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Qin X, Lv J, Zhang J, Mu R, Zheng W, Liu F, Huang B, Li X, Yang P, Deng K, Zhu X. Amide proton transfer imaging has added value for predicting extraprostatic extension in prostate cancer patients. Front Oncol 2024; 14:1327046. [PMID: 38496759 PMCID: PMC10941336 DOI: 10.3389/fonc.2024.1327046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/12/2024] [Indexed: 03/19/2024] Open
Abstract
Background Prostate cancer invades the capsule is a key factor in selecting appropriate treatment methods. Accurate preoperative prediction of extraprostatic extension (EPE) can help achieve precise selection of treatment plans. Purpose The aim of this study is to verify the diagnostic efficacy of tumor size, length of capsular contact (LCC), apparent diffusion coefficient (ADC), and Amide proton transfer (APT) value in predicting EPE. Additionally, the study aims to investigate the potential additional value of APT for predicting EPE. Method This study include 47 tumor organ confined patients (age, 64.16 ± 9.18) and 50 EPE patients (age, 61.51 ± 8.82). The difference of tumor size, LCC, ADC and APT value between groups were compared. Binary logistic regression was used to screen the EPE predictors. The receiver operator characteristic curve analysis was performed to assess the diagnostic performance of variables for predicting EPE. The diagnostic efficacy of combined models (model I: ADC+LCC+tumor size; model II: APT+LCC+tumor size; and model III: APT +ADC+LCC+tumor size) were also analyzed. Results APT, ADC, tumor size and the LCC were independent predictors of EPE. The area under the curve (AUC) of APT, ADC, tumor size and the LCC were 0.752, 0.665, 0.700 and 0.756, respectively. The AUC of model I, model II, and model III were 0.803, 0.845 and 0.869, respectively. The cutoff value of APT, ADC, tumor size and the LCC were 3.65%, 0.97×10-3mm2/s, 17.30mm and 10.78mm, respectively. The sensitivity/specificity of APT, ADC, tumor size and the LCC were 76%/89.4.0%, 80%/59.6%, 54%/78.9%, 72%/66%, respectively. The sensitivity/specificity of model I, Model II and Model III were 74%/72.3%, 82%/72.5% and 84%/80.9%, respectively. Data conclusion Amide proton transfer imaging has added value for predicting EPE. The combination model of APT balanced the sensitivity and specificity.
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Affiliation(s)
- Xiaoyan Qin
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Jian Lv
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Jianmei Zhang
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Ronghua Mu
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Wei Zheng
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Fuzhen Liu
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Bingqin Huang
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
- Department of Radiology, Graduate School of Guilin Medical University, Guilin, China
| | - Xin Li
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Peng Yang
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Kan Deng
- Philips (China) Investment Co., Ltd., Guangzhou Branch, Guangzhou, China
| | - Xiqi Zhu
- Department of Radiology, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
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Xiao VG, Kresnanto J, Moses DA, Pather N. Quantitative MRI in the Local Staging of Prostate Cancer: A Systematic Review and Meta-Analysis. J Magn Reson Imaging 2024; 59:255-296. [PMID: 37165923 DOI: 10.1002/jmri.28742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Local staging of prostate cancer (PCa) is important for treatment planning. Radiologist interpretation using qualitative criteria is variable with high specificity but low sensitivity. Quantitative methods may be useful in the diagnosis of extracapsular extension (ECE). PURPOSE To assess the performance of quantitative MRI markers for detecting ECE. STUDY TYPE Systematic review and meta-analysis. SUBJECTS 4800 patients from 28 studies with histopathologically confirmed PCa on radical prostatectomy were pooled for meta-analysis. Patients from 46 studies were included for systematic review. FIELD STRENGTH/SEQUENCE Diffusion-weighted, T2-weighted, and dynamic contrast-enhanced MRI at 1.5 T or 3 T. ASSESSMENT PubMed, Embase, Web of Science, Scopus, and Cochrane databases were searched to identify studies on diagnostic test accuracy or association of any quantitative MRI markers with ECE. Results extracted by two independent reviewers for tumor contact length (TCL) and mean apparent diffusion coefficient (ADC-mean) were pooled for meta-analysis, but not for other quantitative markers including radiomics due to low number of studies available. STATISTICAL TESTS Hierarchical summary receiver operating characteristic (HSROC) curves were computed for both TCL and ADC-mean, but summary operating points were computed for TCL only. Heterogeneity was investigated by meta-regression. Results were significant if P ≤ 0.05. RESULTS At the 10 mm threshold for TCL, summary sensitivity and specificity were 0.76 [95% confidence interval (CI) 0.71-0.81] and 0.68 [95% CI 0.63-0.73], respectively. At the 15 mm threshold, summary sensitivity and specificity were 0.70 [95% CI 0.53-0.83] and 0.74 [95% CI 0.60-0.84] respectively. The area under the HSROC curves for TCL and ADC-mean were 0.79 and 0.78, respectively. Significant sources of heterogeneity for TCL included timing of MRI relative to biopsy. DATA CONCLUSION Both 10 mm and 15 mm thresholds for TCL may be reasonable for clinical use. From comparison of the HSROC curves, ADC-mean may be superior to TCL at higher sensitivities. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Vieley G Xiao
