World Journal of Urology

, Volume 37, Issue 2, pp 327–335 | Cite as

Defining the target prior to prostate fusion biopsy: the effect of MRI reporting on cancer detection

  • Niklas WesthoffEmail author
  • Fabian Siegel
  • Christian Peter
  • Svetlana Hetjens
  • Stefan Porubsky
  • Thomas Martini
  • Jost von Hardenberg
  • Maurice Stephan Michel
  • Johannes Budjan
  • Manuel Ritter
Original Article



Definition of targets in multiparametric MRI (mpMRI) prior to MRI/TRUS fusion prostate biopsy either by urologist or radiologist, as a prose report or by illustration is crucial for accurate targeted biopsies (TB). The objective was to analyze the effect of MRI reporting on target definition and cancer detection.


202 patients underwent MRI/TRUS fusion biopsy with Artemis™ (Eigen, USA). mpMRI results were submitted in written form to urologists, who marked the targets in the proprietary software. An expert uroradiologist reviewed and marked mpMRI targets blinded to biopsy data. We compared number, localization and volume of targets between the observers and analyzed whether variations impaired TB results by bivariate and logistic regression models.


Interobserver variability was moderate regarding number and low regarding localization of targets. Urologists overestimated target volumes significantly compared to radiologists (p = 0.045) and matching target volume between both observers was only 43.9%. Overall cancer detection rate was 69.8 and 52.0% by TB. A higher matching target volume was a significant predictor of cancer in TB (p < 0.001). Logistic regression revealed prostate volume and PI-RADS as independent predictors. Defining targets in incorrect T2w slices in the cranio-caudal axis are one presumable reason for missing cancer in TB.


A high concordance of the target definition between radiologist and urologist is mandatory for accurate TB. Optimized ROI definition is recommended to improve TB results, preferably as contouring in MRI sequences by the radiologist or, if not feasible, by precise MRI reports including specific localization in sequence and slice as well as an illustration. High prostate volume and low PI-RADS score have to be considered as limiting factors for target definition.


Prostatic neoplasms Multiparametric MRI Biopsy Fusion Interobserver variability 


Author contributions

NW: project development, data collection, data analysis, manuscript writing. FPS: project development, data analysis, manuscript editing. CP: data collection, manuscript editing. SH: data analysis, manuscript editing. SP: data collection, manuscript editing. TM: manuscript editing. JvH: manuscript editing. MSM: manuscript editing. JB: data collection, manuscript editing. MR: project development, manuscript editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

For this type of study formal consent is not required.

Supplementary material

345_2018_2400_MOESM1_ESM.pdf (25 kb)
Supplementary material 1 (PDF 24 kb)
345_2018_2400_MOESM2_ESM.pdf (32 kb)
Supplementary material 2 (PDF 31 kb)
345_2018_2400_MOESM3_ESM.pdf (29 kb)
Supplementary material 3 (PDF 29 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Niklas Westhoff
    • 1
    Email author
  • Fabian Siegel
    • 1
  • Christian Peter
    • 1
  • Svetlana Hetjens
    • 2
  • Stefan Porubsky
    • 3
  • Thomas Martini
    • 4
  • Jost von Hardenberg
    • 1
  • Maurice Stephan Michel
    • 1
  • Johannes Budjan
    • 5
  • Manuel Ritter
    • 1
  1. 1.Department of Urology, University Medical Center Mannheim, Medical Faculty MannheimUniversity of HeidelbergMannheimGermany
  2. 2.Institute of Medical Statistics and Biometry, University Medical Center Mannheim, Medical Faculty MannheimUniversity of HeidelbergMannheimGermany
  3. 3.Department of Pathology, University Medical Center Mannheim, Medical Faculty MannheimUniversity of HeidelbergMannheimGermany
  4. 4.Department of UrologyUniversity Medical Center UlmUlmGermany
  5. 5.Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty MannheimUniversity of HeidelbergMannheimGermany

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