Geometric evaluation of systematic transrectal ultrasound guided prostate biopsy

Misop Han, Doyoung Chang, Chunwoo Kim, Brian J. Lee, Yihe Zuo, Hyung Joo Kim, Doru Petrisor, Bruce Trock, Alan W. Partin, Ronald Rodriguez, H. Ballentine Carter, Mohamad Allaf, Jongwon Kim, Dan Stoianovici

Research output: Contribution to journalArticle

32 Scopus citations

Abstract

Purpose: Transrectal ultrasound guided prostate biopsy results rely on physician ability to target the gland according to the biopsy schema. However, to our knowledge it is unknown how accurately the freehand, transrectal ultrasound guided biopsy cores are placed in the prostate and how the geometric distribution of biopsy cores may affect the prostate cancer detection rate. Materials and Methods: To determine the geometric distribution of cores, we developed a biopsy simulation system with pelvic mock-ups and an optical tracking system. Mock-ups were biopsied in a freehand manner by 5 urologists and by our transrectal ultrasound robot, which can support and move the transrectal ultrasound probe. We compared 1) targeting errors, 2) the accuracy and precision of repeat biopsies, and 3) the estimated significant prostate cancer (0.5 cm3 or greater) detection rate using a probability based model. Results: Urologists biopsied cores in clustered patterns and under sampled a significant portion of the prostate. The robot closely followed the predefined biopsy schema. The mean targeting error of the urologists and the robot was 9.0 and 1.0 mm, respectively. Robotic assistance significantly decreased repeat biopsy errors with improved accuracy and precision. The mean significant prostate cancer detection rate of the urologists and the robot was 36% and 43%, respectively (p <0.0001). Conclusions: Systematic biopsy with freehand transrectal ultrasound guidance does not closely follow the sextant schema and may result in suboptimal sampling and cancer detection. Repeat freehand biopsy of the same target is challenging. Robotic assistance with optimized biopsy schemas can potentially improve targeting, precision and accuracy. A clinical trial is needed to confirm the additional benefits of robotic assistance.

Original languageEnglish (US)
Pages (from-to)2404-2409
Number of pages6
JournalJournal of Urology
Volume188
Issue number6
DOIs
StatePublished - Dec 1 2012
Externally publishedYes

Keywords

  • biopsy
  • prostate
  • prostatic neoplasms
  • robotics
  • ultrasonography

ASJC Scopus subject areas

  • Urology

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  • Cite this

    Han, M., Chang, D., Kim, C., Lee, B. J., Zuo, Y., Kim, H. J., Petrisor, D., Trock, B., Partin, A. W., Rodriguez, R., Carter, H. B., Allaf, M., Kim, J., & Stoianovici, D. (2012). Geometric evaluation of systematic transrectal ultrasound guided prostate biopsy. Journal of Urology, 188(6), 2404-2409. https://doi.org/10.1016/j.juro.2012.07.107