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

31 Citations (Scopus)

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 2012
Externally publishedYes

Fingerprint

Prostate
Biopsy
Robotics
Prostatic Neoplasms
Optical Devices
Clinical Trials
Physicians
Urologists

Keywords

  • biopsy
  • prostate
  • prostatic neoplasms
  • robotics
  • ultrasonography

ASJC Scopus subject areas

  • Urology

Cite this

Han, M., Chang, D., Kim, C., Lee, B. J., Zuo, Y., Kim, H. 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

Geometric evaluation of systematic transrectal ultrasound guided prostate biopsy. / Han, Misop; Chang, Doyoung; Kim, Chunwoo; Lee, Brian J.; Zuo, Yihe; Kim, Hyung Joo; Petrisor, Doru; Trock, Bruce; Partin, Alan W.; Rodriguez, Ronald; Carter, H. Ballentine; Allaf, Mohamad; Kim, Jongwon; Stoianovici, Dan.

In: Journal of Urology, Vol. 188, No. 6, 12.2012, p. 2404-2409.

Research output: Contribution to journalArticle

Han, M, Chang, D, Kim, C, Lee, BJ, Zuo, Y, Kim, HJ, Petrisor, D, Trock, B, Partin, AW, Rodriguez, R, Carter, HB, Allaf, M, Kim, J & Stoianovici, D 2012, 'Geometric evaluation of systematic transrectal ultrasound guided prostate biopsy', Journal of Urology, vol. 188, no. 6, pp. 2404-2409. https://doi.org/10.1016/j.juro.2012.07.107
Han, Misop ; Chang, Doyoung ; Kim, Chunwoo ; Lee, Brian J. ; Zuo, Yihe ; Kim, Hyung Joo ; Petrisor, Doru ; Trock, Bruce ; Partin, Alan W. ; Rodriguez, Ronald ; Carter, H. Ballentine ; Allaf, Mohamad ; Kim, Jongwon ; Stoianovici, Dan. / Geometric evaluation of systematic transrectal ultrasound guided prostate biopsy. In: Journal of Urology. 2012 ; Vol. 188, No. 6. pp. 2404-2409.
@article{9feb2bfc510145bfbfeed1e87a919d68,
title = "Geometric evaluation of systematic transrectal ultrasound guided prostate biopsy",
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.",
keywords = "biopsy, prostate, prostatic neoplasms, robotics, ultrasonography",
author = "Misop Han and Doyoung Chang and Chunwoo Kim and Lee, {Brian J.} and Yihe Zuo and Kim, {Hyung Joo} and Doru Petrisor and Bruce Trock and Partin, {Alan W.} and Ronald Rodriguez and Carter, {H. Ballentine} and Mohamad Allaf and Jongwon Kim and Dan Stoianovici",
year = "2012",
month = "12",
doi = "10.1016/j.juro.2012.07.107",
language = "English (US)",
volume = "188",
pages = "2404--2409",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Geometric evaluation of systematic transrectal ultrasound guided prostate biopsy

AU - Han, Misop

AU - Chang, Doyoung

AU - Kim, Chunwoo

AU - Lee, Brian J.

AU - Zuo, Yihe

AU - Kim, Hyung Joo

AU - Petrisor, Doru

AU - Trock, Bruce

AU - Partin, Alan W.

AU - Rodriguez, Ronald

AU - Carter, H. Ballentine

AU - Allaf, Mohamad

AU - Kim, Jongwon

AU - Stoianovici, Dan

PY - 2012/12

Y1 - 2012/12

N2 - 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.

AB - 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.

KW - biopsy

KW - prostate

KW - prostatic neoplasms

KW - robotics

KW - ultrasonography

UR - http://www.scopus.com/inward/record.url?scp=84869083629&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84869083629&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2012.07.107

DO - 10.1016/j.juro.2012.07.107

M3 - Article

C2 - 23088974

AN - SCOPUS:84869083629

VL - 188

SP - 2404

EP - 2409

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 6

ER -