Ansgar Malich MD, Presenter: Nothing to Disclose

Arnhild Kott MD, Abstract Co-Author: Nothing to Disclose

Andreas Ulrich, Abstract Co-Author: Nothing to Disclose

Christian Linder, Abstract Co-Author: Nothing to Disclose

Ralf Eeckert, Abstract Co-Author: Nothing to Disclose

Jörg Bauersfeld, Abstract Co-Author: Nothing to Disclose

Many patients with a negative sonographically based biopsy of the prostate gland still are suspect to suffer from prostate cancer.  Instead of a rebiopsy or saturation biopsy, these patients were sent for MRI and in case of a suspicious finding, were biopsied MR-guided. Study aimed to verify clinical value of this strategy and to analyze histopathological outcome, feasibility, side effects and pitfalls.

188 samples of 66 lesions of 34 patients were extracted during MR-guided biopsy of the prostate gland as a consequence of suspicious findings of prostate-MRI including CAD-based dynamic analysis (MeVis; Germany), T2-analysis and DWI (b1000), performed using Philips Achiva 1.5 T-system. Intervention was done with a 18G biopsy needle using CAD-based access data and interventional equpiment (INVIVO, USA).  

13/34 patients were proven to suffer from an invasive adenocarcioma, in 3/34 patients at least one ASAP-lesion was verified, spurring the prostate gland to be at high risk (detection rate 38.2% and 47.1%, resp.). 24/66 histologically verified lesions were proven to be malignant/premalignant (36.4%), 46/188 samples contained malignant material (24.5%). In 11/188 samples no prostatic tissue was found (5.9%). 19/66 verified lesions were invasive malignant, 5/66 ASAP. Out of the invasive cancers, 4 were summarized as high grade, 5 intermediate and 10 low grade. 4 malignant lesions were histologically confirmed as T1, 7 as 2a and 8 as 2b. Mean Gleason-score was 6.4. Among the benign entities prostatitis was most common 21/66 cases (31.8%), hyperplasia was detected in 8/66 cases (12.1%). Mean biopsy time was 60 minutes. In 1 case a postbioptic infection occurred. No major bleeding nor any other side effects were observed.  

MR-guided prostate biopsy is a useful, reliable, precise technology to be recommended as the method of choice especially for patients having had a negative ultraound-based biopsy before with still clinical signs of malignancy and suspicious MR-imaging of the prostate gland. The clinical importance of ASAP should be discussed more in detail, due to the available precise MR-biopsy technology the number of such histological verifications will significantly increase.  

MR-guided prostate biopsy allows a precise and valuable histological verification. It should be performed if sonografically based biopsy is negative with still existing signs for malignancy.

Malich, A, Kott, A, Ulrich, A, Linder, C, Eeckert, R, Bauersfeld, J, Feasibility and Reliability of MR-guided Biopsy of the Prostate Gland with CAD-guidance: Comparison to Histopathological Outcome.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11014308.html