Challenging the Evolving Nomenclature of Ultrasound-Guided Transperineal Prostate Biopsy: A Call for Standardization

The rapid global adoption of ultrasound-guided transperineal prostate biopsy has been accompanied by inconsistent nomenclature, particularly surrounding the term "freehand." This lexical imprecision creates confusion in the scientific literature, limits comparability across studies, and complicates clinical communication.

To clarify the historical and current use of terminology in ultrasound-guided prostate biopsy and to propose a simplified, standardized classification system.

We reviewed the historical evolution of ultrasound-guided biopsy techniques, focusing on the original definition of "freehand" and its subsequent misuse in contemporary practice. We examined the technical distinctions between guideless biopsy, probe-mounted needle guides, and template/grid-based systems, including the role of stepper devices.

The term "freehand" was originally introduced to describe a guideless technique and should not be applied to procedures using a mechanical needle guide attached to the ultrasound transducer. The growing proliferation of expressions such as "full freehand," "pure freehand," "totally freehand," and "double freehand" does not resolve the underlying ambiguity. We further argue that a stepper used only to stabilize the ultrasound probe, without a needle-guiding grid, does not alter the freehand nature of needle manipulation. To reduce ambiguity, we propose a three-tier classification: (1) Template/Grid, (2) Probe-Mounted Guide, and (3) Freehand.

Standardized terminology is essential for accurate scientific reporting, meaningful comparison of outcomes, and effective clinical communication. Adoption of a simplified classification system may improve clarity across future studies and practice.