Home > Journals > Minerva Urologica e Nefrologica > Past Issues > Minerva Urologica e Nefrologica 2015 September;67(3) > Minerva Urologica e Nefrologica 2015 September;67(3):233-46



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Minerva Urologica e Nefrologica 2015 September;67(3):233-46


language: English

MRI/TRUS fusion software-based targeted biopsy: the new standard of care?

Manfredi M. 1, Costa Moretti T. B. 1, 2, Emberton M. 3, 4, Villers A. 5, Valerio M. 3, 4, 6

1 Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy; 2 Department of Urology, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil; 3 Division of Surgery and Interventional Science, University College London, London, UK; 4 Department of Urology, University College London Hospitals, NHS Foundation Trust, London, UK; 5 Department of Urology, CHRU Lille, Université Lille Nord de France, Lille, France; 6 Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland


The advent of multiparametric MRI has made it possible to change the way in which prostate biopsy is done, allowing to direct biopsies to suspicious lesions rather than randomly. The subject of this review relates to a computer-assisted strategy, the MRI/US fusion software-based targeted biopsy, and to its performance compared to the other sampling methods. Different devices with different methods to register MR images to live TRUS are currently in use to allow software-based targeted biopsy. Main clinical indications of MRI/US fusion software-based targeted biopsy are re-biopsy in men with persistent suspicious of prostate cancer after first negative standard biopsy and the follow-up of patients under active surveillance. Some studies have compared MRI/US fusion software-based targeted versus standard biopsy. In men at risk with MRI-suspicious lesion, targeted biopsy consistently detects more men with clinically significant disease as compared to standard biopsy; some studies have also shown decreased detection of insignificant disease. Only two studies directly compared MRI/US fusion software-based targeted biopsy with MRI/US fusion visual targeted biopsy, and the diagnostic ability seems to be in favor of the software approach. To date, no study comparing software-based targeted biopsy against in-bore MRI biopsy is available. The new software-based targeted approach seems to have the characteristics to be added in the standard pathway for achieving accurate risk stratification. Once reproducibility and cost-effectiveness will be verified, the actual issue will be to determine whether MRI/TRUS fusion software-based targeted biopsy represents anadd-on test or a replacement to standard TRUS biopsy.

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