Day surgery mode of multi-modal image AI fusion targeted transperineal biopsy technique using electromagnetic navigation tracking system under local anesthesia

The aim of this study was to explore the safety and feasibility of multi-modal image artificial intelligence (AI) fusion targeted transperineal biopsy (TPB) technique using electromagnetic navigation tracking system (ENTS) in day surgery mode. Furthermore, the integration of rapid paraffin-embedded section (RPES) pathological examination with this advanced TPB technique was assessed to determine its effectiveness in the diagnosis and treatment of prostate cancer. The clinicopathological data of 192 consecutive patients who underwent multi-modal image AI fusion targeted TPB technique using ENTS in Hunan Provincial People’s Hospital from January 2023 to March 2024 were retrospectively analyzed. Based on American Society of Anesthesiologists (ASA) classification, the patients were divided into observation group (ASA grade ≥ III) and control group (ASA grade < III). First, multi-parametric magnetic resonance imaging (mpMRI) and transrectal ultrasound (TRUS) image were fused by AI technology, and 2-core targeted biopsy were performed on target lesion, and then 12-core systematic biopsy were performed. The specimen obtained from targeted biopsy were sent for RPES. The pain and satisfaction scores during TPB and 1 h after TPB, the incidence of perioperative complications and the detection rate of csPCa were recorded. The patients with an average age of 69.13 ± 7.89 years. Serum tPSA was 25.51 ± 23.73 ng/mL. Prostate volume was 58.83 ± 38.55 mL. The patients with PI-RADS score of 2, 3, 4 and 5 were 34, 53, 38 and 67, respectively. The detection rate of csPCa was 59.38% (114/192). Based on ASA classification, there were 56 cases in the observation group and 136 cases in the control group. The age of the observation group (72.11 ± 7.14 years) was significantly higher than that of the control group (67.90 ± 7.88 years) (P < 0.01). There were no statistically significant differences in prostate volume, tPSA, PI-RADS score distribution, csPCa detection rates, operation time, pain and anesthesia satisfaction, and complication between the two group (P > 0.05). 158 patients with PI-RADS score ≥ 3 underwent targeted biopsy and systematic biopsy, and the detection rate of csPCa in combined biopsy (67.72%) was higher than that of targeted biopsy (59.49%) and systematic biopsy (65.82%), but there was no statistically significant difference between the three biopsy methods (P > 0.05). For patients with PI-RADS score of 3, 4, and 5, there was no statistically significant difference in the detection rate of csPCa among the difference three biopsy methods (P > 0.05), and the missed detection rate of csPCa in targeted biopsy were 26.32% (5/19), 16.67% (4/24), and 6.25% (4/64), respectively. For patients with suspected prostate cancer, day surgery mode of TPB using ENTS under local anesthesia shows good patient tolerance, high surgical safety, and a relatively high csPCa detection rate. RPES with this advanced TPB technique can quickly acquire pathological reports with excellent diagnostic accuracy.