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Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
Inflammation appears as high Prostate Imaging-Reporting and Data System scores on prostate magnetic resonance imaging
Elizabeth Rourke1, Abhijit Sunnapwar2, Daniel Mais3
1Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA.
Purpose:
To investigate if inflammation as a potential cause of false-positive lesions from recent UroNav magnetic resonance imaging (MRI) fusion prostate biopsy patients.
Materials And Methods:
We retrospectively identified 43 men with 61 MRI lesions noted on prostate MRI before MRI ultrasound-guided fusion prostate biopsy. Men underwent MRI with 3T Siemens TIM Trio MRI system (Siemens AG, Germany), and lesions were identified and marked in DynaCAD system (Invivo Corporation, USA) with subsequent biopsy with MRI fusion with UroNav. We obtained targeted and standard 12-core needle biopsies. We retrospectively reviewed pathology reports for inflammation.
Results:
We noted a total of 43 (70.5%) false-positive lesions with 28 having no cancer on any cores, and 15 lesions with cancer noted on systematic biopsy but not in the target region. Of the men with cancer, 6 of the false positive lesions had inflammation in the location of the targeted region of interest (40.0%, 6/15). However, when we examine the 21/28 lesions with an identified lesion on MRI with no cancer in all cores, 54.5% had inflammation on prostate biopsy pathology (12/22, p=0.024). We noted the highest proportion of inflammation.
Conclusions:
Inflammation can confound the interpretation of MRI by mimicking prostate cancer. We suggested focused efforts to differentiate inflammation and cancer on prostate MRI.
Insights
Inflammation can mimic prostate cancer on MRI, leading to false positives in UroNav biopsies. Differentiating inflammation from cancer on prostate MRI is crucial for accurate diagnosis.
Area of Science:
- Radiology
- Pathology
- Urology
Background:
- Prostate MRI is essential for detecting cancer.
- MRI-guided fusion biopsy improves accuracy.
- False-positive findings can lead to unnecessary procedures.
Purpose of the Study:
- To determine if inflammation causes false-positive lesions in MRI-guided prostate biopsies.
- To investigate the role of inflammation in MRI-detected prostate lesions.
Main Methods:
- Retrospective analysis of 43 patients with 61 MRI lesions before UroNav biopsy.
- Utilized 3T Siemens MRI and DynaCAD for lesion identification.
- Reviewed pathology reports for inflammation in targeted and systematic biopsy cores.
Main Results:
- 70.5% of lesions were false positives (43/61).
- Inflammation was present in 40% of false-positive lesions with cancer in systematic cores (6/15).
- Significantly, 54.5% of false-positive lesions without cancer had inflammation (12/22, p=0.024).
Conclusions:
- Inflammation can mimic prostate cancer on MRI, causing false-positive results.
- Distinguishing inflammation from malignancy on prostate MRI requires further investigation.
- Focused efforts are needed to improve diagnostic accuracy.
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