1. Why Does Magnetic Resonance Imaging-Targeted Biopsy Miss Clinically Significant Cancer?
- Author
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Nabila Khondakar, Christian Hague, Nitin Yerram, Michael Ahdoot, Peter A. Pinto, Baris Turkbey, Howard L. Parnes, Joanna Shih, Sherif Mehralivand, Michael Daneshvar, Maria J. Merino, Patrick T. Gomella, Andrew R Wilbur, Bradford J. Wood, Cheyenne Williams, Paul F. Pinsky, Sandeep Gurram, and Minhaj Siddiqui
- Subjects
Image-Guided Biopsy ,Male ,medicine.medical_specialty ,medicine.diagnostic_test ,Missed Diagnosis ,business.industry ,Urology ,Prostate ,Cancer ,Prostatic Neoplasms ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Targeted biopsy ,Magnetic Resonance Imaging ,Article ,Biopsy ,medicine ,Humans ,Radiology ,business ,Systematic biopsy ,Aged ,Retrospective Studies - Abstract
PURPOSE: Multiple studies demonstrate MRI-targeted biopsy detects more clinically significant cancer than systematic biopsy, however some clinically significant cancers are detected by systematic biopsy only. While these events are rare, we sought to perform a retrospective analysis of these cases to ascertain the reasons that MRI-targeted biopsy missed clinically significant cancer, which was subsequently detected on systematic prostate biopsy. METHODS: Patients were enrolled in a prospective study comparing cancer detection rates by transrectal MRI-targeted fusion biopsy and systematic 12-core biopsy. Patients with an elevated PSA, abnormal digital rectal exam, or imaging findings concerning for prostate cancer underwent prostate MRI and subsequent MRI-targeted and systematic biopsy in the same setting. The subset of patients with grade group (GG) ≥3 cancer found on systematic biopsy and GG≤2 cancer (or no cancer) on MRI-targeted biopsy were classified as MRI-targeted biopsy misses. A retrospective analysis of the MRI and MRI-targeted biopsy real-time screen captures determined the cause of MRI-targeted biopsy miss. Multivariable logistic regression analysis compared baseline characteristics of patients with MRI-targeted biopsy misses to GG-matched patients whose clinically significant cancer was detected by MRI-targeted biopsy. RESULTS: Over the study period of 2007 to 2019, 2103 patients met study inclusion criteria and underwent combined MRI-targeted and systematic prostate biopsies. 41 (1.9%) men were classified as MRI-targeted biopsy misses. Most MRI-targeted biopsy misses were due to errors in lesion targeting (n=21, 51.2%), followed by MRI-invisible lesions (n=17, 40.5%), and MRI lesions missed by the radiologist (n=3, 7.1%). On logistic regression analysis, lower PI-RADS score was associated with having clinically significant cancer missed on MRI-targeted biopsy. CONCLUSION: While uncommon, most MRI-targeted biopsy misses are due to errors in lesions targeting, which highlights the importance of accurate co-registration and targeting when using software-based fusion platforms. Additionally, some patients will harbor MRI-invisible lesions which are un-targetable by MRI-targeted platforms. The presence of a low PI-RADS score despite a high PSA is suggestive of harboring an MRI-invisible lesion.
- Published
- 2023