Presentation Authors: Jeffrey L. Ellis*, Philadelphia, PA, Richard E. Fan, Geoffrey A. Sonn, Stanford, CA, David Y. T. Chen, Philadelphia, PA, Benjamin T. Ristau, Farmington, CT, Rosaleen B. Parsons, Barton Milestone, Marion Brody, Laura Levin, Rosalia Viterbo, Richard Greenberg, Marc Smaldone, Robert Uzzo, Jordan Anaokar, Alexander Kutikov, Philadelphia, PA
Introduction: The AIM and ReM were recently introduced to objectify fusion biopsy deliverables. The AIM metric affords a quantifiable assessment of when US/MRI fusion targeted biopsy (TB) technology provides actionable information over standard systematic template biopsy (SB). Meanwhile, ReM captures the cases where a SB could have been omitted. Here we applied these tools to two large tertiary center cohorts at disparate geographic locations, diverse patient populations, and different fusion biopsy methods to help understand how TB technology performs in varied clinical settings.
Methods: Using prospectively maintained databases, we identified men who underwent concomitant TB and SB using the UroNav System (InVivoÂ®) at Fox Chase Cancer Center and the Artemis System (EigenÂ®) at Stanford University Medical Center. Actionable intelligence metric (AIM) was defined as all patients with higher Gleason score (GS) on TB (minimum GS â‰¥ 3+4=7) relative to SB divided by total patients with GS â‰¥ 3+4=7 CaP (i.e. % patients for whom TB offered actionable information over SB). Reduction metric (ReM) was defined as 1 - [all patients with higher GS on SB relative to TB &[divide] total patients undergoing biopsy] (i.e. % patients who could have foregone SB).
Results: We analyzed 1,505 biopsies (patient median age: 65.2, median PSA: 7.1) performed at two institutions between March 2014 and September 2018. Across both institutions, patients with a previous negative biopsy had considerably higher AIM&[prime]s than naive patient or those on active surveillance, while patients with a PIRADS 3 lesion on MRI had the lowest AIM of any subgroup (Figure 1). Patients with a PIRADS 3 lesion had the highest ReM while patients on active surveillance had the lowest ReM at both institutions (Figure 1).
Conclusions: Significantly more patients benefited from fusion targeting technology at Institution 2 (45%) than Institution 1 (26%). While relatively similar percentage of patients (~85%) could have had SB omitted at both Centers. AIM and ReM metrics are likely a reflection of patient case-mix, mpMRI read accuracy, and co-registration quality. Assessment of AIM/ReM provides meaningful and useful comparisons of fusion biopsy deliverables and affords opportunities for multidisciplinary optimization of this complex technology.