Biparametric MRI and 41 sector map for MRI/Transrectal ultrasound fusion biopsy to increase diagnostic accuracy of prostate cancer

Özet

Optimizing the number of prostate biopsy (PB) cores in the initial diagnosis of prostate cancer is still anopen question. Increasing the number of cores can expectedly lead to a higher cancer detection rate but morefrequent, and greater number of adverse effects should be considered. It is necessary to limit the numberof PBs, obtained from tumor areas and areas with a high suspect of malignancy. Simplified Prostate Imaging Reporting and Data System (PIRADS) using biparametric MR imaging (bpMRI) protocol identifies4 categories indicating the management for each one. We suggest targeted biopsy for category 3b [lesionwith a volume ≥0.5 cc, homogeneous or inhomogeneous, mild/moderately or markedly hypointense on T2-weighted, hyperintense on high b value diffusion-weighted (DW) imaging and moderately hypointense onapparent diffusion coefficient (ADC) map] and category 4 (homogeneous or heterogeneous lesion intra- orextraglandular, mild/moderately or markedly hypointense on T2-weighted, hyperintense on high b valueDW imaging and markedly hypointense on ADC map). For a precise localization of the suspected prostatelesions we used a model of 41 sectors/regions map. BpMRI/Transrectal ultrasound fusion-targeted biopsyand the 41 sectors map represent a valid alternative model to the core biopsy of 10-12 systematic transrectalor transperineal peripheral zone biopsies.