Genitourinary Cancer

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SU_27_2278 - Radiologic and Pathologic Correlation Using a Commercially Available MRI-Guided Transperineal Prostate Biopsy Planning System

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Radiologic and Pathologic Correlation Using a Commercially Available MRI-Guided Transperineal Prostate Biopsy Planning System
R. A. Hsi1, K. Schulze2, S. Bildsten2, C. Bensen3, A. Sabolch4, A. Li5, and M. Henne6; 1Peninsula Cancer Center, Poulsbo, WA, 2CHI Franciscan Urology, Port Orchard, WA, 3Olympic Medical Center, Port Angeles, WA, 4Department of Radiation Oncology, Kaiser Permanente, Portland, OR, 5The Doctors Clinic, Silverdale, WA, 6In Health Imaging, Poulsbo, WA

Purpose/Objective(s): To define the correlation between radiologic and pathologic findings using a commercially available MRI-guided transperineal prostate biopsy planning system.

Materials/Methods: Seventy-seven patients underwent MRI-guided prostate biopsy using a transperineal approach under general anesthesia. For each patient, a pre-biopsy multiparametric MRI (mpMRI) scan was obtained and imported into a commercially available prostate biopsy planning system. Transverse images were then reoriented from the supine to dorsal lithotomy position. Dividing the prostate into an apical and base section, an array of transperineal biopsies spaced approximately 10mm apart was planned with additional biopsies targeting mpMRI-identified PI-RADS 3, 4 or 5 lesions. Biopsy procedures were carried out in the dorsal lithotomy position using a transrectal ultrasound with stepper-stabilizer and template grid. Matching of the planning mpMRI images to live ultrasound images was achieved using the template grid as a reference.

Results: All patients successfully underwent their biopsy procedure as planned. An average of 27 biopsy specimens were obtained per patient (range 11-44). Prostate cancer of any grade was identified in 56% (43/77) of patients and Gleason score ≥ 7 disease was identified in 44% (34/77) of patients. Twenty-six percent (10/39) of PI-RADS 3 lesions, 48% (24/50) of PI-RADS 4 lesions, and 70% (19/27) of PI-RADS 5 lesions were pathologically confirmed prostate cancer. Ninety-five percent (18/19) of PI-RADS 5 lesions associated with cancer were found to identify GS ≥ 7 disease. Thirty-two percent (25/77) patients had pathologically confirmed tumors that were not identified on mpMRI. However, only 5% (4/77) of patients harbored mpMRI-unidentified GS≥8 disease. Post biopsy urinary retention requiring temporary catheter placement occurred in 3.9% (3/77) patients and no patients experienced post biopsy infection.

Conclusion: Pathologic confirmation of MRI-identified prostate cancer increases with increasing PI-RADS category using a commercially available transperineal MRI-guided prostate biopsy system. Although significant numbers of pathologically positive lesions were not identified by mpMRI, most clinically significant (GS ≥ 8) disease was identified.

Author Disclosure: R.A. Hsi: Honoraria; Varian Medical Systems, Augmenix, Inc. K. Schulze: None. S. Bildsten: None. C. Bensen: None. A. Li: None. M. Henne: None.

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