{
  "abstract": "Aims MRI-targeted needle core biopsy (MRI-NCB) improves detection of clinically significant prostate cancer (csPCa), but whether it can replace systematic ultrasound-guided biopsy (US-NCB) remains debated, as most studies have focused on cancer detection and grade.Methods We retrospectively analysed 562 patients with PI-RADS 3–5 lesions who underwent both MRI-NCB and concurrent US-NCB. Outcomes included cancer detection, Grade Group (GG) and adverse features (cribriform morphology and intraductal carcinoma (IDCP)). csPCa was defined as GG ≥2. A composite endpoint of clinically meaningful under-detection or underestimation was defined as missed or under-graded csPCa and/or missed adverse histological features on MRI-NCB relative to US-NCB.Results MRI-NCB alone would have missed PCa in 13.0% (73/562) of patients, including csPCa in 11.4% (64/562) and would have underestimated GG in 13.3% (75/562). Systematic biopsy identified additional cribriform morphology in 4.3% (24/562) and IDCP in 2.5% (14/562) of patients not detected on MRI-NCB. Overall, MRI-NCB alone would have resulted in clinically meaningful under-detection or underestimation in 16.4% (92/562). Of these, 63.0% had missed or under-graded csPCa only, 30.4% had missed adverse histologic features only and 6.5% had both. Missed cancers were more frequent in lower PI-RADS lesions whereas upgrading was more common in higher PI-RADS lesions. Incremental detection of IDCP was significantly higher in PI-RADS 5 compared with PI-RADS 4 lesions (adjusted p=0.048).Conclusions MRI-targeted biopsy alone may incompletely assess cancer detection and tumour biology. Systematic biopsy provides complementary diagnostic value, and omission may result in clinically meaningful under-detection or underestimation, even in high PI-RADS lesions.",
  "authors": [
    {
      "affiliations": [
        "Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA",
        "Emory University Winship Cancer Institute, Atlanta, Georgia, USA"
      ],
      "name": "Faisal Saeed"
    },
    {
      "affiliations": [
        "Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA",
        "Emory University Winship Cancer Institute, Atlanta, Georgia, USA",
        "Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA",
        "Department of Pathology, Veterans Affairs Medical Center, Decatur, Georgia, USA"
      ],
      "name": "Adeboye O Osunkoya"
    }
  ],
  "title": "MRI-targeted versus systematic needle core biopsies in prostate cancer: a patient-based analysis of potential diagnostic and biologic underestimation",
  "uid": "54e79f4d-e3ce-514f-b321-e86f08ecc05e"
}