Matsugasumi T., Baco E., Palmer S., Aron M., Sato Y., Fukuda N., Süer E., Bernhard J.-C., Nakagawa H., Azhar R.A., Gill I.S., Ukimura O.
Journal of Urology 2015 194:4 (957-965)
Purpose Multiparametric magnetic resonance imaging often underestimates or overestimates pathological cancer volume. We developed what is to our knowledge a novel method to estimate prostate cancer volume using magnetic resonance/ultrasound fusion, biopsy proven cancer core length. Materials and Methods We retrospectively analyzed the records of 81 consecutive patients with magnetic resonance/ultrasound fusion, targeted biopsy proven, clinically localized prostate cancer who underwent subsequent radical prostatectomy. As 7 patients each had 2 visible lesions on magnetic resonance imaging, 88 lesions were analyzed. The dimensions and estimated volume of visible lesions were calculated using apparent diffusion coefficient maps. The modified formula to estimate cancer volume was defined as the formula of vertical stretching in the anteroposterior dimension of the magnetic resonance based 3-dimensional model, in which the imaging estimated lesion anteroposterior dimension was replaced by magnetic resonance/ultrasound targeted, biopsy proven cancer core length. Agreement of pathological cancer volume with magnetic resonance estimated volume or the novel modified volume was assessed using a Bland-Altman plot. Results Magnetic resonance/ultrasound fusion, biopsy proven cancer core length was a stronger predictor of the actual pathological cancer anteroposterior dimension than magnetic resonance estimated lesion anteroposterior dimension (r = 0.824 vs 0.607, each p <0.001). Magnetic resonance/ultrasound targeted, biopsy proven cancer core length correlated with pathological cancer volume (r = 0.773, p <0.001). The modified formula to estimate cancer volume demonstrated a stronger correlation with pathological cancer volume than with magnetic resonance estimated volume (r = 0.824 vs 0.724, each p <0.001). Agreement of modified volume with pathological cancer volume was improved over that of magnetic resonance estimated volume on Bland-Altman plot analysis. Predictability was more enhanced in the subset of lesions with a volume of 2 ml or less (ie if spherical, the lesion was approximately 16 mm in diameter). Conclusions Combining magnetic resonance estimated cancer volume with magnetic resonance/ultrasound fusion, biopsy proven cancer core length improved cancer volume predictability.