biopsy
KW - Prostate cancer
UR - http://www.scopus.com/inward/record.url?scp=85123838063&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2022.01.008
DO - 10.1016/j.eururo.2022.01.008
M3 - Artículo
C2 - 35115177
AN - SCOPUS:85123838063
JO - European Urology
JF - European Urology
SN - 0302-2838
ER -