Cognitive Fusion Versus Software Fusion for Subcentimeter Lesions in Transperineal mpMRI/TRUS Fusion-Guided Prostate Biopsy Under Local Anesthesia

Abstract

Background: The accuracy debate between cognitive and software fusion for small lesions in multiparametric magnetic resonance imaging (mpMRI)/transrectal ultrasound (TRUS) fusion-guided prostate biopsy remains inconclusive. This study compares the diagnostic accuracy of these fusion methods for prostate cancer, specifically for lesions < 1 cm under local anesthesia.

Methods: Retrospective analysis of prostate biopsies performed at The Affiliated Yantai Yuhuangding Hospital of Qingdao University (Feb 16, 2019–Feb 16, 2023). The Cognitive Fusion Group used free-hand technique for mentally integrating mpMRI and TRUS fusion, while the Software Fusion Group used MIM software with a fusion guidance grid. Lesions were defined as < 1 cm of maximum diameter on coronal using mpMRI. Each patient underwent 2–4 targeted biopsies for the identified lesion, followed by 12 systematic biopsies. All biopsies were transperineal and performed under local anesthesia.

Results: Histology showed clinically significant prostate cancer (International Society of Urological Pathology ≥ 2) in 55 cases (42.6%) in the software fusion group and 66 cases (40.2%) in the cognitive fusion group within the targeted prostate cancer category. However, cognitive fusion had a shorter median operative time of 11 min compared to 22 min in the software fusion group. Complication rates did not significantly differ between the two fusion strategies.

Conclusion: This study suggests that experienced operators can achieve comparable diagnostic accuracy for sub-centimeter lesions in mpMRI/TRUS fusion-guided prostate biopsy using cognitive fusion. Furthermore, cognitive fusion offers simplicity and shorter procedural time. These findings contribute to the discourse on fusion methods in prostate cancer diagnosis, and further validation studies are warranted.