Learning to Hit the Target: Improving Accuracy of Fusion Biopsy over Time at Maine Medical Center
Madeline Rutan, BA1, William C. Daly, BA1, Christina Gentile, MPH2, Moritz Hansen, MD3, Matthew Hayn, MD3, Stephen Ryan, MD4, Jesse D. Sammon, DO3.
1Tufts University School of Medicine, Boston, MA, USA, 2Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA, 3Division of Urology, Maine Medical Center, Portland, ME, USA, 4Tufts University School of Medicine, Portland, ME, USA.
BACKGROUND:Multiparametric MRI (mpMRI) and fusion biopsy technology has allowed for more accurate diagnosis of clinically significant prostate cancer (PCa) while helping to limit the overdiagnosis of non-significant disease. Little data exists, however, about the feasibility and success of implementation outside of large academic centers. This study sought to evaluate fusion biopsy adoption at Maine Medical Center for improvement over time and to discover meaningful areas for improvement.
METHODS:Starting in 2016 data was collected for patients undergoing mpMRI at Maine Medical Center and subsequent biopsy with the Phillips Uronav system. We also collected urology specific and general demographic information. We analyzed this data with special focus on the probability of cancer detection (PCD) of PI-RADS 3, 4, 5 lesions, as well as the percentage of patients who had negative targeted biopsies but PCa on 12-Core biopsy (our “false negative” rate).
Data from 224 patients was analyzed (179 underwent both fusion and 12-core biopsy, 10%, 52%, 37% PI-RADS 3, 4, 5 respectively). 49% underwent MRI as part of active surveillance protocol. Our overall PCD increased yearly, from 39% in 2016 to 67% in 2019. Most importantly, the positive predictive value (PPV) of PI-RADS 5 lesions has increased, from 54% in 2016 to 100% in 2019. Our overall “false negative” rate was 50%, our “false negative” rate for clinically significant disease (≥ Gleason 3+4=7) was 24.6% (range 11%-35% annually).
Our findings highlight the significant institutional learning curve associated with implementation of a fusion biopsy program at a large regional medical center. Our institution did not achieve desired outcomes immediately, but our results improved consistently over the study period. These outcomes highlight the importance of a rigorous iterative approach to quality improvement when implementing a fusion biopsy program.
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