Systematic versus perilesional sampling in transperineal MRI-fusion biopsy: is perilesional sampling ready for prime time? A high-volume center analysis.

Authors

Agneta Seebold, Thomas Büttner, Jörg Ellinger, Glen Kristiansen, Marit Bernhardt, Alexander Isaak, Christian Hoffmann, Julian A Luetkens, Manuel Ritter, Philipp Krausewitz

Published in

World journal of surgical oncology. Volume 24. Issue 1. Sep 23, 2026. Epub Sep 23, 2026.

Abstract

Multiparametric MRI has improved prostate cancer (PCa) diagnostics. The current standard combines MRI-targeted fusion biopsy (TB) with 12-core systematic biopsy (SB); current guidelines allow replacing SB with perilesional sampling (PB) penumbra to maintain diagnostic performance while reducing biopsy burden.
We retrospectively analyzed 314 biopsy-naive men with Prostate Imaging Reporting and Data System (PI-RADS) 3-5 lesions who underwent transperineal MRI-fusion biopsy (TB plus 12-core systematic biopsy) under local anesthesia. A simulated PB strategy was evaluated post hoc by selecting four of the twelve systematic cores located in the directly adjacent sectors to the MRI-visible lesion on the standardized PI-RADS sector map and compared with SB. The primary objective was to assess whether PB replicates the diagnostic performance of SB for detecting clinically significant PCa (csPCa; ISUP grade group ≥ 2). We also compared biopsy and prostatectomy ISUP-grading, NCCN (National Comprehensive Cancer Network) -classification and the Briganti nomogram-based lymph-node metstasis risk. Statistical analyses used R and SPSS, with chi-square or Fisher's exact tests for categorial and t-tests for continuous variables; two-sided p < 0.05 was considered significant.
PCa was detected in 79.9% (251/314) of men, including 68.8% (216/314) with csPCa. TB alone detected 94.4% of csPCa, while SB detected 73.1%. The simulated TB + PB approach achieved 98.0% overall PCa detection and 99.1% csPCa detection (p = 0.48 vs. TB + SB). Concerning the impact on NCCN risk assessment, ISUP grade distribution was comparable across TB-based strategies, whereas SB alone detected fewer cancers and showed a trend towards lower ISUP grades. In the prostatectomy subgroup, ISUP grade concordance did not differ significantly between TB + SB and TB + PB (both 62.0%; p = 1.0). Mean Briganti scores did not differ significantly between TB + SB and TB + PB, with a minimal absolute difference of 0.17%. A 75% reduction of biopsy cores would be reached by a replacement of SB with PB. There was no significant loss of detection for csPCa (ISUP grade group 2-5; 99.1%) and no association with a loss of diagnostic yield for all ISUP grade groups. 11% reduction in detected cases was confined to ISUP grade group 1 (Supplementary Table S2).
A TB plus 4-core PB may serve as an efficient alternative to conventional 12-core SB, without a significant reduction in diagnostic accuracy or a change in pretreatment risk assessment while markedly reducing procedural burden and resource use.

PMID:
42778928
Bibliographic data and abstract were imported from PubMed on 24 Sep 2026.

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