Impact of Discordance Between Magnetic Resonance Imaging and Ultrasound Volume Measurements on Prostate Fusion Biopsy Outcomes

Tabea Borde; Nicole A Varble; Lindsey A Hazen; Laetitia Saccenti; Charisse Garcia; Meredith Digennaro; Sandeep Gurram; Peter A Pinto; Baris Turkbey; Bradford J Wood

doi:10.1097/JU.0000000000004368

Impact of Discordance Between Magnetic Resonance Imaging and Ultrasound Volume Measurements on Prostate Fusion Biopsy Outcomes

J Urol. 2024 Dec 10:101097JU0000000000004368. doi: 10.1097/JU.0000000000004368. Online ahead of print.

Authors

Tabea Borde¹, Nicole A Varble^{1

2}, Lindsey A Hazen¹, Laetitia Saccenti^{1

3}, Charisse Garcia¹, Meredith Digennaro¹, Sandeep Gurram⁴, Peter A Pinto⁴, Baris Turkbey⁵, Bradford J Wood^{1

4}

Affiliations

¹ Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland.
² Philips Healthcare, Cambridge, Massachusetts.
³ Henri Mondor Biomedical Research Institute, INSERM U955, Créteil, France.
⁴ Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
⁵ Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.

PMID: 39657598
DOI: 10.1097/JU.0000000000004368

Abstract

Purpose: To determine whether the difference between MRI-based and ultrasound (US)-based volume measurements are associated with MRI/US-targeted fusion-guided biopsy outcomes.

Materials and methods: This retrospective, single-center study involved 4177 consecutive patients biopsied between 2010 and 2023 using both MRI/US-targeted fusion and systematic biopsy. Biopsies were indicated because of elevated PSA levels or abnormal multiparametric MRI results. US volume measurements were calculated using the triplane ellipsoid formula, and MRI volumes were obtained by semiautomatic planimetric segmentation. Performance of fusion biopsy compared with systematic biopsy was analyzed with respect to the discordance between MRI and US volume measurements.

Results: In 2736 patients (66%), biopsy detected prostate cancer. In cases where both techniques yielded prostate cancers (1695/2736 [62%]), a statistically higher proportion of patients had higher Gleason scores on MRI/US-targeted fusion biopsy compared with systematic biopsy (343 patients [20.2%] vs 137 patients [8.1%], P < .001). MRI volume measurements were significantly smaller compared with US volume measurements (median [IQR] 54 mL [39-77], 56 mL [40-80], respectively, P < .001). Beyond 5 mL volume discordance, MRI/US-targeted fusion biopsy gradually showed less added diagnostic benefit compared with systematic biopsy. In the ≤ 5 mL cohort, MRI/US-targeted fusion biopsy detected more aggressive tumors in 4 times as many patients than systematic biopsy (136 vs 32 patients, P < .001).

Conclusions: Although MRI/US-targeted fusion biopsy detected more prostate cancers than systematic biopsy, the performance of MRI/US-targeted fusion biopsy declined with more discordance between volumes measured in MRI vs US. Awareness of volume discordance in MRI and US-based volume measurements should alert the operator about the possibility of reduced performance of MRI/US-targeted fusion biopsy.

Keywords: MRI; image-guided biopsy; organ size; prostate; prostatic neoplasms; ultrasonography.