A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound

This research aims to improve prostate cancer detection by developing a costly effective cognitive fusion-guided biopsy method that integrates MRI and ultrasound for precise lesion targeting. Recent advancements include the integration of mpMRI with ultrasound for targeted biopsies, which enhances the detection of clinical significant prostate cancer with higher occurrence and reproducibility. This protocol is costly effective, easy to implement, and reduces reliance on operator experience, making it suitable for widespread clinical adoption compared to equipment intended for using biopsy method. Future research will explore combining cognitive fusion biopsy with AI-based imaging analysis to further improve occurrence and reduce procedural variability in prostate cancer diagnosis.

[Narrator] To begin, thoroughly review the T2-weighted imaging, diffusion-weighted imaging, and apparent diffusion coefficient maps of multi-parametric MRI, or mpMRI scans to identify the prostate lesions. Use a vertex located approximately seven millimeters from the anterior rectal wall to draw one line through the body's midline, which is determined by the pubic synthesis or the bulbous urethra. Draw another line through the center of the lesion. The angle between these two lines is the angular displacement recorded as alpha. Now measure the distance from the center of the lesion to the rectal serosal surface on the T2-weighted imaging sequence and record it as X. Using a DICOM viewer with multiplanar reconstruction or another slice function, create a plane passing through both the vertex of the alpha angle and the center of the lesion. Measure the distance from the lesion to the apex of the prostate in this plane and record it as Y. Position the patient in the lithotomy position. Subcutaneously inject 1% lidocaine for local anesthesia at the projection of the prostate's largest transverse plane on the perineal skin. Using ultrasound guidance in the sagittal plane, inject 1% lidocaine into the levator ani muscle, muscle prostatic capsule, and apex of the prostate to ensure adequate anesthesia during the biopsy. Align the ultrasound probe with the midline by locating a plane on the transverse ultrasound image that closely matches the lesion's position from the T2-weighted imaging transverse image on the mpMRI. Once identified, hold the probe steady and freeze the ultrasound image at this cross-sectional level. Use the center of the probe as the vertex to measure the alpha angle on ultrasound. Align one edge of the alpha angle with the central guideline on the transverse ultrasound image. Unfreeze the image and rotate the probe until the central guideline of the transverse ultrasound image aligns with the lesion position identified on MRI. Hold the probe steady without further rotation once the alpha angle alignment is achieved. To position the ultrasound probe in the lesion plane, advance the probe horizontally along the rectum and rotate it to the correct alpha angle until the linear array ultrasound probe displays the prostate image. Measure the distance from the rectal serosal surface to the location corresponding to the previously measured X value on MRI to confirm the insertion point for the biopsy needle. Measure the distance from the apex of the prostate to the location corresponding to the previously measured Y value on MRI in the direction parallel to the rectum, ensuring the correct depth for biopsy needle insertion. For a targeted biopsy, insert the biopsy needle along the needle guideline corresponding to the distance from the rectum measured as X on the ultrasound image under sagittal plane ultrasound guidance using the linear array probe. Adjust the needle depth according to the previously measured Y value, which represents the distance from the apex of the prostate. Perform two to three targeted biopsy cores at the correct depth in the lesion area. Pathologic staining of the prostate biopsy target lesion is presented here, highlighting its histopathological and immunohistochemical characteristics. Hematoxylin and eosin staining of the biopsy lesion reveal prostatic acinar adenocarcinoma with a Gleason score of eight, indicating a high grade tumor. Furthermore, immunohistochemistry demonstrated strong nuclear positivity in tumor cells, confirming prostatic origin.