Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co ULTRASOUND MRI FUSION BIOPSY IN PROSTATE GLAND • 41  Table 1: Summary of MR/TRUS fusion software-based targeted biopsy platform specifications. MRI/US fusion software (manufacturer) US image acquisition Method of registration Tracking system Manipulation Sampling route Year of FDA approval Artemis (Eigen) Manual Elastic Mechanical arm with encoders Via mechanical arm Transrectal or transperineal 2008 BioJet (D&K Technologies) Manual Rigid (elastic for minor deformations) Stepper with digital encoders Via stepper Transrectal or transperineal 2012 BiopSee (MedCom) Manual Rigid (elastic for minor deformations) Stepper with digital encoders Via stepper Transrectal or transperineal NR Real-time virtual sonography (Hitachi) Manual Rigid Electromagnetic Freehand Transrectal or transperineal 2010 UroNav (Invivo/ Philips) Manual Rigid Electromagnetic Freehand Transrectal or transperineal 2005 Urostation (Koelis) Automatic Elastic 3D ultrasound Freehand Transrectal 2010 Virtual Navigator (Esaote) Manual Rigid Electromagnetic Freehand Transrectal 2014 MRI/TRUS magnetic resonance imaging/transrectal ultrasound, FDA Food and Drug Administration, NR not reported the other hand, two recently published randomized controlled trial (RCT) concluded that detec- tion rates for any cancer and clinically significant PCa did not significantly differ between the two approaches, [36, 37]. Concerning the length of biopsy positive cores, Puech et al . reported a statistically significant longest core cancer length in MRI/US fusion software-based targeted biopsy compared to stand- ard biopsy (mean: 7.3 mm ± 3.8 vs 4.6 mm ± 3.1, respectively; p = 0.0001) [38]. In all studies reporting the data, MRI/US fusion software-based targeted biopsy necessitates fewer cores to diagnose PCa compared to standard biopsies. In the systematic revision of Valerio et al ., MRI/US fusion software-based targeted biopsies detected more clinically significant cancers using fewer cores compared with standard biopsy (median, 9.2 vs 37.1, respectively) [27]. Finally, in terms of more accurate grading of PCa, Lanz et al . published a study including 125 men undergoing radical prostatectomy for PCa diagnosed both by MRI/US fusion software-based targeted and standard biopsy. Targ eted biopsy detected 126 lesions in 115 patients. The primary Gleason grad e, secondary Glea son grade, and Gleason score of the 126 individual tumors were determined accu rately in 11 4 (90%), 75 (59%), and 85 (67%) cases, respectively [39]. Template Systematic Biopsy vs MRI/US Fusion Software-Based Targeted Biopsy Radtke et al . reported a comparative analysis of 294 consecutive patients undergoing systematic transperineal biopsy and MRI/US fusion software-based targeted biopsy. The authors reported that sampling efficiency was in favor of the second method, with 46.0% of MRI/US fusion Cutting EDGE_Urology(SUN)_final.indd 41 27-Mar-18 10:00:31 AM