REVIEW   Free access

Minerva Urologica e Nefrologica 2020 April;72(2):144-51

DOI: 10.23736/S0393-2249.20.03639-5

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

The optimal core number and site for MRI-targeted biopsy of prostate? A systematic review and pooled analysis

Xiang TU ¹, Tianhai LIN ¹, Diming CAI ², Zhenhua LIU ¹, Lu YANG ¹, Qiang WEI ¹ ✉

¹ Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China; ² Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China

INTRODUCTION: Prebiopsy multiparametric magnetic resonance imaging (mpMRI) has been increasingly utilized for patients of suspicious prostate cancer (PCa). However, the optimal core number and site for MRI-targeted biopsy have not been clearly elucidated.
EVIDENCE ACQUISITION: A systematic search in Pubmed, Embase and Ovid up to June 2019 was conducted and we identified studies reporting detection details of every MRI-targeted core. The incremental diagnostic value of performing additional cores was pooled on per-lesion analysis. Our secondary outcome concentrated on detection accuracy for cores of different site within one lesion.
EVIDENCE SYNTHESIS: Five studies comprising 2291 patients were identified to elucidate the association between targeted core number and cancer detection rates. Adding the second core to the first one resulted in 19.8% (range: 13.6-26.7%) increase in the detection rate of clinically significant lesions, and adding the third one to the first two resulted in 11.5% (range: 7.8-14.3%) increase. The incremental value of adding the fourth or the fifth core was 6.0% (4.7%, 6.9%) and 4.1% respectively. Four studies arranging MRI-targeted biopsy of more than two cores in well-determined sequences indicated more positive cores with higher cancer grade through center of the lesions.
CONCLUSIONS: Increasing the number of samples per target from one to two, or two to three resulted in a nonnegligible incremental detection rate of clinically significant lesions, while obtaining more than 3 cores per target provided a diminished incremental value. And performing targeted cores accurately through center of the lesions may help improve diagnostic accuracy.

KEY WORDS: Biopsy; Magnetic resonance imaging; Prostatic neoplasms