<p><strong>Clinicians may use software registration of MRI and ultrasound images during fusion biopsy, when available. (<em>Expert Opinion</em>)</strong></p>
Discussion
Discussion
<p>Targeted prostate biopsy of a visible lesion on mpMRI can be performed using software-based registration of mpMRI images and real-time ultrasound or cognitive registration. Other than in 1 RCT<sup>300</sup> where software-based registration demonstrated better cancer detection rate (CDR) compared with cognitive registration (33.3% versus 19.0%; p=0.016), both approaches have been shown to have similar CDR in multiple studies,<sup>301-304</sup> inclusive of an RCT showing no difference in CDR of software-based versus cognitive fusion or in-bore MRI targeted biopsy.<sup>305</sup> Nonetheless, use of software registration facilitates the fusion of multiple MRI and ultrasound images in two to three planes, allowing for the creation of a composite image that provides a more comprehensive view of the target lesion. Thus, clinicians with relevant training and experience may use software-based registration of mpMRI and ultrasound images during fusion biopsy, when available, especially for small MRI lesions. There are drawbacks, however, to implementing software-based fusion biopsy program. There are technical issues (e.g., software bugs, system crashes), operator error, and unusual anatomy (e.g., large prostates, previous transurethral resections of the prostate). Thus, the ability to perform cognitive fusion techniques using anatomic fiducial markers such as intraprostatic cysts may augment software-based fusion approaches in some cases such as to minimize the risk of misregistration. Clinicians who adopt the cognitive fusion technique exclusively should undergo advanced training in MRI interpretation to optimize cancer detection.</p>