SIU 2014 High PIRADS Final

Correla'on of High PIRADS Score on Three-­‐Tesla Magne'c Resonance with in-­‐Gantry Magne'c Resonance Guided Biopsy Insert your logos R Jyo', N Hamesh Jina, H Haxhimolla Calvary Hospital, Bruce, ACT, Australia
BACKGROUND Prostate cancer detection is a difficult process despite the
various modalities available. The current standard of
practice is based on stratifying risk using Prostate Specific
Antigen (PSA), digital rectal examination (DRE) and
performing a transrectal ultrasound (TRUS) or transperineal
(TP) guided biopsy. There are limitations with this tool which
include a 21% false negative rate using the standard 12
core approach(1), a 42% false negative rate with saturation
sampling and a 30-45% risk of cancer up/downstaging (2)
Recent advances in three-tesla multiparametric magnetic
resonance imaging (MP-MRI) technology has revolutionised
prostate cancer detection. In particular, the availability of ingantry MRI guided biopsies (MRGB) have added another
diagnostic tool to help facilitate this and superior over TRUS
biopsies (3). The literature has shown that prostate cancer
detection rates range from 37-59% with 93% of clinically
significant disease being detected with this modality.(4-6)
RESULTS IMAGES MATERIALS & METHODS We retrospectively present the results from a single surgeon
working in a tertiary hospital who performed MRI guided
biopsies over a 15 month period from December 2012.
Patients recruited in the study were high risk which qualified
as having an elevated PSA (>2.5) on more than one reading
and/or a palpable nodule on rectal examination or
ultrasound, or a previous negative TRUS biopsy
The MRI was interpreted by a single experienced
genitourinary MRI radiologist and the biopsies were
interpreted by a single pathologist. A single report was
generated which was standardised and scored as per a
modified PIRADS criteria.
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There were 121 patients who had PIRADS 4+ lesions
comprising of which were suspicious for a cancer with 75
patients having a PIRADS score 4 and 46 patients having a
PIRADS score 5. There were 38 patients in the PIRADS 4
group (51%) who had a previous negative TRUS and 18 in
the PIRADSS 5 group (39%).
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There were 77 patients (mean age of 63) with high PIRADS
score (4 and 5) that underwent in-gantry MRGB. Out of the
total 77 high PIRADS patients, 54 were PIRADS score 4
(70%) and 23 PIRADS score 5 (30%). There were 22
positive biopsies for adenocarcinoma of prostate with
Gleason’s score of 3+3=6 or higher. Out of the 54 PIRADS
score 4 lesions, 13 were positive (24%) and out of 23
PIRADS 5 lesions, 9 were positive (39%). The remaining 55
biopsies were negative for prostate cancer..
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REFERENCES 1. Noguchi M et al. RelaDonship between systemaDc biopsies and histological features of 222 radical prostatectomy specimens: lack of predicDon of tumour significance for men with nonpalpable prostate cancer. J Urol 2001; 166: 104-­‐109 2. King CR et al. Extended prostate biopsy scheme improves reliability of Gleason grading implicaDonsfor radiotherpy paDents. Int J Radiat Oncol 2004; 59: 386-­‐391 3. Hoeks et al. Three-­‐Tesla MagneDc Resonance–Guided Prostate Biopsy in Men With Increased Prostate-­‐Specific AnDgen and Repeated, NegaDve, Random, SystemaDc, Transrectal Ultrasound Biopsies: DetecDon of Clinically Significant Prostate Cancers. Euro Uro 2012; 62: 902-­‐909 4. Hambrock T et al. MagneDc resonance imaging guided prostate biopsy in men with repeat negaDve biopsies and increased pros_e specific anDgen. J Urol 2012; 183: 520-­‐27 5.Roethke M et al. MRI-­‐guided prostate biopsy detects clinically significant cancer: analysis of a cohort of 100 paDents aaer previous negaDve TRUS biopsy. World J Urol 6. Franiel T et al. Areas suspicious for prostate cancer: MR-­‐guided biopsy in paDents with at least one transrectal US-­‐guided biopsy with a negaDve finding—mulDparametric MR imaging for detecDon and biopsy planning. Radiology 2011;259:162–72. All the biopsies were performed utilizing DynaTrim (Invivo
Inc) prostate biopsy system on a three-tesla MRI scanner
(Philips Ingenia 3.0T). Two to three samples were obtained
from each lesion.
CONCLUSIONS MRI is now widely used as a diagnostic tool for the detection
of prostate cancer in patients who have had negative TRUS
biopsies, a persistently elevated PSA and/or a prostate
nodule clinically or on ultrasound.
We present our series of MRGB in patients with a high
PIRADS score for prostate cancer. Our results do support a
role for MRGB and our positive biopsy rates of 24% with
PIRADS four lesions and 39% with PIRADS five lesions
which is lower than other studies (52-59%), however not all
our patients with high PIRADS score underwent MRGB.
Brisbane series showed that MRI reduces the need for
biopsies by 51% and increased the detection of
intermediate/high grade cancer by 17.7%. None of our
patients have had disease which has been missed and this
is supported with a negative predictive value of 96.9% with
MRGB
While this diagnostic paradigm is in its infancy stages,
MRGB represents an excellent modality for prostate cancer
diagnosis and should be considered in the management of
this condition.
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We recruited 191 patients who met the criteria. The mean
age of the patients was 63 with a majority Caucasian
background. The average size of the gland biopsied on MRI
was 73cc (17-263cc range) with a median PSA of 6.37ng/ml
(0.91-15.9ng/ml range).
OBJECTIVES We review MRGB performed on high PIRADS score
(Prostate Imaging Reporting And Data System) lesions. Our
aim is to correlate the high PIRADS score with the histology
from the in-gantry biopsies.
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Excel. Figures 1-­‐4: Images from paDents with a IRADS 5 lesion which had posiDve biopsies ACKNOWLEDGEMENTS Dr Sanjiv Jain, Pathologist, ACT Health, Australia CONTACT INFORMATION: Dr N Hamesh Jina. Email: [email protected] Tip
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