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Keywords:
Interventional non-vascular, Genital / Reproductive system male, Ultrasound, MR, Biopsy
Authors:
G. Bizzarri1, A. Bianchini1, D. Valle1, L. Di Vito1, L. Velari1, L. Lodigiani1, A. Dell'Era1, V. Anelli2; 1Albano Laziale/IT, 2Rome/IT
DOI:
10.1594/ecr2017/B-0390
Conclusion
Our feasibility study demonstrates that TRUS guided biopsy with MRI-TRUS fusion using an EM tracking system can be easily incorporated in the conventional procedure for systematic biopsies.
This result offers a valuable opportunity to all patients (both biopsy-naïve and not),
referred for a systematic prostatic biopsy,
which already performed a prostatic mpMRI.
In fact,
no significant additional cost as regard time consumption and personnel requirement was generated.
As regard the cost of the equipment,
we should consider that the EM tracking systems are currently embedded in many commercial US scanners,
and can be used for countless interventional and diagnostic applications [10].
Realistically,
the break-even-point can be rapidly reached in any standard radiological department.
The accuracy of the TRUS-MRI co-registration using an EM tracking system appears to be adequate and similar to what has been reported for MRI guided in bore biopsies [1].
Considering that systematic TRUS guided biopsy misses a considerable number of significant prostate cancers visible on mpMRI [1-4-5],
the introduction of an easily available and sustainable system for targeted biopsy is desirable.
In patients with persistent increased PSA levels and a previous negative systematic biopsy,
TRUS-MRI fusion guided targeted biopsy should be the technique of choice [12-13].
Although accurate,
the MRI guided in bore biopsy requires specific hardware and software,
is time consuming and expensive and should be limited to particular clinical settings.
It should most likely be used as a second line technique in the case of divergence between TRUS-MRI fusion guided biopsies and clinical data,
or between mpMRI PI-RADS and histopathological score after a TRUS-MRI fusion guided biopsy [1].
Furthermore,
the access to sustainable TRUS-MRI fusion systems,
along with the increasing popularity of simplified prostate MRI protocols such as Biparametric-MRI [14-15],
can pave the way to the development of new algorithms in the diagnosis and management of prostate cancer.