Sub-differentiating equivocal PI-RADS-3 lesions in multiparametric magnetic resonance imaging of the prostate to improve cancer detection
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Publication Date
2017-10-01Journal Title
European Journal of Radiology
ISSN
0720-048X
Publisher
Elsevier
Volume
95
Pages
307-313
Language
eng
Type
Article
This Version
AM
Metadata
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Barrett, T., Kastner, C., Koo, B., Hansen, N., & Warren, A. (2017). Sub-differentiating equivocal PI-RADS-3 lesions in multiparametric magnetic resonance imaging of the prostate to improve cancer detection. European Journal of Radiology, 95 307-313. https://doi.org/10.1016/j.ejrad.2017.08.017
Abstract
Purpose
To evaluate sub-differentiation of PI-RADS-3 prostate lesions using pre-defined T2- and diffusion-weighted (DWI) MRI criteria, to aid the biopsy decision process.
Methods
143 patients with PIRADS-3 index lesions on MRI underwent targeted transperineal-MR/US fusion biopsy. Radiologists with 2 and 7-years experience performed blinded retrospective second-reads using set criteria and assigned biopsy recommendations. Inter-reader agreement, Gleason score (GS), positive (PPV) predictive values (±95% confidence intervals) were calculated and compared by Fisher’s exact test with Bonferroni-Hom correction.
Results
43% (61/143) patients had GS 6-10 and 21% (30/143) GS ≥ 3 + 4 cancer. For peripheral zone lesions, significant differences in any cancer detection were found for shape (0.26 ± 0.13 geographical vs. 0.69 ± 0.23 rounded; p = 0.0055) and ADC (mild 0.21 ± 0.12 vs marked 0.81 ± 0.19; p = 0.0001). For transition zone, significantly increased cancer detection was shown for location (anterior 0.63 ± 0.15 vs. mid/posterior 0.31 ± 0.14; p = 0.0048), border (pseudo-capsule 0.32 ± 0.14 vs. ill-defined 0.61 ± 0.15; p = 0.0092), and ADC (mild 0.35 ± 0.12 vs marked restriction 0.68 ± 0.17; p = 0.0057). Biopsy recommendations had 62% inter-reader agreement (89/143). Experienced reader PPVs were significantly higher for any cancer with “biopsy-recommended” 0.61 ± 0.11 vs. “no biopsy” 0.21 ± 0.10 (p = 0.0001), and for GS 7-10 cancers: 0.32 ± 0.10 vs. 0.08 ± 0.07, respectively (p = 0.0003).
Conclusion
Identification of certain objective imaging criteria as well as a subjective biopsy recommendation from an experienced radiologist can help to increase the predictive value of equivocal prostate lesions and inform the decision making process of whether or not to biopsy.
Keywords
prostate, MRI, PIRADS, indeterminate
Sponsorship
The authors acknowledge research support from Cancer Research UK, National Institute of Health Research Cambridge Biomedical Research Centre, Cancer Research UK and the Engineering and Physical Sciences Research Council Imaging Centre in Cambridge and Manchester and the Cambridge Experimental Cancer Medicine Centre.
Identifiers
External DOI: https://doi.org/10.1016/j.ejrad.2017.08.017
This record's URL: https://www.repository.cam.ac.uk/handle/1810/270009
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