Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co 42 • CUTTING EDGE - UROLOGY software-based targeted biopsy versus 7.5% of systematic biopsy cores detecting PCa with a Gleason score ≥7. However, as 12.8% Gleason score ≥7 was missed by the targeted approach, the authors concluded that the gold standard for cancer detection is a combination of systematic and targeted cores [40]. MRI/US Fusion Visual Targeted Biopsy vs MRI/US Fusion Software-Based Targeted Biopsy Only two studies directly compared MRI/US fusion software-based targeted biopsy with MRI/ US fusion visual targeted biopsy [37, 40], thus indicating the need for further studies. In details, Puech et al . reported that in 79 MR imaging targets among 95 patients, positivity for cancer was 47% with cognitive and 53% with MRI/US fusion software-based targeted biopsy ( p = 0.16) [38]. The same results were reported in a prospective study in 125 consecutive men by Wysock et al . concluding that MRI/US fusion softwarebased targeted biopsy was more often histologically informative than visual targeting but did not increase cancer detection [41]. Moreover, Cool et al . reported the results of 225 simulated targeted biopsies on suspected lesions on MRI, with MRI/ US fusion visual targeted biopsy sampling the 45–48% of clinically significant lesions compared with 100% obtained with MRI/US fusion software-based targeted biopsy [42]. Delongchamps et al . indirectly compared various targeted biopsy approaches in a consecutive series of patients. They reported that rigid and elastic MRI/US fusion software-based targeted biopsies performed significantly better than standard biopsies ( p = 0.0065 and 0.0016, respectively), while MRI/US fusion visual targeted biopsy did not perform better ( p = 0.66) [32]. Finally, in a preliminary study including 32 consecutive patients, Mouraviev et al . divided 32 consecutive patients into three groups based on the method used to target the suspected lesion. They concluded that MRI/US fusion software-based targeted biopsy (using two different platforms) increases diagnostic accu- racy compared with MRI/US fusion visual targeted biopsy [43]. In-Bore MRI Biopsy vs MRI/US Fusion Software-Based Targeted Biopsy Recently, Arsov et al . compared in a prospective randomized trial the PCa detection between inbore MRI biopsy and MRI/US fusion software-based targeted biopsy + 12-core standard biopsy in 210 patients with at least one negative standard biopsy. They reported that PCa detection ( p = 0.7), detecti on rates for significant PCa ( p = 0.7), and the highest percentage tumor involvement per biopsy co re ( p = 0.4) were s imilar between the arms [44]. Future Perspec tive s The most important issue that will have to be addressed with the current use of MRI/US fusion software-based targeted biopsy concerns its role in the diagnostic pathway. The actual scenario is represented by an existing test, the standard 12-core biopsy. The new test, the MRI/US fusion software-based targeted biopsy, could add on or replace the existing test. In most studies, patients Cutting EDGE_Urology(SUN)_final.indd 42 27-Mar-18 10:00:31 AM