273P - The diagnostic performance of cognitive MRI-targeted biopsy in biopsy-naïve patients undergoing systematic 14-region 18-core biopsy: Do the three areas affect the results?

Background

We compared the diagnostic performance of cognitive transrectal MRI-targeted biopsy (MRITB) between three anatomical zones of the prostate.

Methods

Of the 569 initial cases with suspected prostate cancer, those who received standard biopsy (14-region, 18-core biopsy: SB) between June 2019 and March 2023 were selected (SB 57 cases, SB+MRITB 509 cases). SB alone was performed in PI-RADS v2.1 ≦2, and MRITB was added in ≧3. In this study, we investigated whether zonal anatomy affects the diagnostic performance of MRITB retrospectively.

Results

In 569 cases, 394 cases (69.2%) were positive for cancer. Of 394 cancer cases, 25 (6.3%) were from SB alone and 369 (93.7%) from SB+MRITB. According to the Epstein criteria, 359 cases (91.1%) were clinically significant. In all cases, the diagnostic performance of MRITB was 80.1% for sensitivity, 20.5% for specificity, 71.4% for positive predictive value, 29.4% for negative predictive value, and 63.0% for accuracy. The true positive rates of cancer detection by MRITB in each zone were 22 cores (43.1%) in CZ, 125 cores (41.9%) in TZ, and 283 cores (64.6%) in PZ. CZ and TZ groups were significantly lower than the PZ group, respectively, and especially, midgland TZ was the highest false-positive rates compared to midgland-apex TZ (87.3% v.s.33.3%).

Conclusions

In the case of SB including apex anterior biopsy, MRITB alone missed clinically significant cancers in 65 cases (18.1%) in PI-RADS v2.1 ≥3, which was a higher rate than those reported by many previous reports. In contrast, MRITB showed a high false-positive rate especially in TZ, suggesting that the positive criteria and approach model for these lesions need to be discussed.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Y. Toyama.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.