Assessment of the Minimal Targeted Biopsy Core Number per MRI Lesion for Improving Prostate Cancer Grading Prediction

• Main Authors: Guillaume Ploussard, Jean-Baptiste Beauval, Raphaële Renard-Penna, Marine Lesourd, Cécile Manceau, Christophe Almeras, Jean-Romain Gautier, Guillaume Loison, Daniel Portalez, Ambroise Salin, Michel Soulié, Christophe Tollon, Bernard Malavaud, Mathieu Roumiguié
• Format: Article
• Language: English
• Published: MDPI AG 2020-01-01
• Series: Journal of Clinical Medicine
• Subjects: prostate cancer; radical prostatectomy; upgrading; biopsy; targeted biopsies; mri; fusion biopsies; systematic biopsies
• Online Access: https://www.mdpi.com/2077-0383/9/1/225

Background: To study the impact of MRI characteristics and of targeted biopsy (TB) core number on the final grade group (GG) prediction. Materials and Methods: The cohort was 478 consecutive patients who underwent radical prostatectomy (RP) after positive mpMRI (multiparametric magnetic resonance imaging) followed by fusion TB. Endpoints were the upgrading and concordance rates between TB and RP specimens. Results: Upgrading rate after TB was 40.6%. Patients with upgrading had lower PIRADS (Prostate Imaging-Reporting and Data System) scores (<i>p</i> &lt; 0.001), smaller lesion size (<i>p</i> = 0.017), fewer TB cores (<i>p</i> &lt; 0.001), and lower TB density (<i>p</i> = 0.015) compared with cases with grade concordance. There was a significant continuous improvement in upgrading rate when TB core number per lesion increased from 56.3% to 25.6% when &lt;2 or &#8805;5 TB cores were taken, respectively (<i>p</i> = 0.002). The minimal TB number per lesion to reduce upgrading risk to approximately 30%was 4 in PIRADS 3, and 3 in PIRADS 4&#8722;5 cases. Conclusions: Grade group prediction by TB is significantly improved by higher PIRADS score, larger lesion size, and increased TB per lesion. At least four TB cores should be taken in PIRADS 3 score lesions, whereas three cores seem enough in PIRADS 4&#8722;5 cases to improve GG prediction and limit upgrading risk.