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Minerva Urologica e Nefrologica 2017 December;69(6):589-95

DOI: 10.23736/S0393-2249.17.02845-4

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Prospective nonrandomized study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound-guided biopsy to magnetic resonance imaging with subsequent MRI-guided biopsy in biopsy-naïve patients

Roberto CASTELLUCCI 1, 2 , Ana I. LINARES QUEVEDO 2, Francisco J. SÁNCHEZ GÓMEZ 2, Jesús DÍEZ RODRÍGUEZ 2, Leopoldo COGORNO 2, Isidro COGOLLOS ACUÑA 3, Isabel SALMERÓN BÉLIZ 3, Marta MUÑOZ FERNÁNDEZ de LEGARÍA 4, Luis MARTÍNEZ PIÑEIRO 2

1 Department of Urology, “SS. Annunziata” Hospital, Chieti, Italy; 2 Department of Urology, University Hospital “Infanta Sofia”, European University of Madrid, Madrid, Spain; 3 Department of Radiology, University Hospital “Infanta Sofia”, Madrid, Spain; 4 Department of Pathology, University Hospital “Infanta Sofia”, Madrid, Spain


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BACKGROUND: To evaluate the diagnostic efficacy in cancer prostate (PCa) of Multiparametric prostate magnetic resonance imaging (mp-MRI) targeted biopsy compared to standard systematic transrectal ultrasound-guided biopsy (TRUSGB) in biopsy-naïve patients.
METHODS: A total of 168 biopsy-naïve men with clinical suspicion of PCa due to elevated PSA levels and/or an abnormal digital rectal examination were consecutively enrolled from July 2011 to July 2014. All patients underwent TRUSGB. Patients with equivocal (Pi-rads 3) or suspicious lesion (Pi-rads 4-5), were additionally biopsied using two cores, by the same operator (cognitive technique).
RESULTS: Among the 168 cases, mp-MRI was equivocal for PCa (Pi-rads 3) in 46 subjects (27.4%) and suspicious (Pi-rads 4, 5) in 40 cases (23.8%). Of the 69 patients with PCa, standard TRUSGB showed Gleason ≥7 in 75% of patients with Pirads 3 and 77.8% in cases with Pirads 4-5 on mp-MRI. Among the 40 patients with Pi-rads 4-5 lesion on the MRI, cognitive mp-MRI-guided biopsy (MRCGB) detected a higher number of cases of PCa with a Gleason score equal or superior to 7 (90%) with a higher negative predictive value (97.5%) than cases with Pi-rads 3 lesion or subjects with TRUSGB alone.
CONCLUSIONS: mp-MRI followed by selective biopsy seems to be a valuable tool to improve the diagnosis of intermediate and high risk PCa compared to standard TRUSGB.


KEY WORDS: Prostatic neoplasms - Biopsy - Magnetic resonance imaging

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