5 years ago

Defining Novel and Practical Metrics to Assess the Deliverables of Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion Prostate Biopsy

Multiparametric magnetic resonance (mpMRI)/ultrasound targeted prostate biopsy (TB) is touted as a tool to improve prostate cancer care. Yet, the true clinical utility of TB over transrectal ultrasound-guided prostate biopsy (TRUS-B) has not been systematically analyzed. We introduce two metrics to better quantify and report the deliverables of TB. Materials and Methods We reviewed our prospective database containing patients who underwent simultaneous TB/TRUS-B. Actionable Intelligence Metric (AIM) was defined as the proportion of patients for whom TB provided actionable information over TRUS-B. Reduction Metric (ReM) was defined as the proportion of men in whom TRUS-B could have been omitted. We compared metrics within our cohort and prior reports. Results 371 men were included. AIM and ReM were 22.2% and 83.6% for biopsy naïve, 26.7% and 84.2% for prior negative TRUS-B, and 24% and 77.5% for active surveillance patients. No significant differences among groups were observed (p = 0.89 for AIM; p = 0.27 for ReM). AIM was 25.0% for PIRADS 3, 27.5% for PIRADS 4 and 21.7% for PIRADS 5 (p = 0.73) lesions. TRUS-B could have been avoided in more patients with PIRADS 3 compared to PIRADS 4/5 lesions (ReM 92.0% vs. 76.7%, p < 0.01). Our results compare favorably to other reported series. Conclusions AIM and ReM are novel, clinically relevant quantification metrics to standardize reporting of TB deliverables. TB affords actionable information (AIM) in ∼25% of men. ReM assessment highlights that TRUS-B may only be omitted after carefully considering the risk of missing clinically significant cancers.

Publisher URL: www.sciencedirect.com/science

DOI: S0022534717776732

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