Minerva Urologica e Nefrologica 2020 Nov 12

DOI: 10.23736/S0393-2249.20.04008-4

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Fusion US/MRI prostate biopsy using a Computer Aided Diagnostic (CAD) system

Mariaconsiglia FERRIERO ¹ ✉, Umberto ANCESCHI ¹, Alfredo M. BOVE ¹, Luca BERTINI ², Rocco S. FLAMMIA ³, Guglielmo ZECCOLINI ⁴, Bernardino DE CONCILIO ⁴, Gabriele TUDERTI ¹, Riccardo MASTROIANNI ³, Leonardo MISURACA ¹, Aldo BRASSETTI ¹, Salvatore GUAGLIANONE ¹, Michele GALLUCCI ³, Antonio CELIA ⁴, Giuseppe SIMONE ¹

¹ Department of Urology, Regina Elena National Cancer Institute, Rome, Italy; ² Department of Radiology, Regina Elena National Cancer Institute, Rome, Italy; ³ Department of Urology, Policlinico Umberto I, Sapienza University, Rome, Italy; ⁴ Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy

BACKGROUND: To investigate the impact of Computer Aided Diagnostic (CAD) system on the detection rate of prostate cancer (PCa) in a series of fusion prostate biopsy (FPB).
METHODS: Two prospective transperineal FPB series (with or without CAD assistance) were analyzed and PCa detection rates compared with per patient and per target analyses. Chi-Square and Mann-Whitney test were used to compare categorical and continuous variables, respectively. Univariable and multivariable regression analyses were applied to identify predictors of any and clinically-significant (cs) PCa detection. Subgroup analyses were performed after stratifying for PIRADS Score and lesion location.
RESULTS: Out of 183 FPB, 89 were performed with CAD assistance. At per patient analysis the detection rate of any PCa and of cs PCa were 56.3% and 30.6%, respectively; the aid of CAD was negligible for either any PCa or csPCa detection rates (p=0.45 and p=0.99, respectively). Conversely in a per target analysis, CAD-assisted biopsy had significantly higher positive predictive value (PPV) for any PCa versus MRI-only group (58%vs37.8%, p=0.001). PI-RADS Score was the only independent predictor of any and csPCa, either in per patient or per target multivariable regression analysis (all p<0.029). In a subgroup per patient analysis of anterior/transitional zone lesions, csPCa detection rate was significantly higher in the CAD cohort (54.5%vs11.1%, respectively; p=0.028), and CAD assistance was the only predictor of csPCa detection (p=0.013).
CONCLUSIONS: CAD assistance for FPB seems to improve detection of csPCa located in anterior/transitional zone. Enhanced identification and improved contouring of lesions may justify higher diagnostic performance.

KEY WORDS: Fusion prostate biopsy; Computer aided diagnosis; MRI; Detection rate, Imaging