- Medical Education, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
| | - Jordan Kresnanto
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
| | - Daniel A Moses
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Kensington, New South Wales, 2052, Australia
- Prince of Wales Hospital, Sydney, New South Wales, 2031, Australia
| | - Nalini Pather
- Medical Education, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, 2052, Australia
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Kim SH, Cho SH, Kim WH, Kim HJ, Park JM, Kim GC, Ryeom HK, Yoon YS, Cha JG. Predictors of Extraprostatic Extension in Patients with Prostate Cancer. J Clin Med 2023; 12:5321. [PMID: 37629363 PMCID: PMC10455404 DOI: 10.3390/jcm12165321] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/05/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE To identify effective factors predicting extraprostatic extension (EPE) in patients with prostate cancer (PCa). METHODS This retrospective cohort study recruited 898 consecutive patients with PCa treated with robot-assisted laparoscopic radical prostatectomy. The patients were divided into EPE and non-EPE groups based on the analysis of whole-mount histopathologic sections. Histopathological analysis (ISUP biopsy grade group) and magnetic resonance imaging (MRI) (PI-RADS v2.1 scores [1-5] and the Mehralivand EPE grade [0-3]) were used to assess the prediction of EPE. We also assessed the clinical usefulness of the prediction model based on decision-curve analysis. RESULTS Of 800 included patients, 235 (29.3%) had EPE, and 565 patients (70.7%) did not (non-EPE). Multivariable logistic regression analysis showed that the biopsy ISUP grade, PI-RADS v2.1 score, and Mehralivand EPE grade were independent risk factors for EPE. In the regression assessment of the models, the best discrimination (area under the curve of 0.879) was obtained using the basic model (age, serum PSA, prostate volume at MRI, positive biopsy core, clinical T stage, and D'Amico risk group) and Mehralivand EPE grade 3. Decision-curve analysis showed that combining Mehralivand EPE grade 3 with the basic model resulted in superior net benefits for predicting EPE. CONCLUSION Mehralivand EPE grades and PI-RADS v2.1 scores, in addition to basic clinical and demographic information, are potentially useful for predicting EPE in patients with PCa.
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Affiliation(s)
- See Hyung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Seung Hyun Cho
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Won Hwa Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Hye Jung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Jong Min Park
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Gab Chul Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Hun Kyu Ryeom
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Yu Sung Yoon
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Jung Guen Cha
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
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Michael J, Neuzil K, Altun E, Bjurlin MA. Current Opinion on the Use of Magnetic Resonance Imaging in Staging Prostate Cancer: A Narrative Review. Cancer Manag Res 2022; 14:937-951. [PMID: 35256864 PMCID: PMC8898014 DOI: 10.2147/cmar.s283299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/10/2022] [Indexed: 12/02/2022] Open
Abstract
Accurate staging is critical for treatment planning and prognosis in men with prostate Cancer. Prostate magnetic imaging resonance (MRI) may aid in the staging evaluation by verifying organ-confined status, assessing the status of the pelvic lymph nodes, and establishing the local extent of the tumor in patients being considered for therapy. MRI has a high specificity for diagnosing extracapsular extension, and therefore may impact the decision to perform nerve sparing prostatectomy, along with seminal vesicle invasion and lymph node metastases; however, its sensitivity remains limited. Current guidelines vary significantly regarding endorsing the use of MRI for staging locoregional disease. For high-risk prostate cancer, most guidelines recommend cross sectional imaging, including MRI, to evaluate for more extensive disease that may merit change in radiation field, extended androgen deprivation therapy, or guiding surgical planning. Although MRI offers reasonable performance characteristics to evaluate bone metastases, guidelines continue to support the use of bone scintigraphy. Emerging imaging technologies, including coupling positron emission tomography (PET) with MRI, have the potential to improve the accuracy of prostate cancer staging with the use of novel radiotracers.
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Affiliation(s)
- Jamie Michael
- University of North Carolina, School of Medicine, Chapel Hill, NC, USA
| | - Kevin Neuzil
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marc A Bjurlin
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Correspondence: Marc A Bjurlin, Associate Professor, Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, 2nd Floor, Chapel Hill, NC, USA, Email
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Lim CS, Abreu-Gomez J, Thornhill R, James N, Al Kindi A, Lim AS, Schieda N. Utility of machine learning of apparent diffusion coefficient (ADC) and T2-weighted (T2W) radiomic features in PI-RADS version 2.1 category 3 lesions to predict prostate cancer diagnosis. Abdom Radiol (NY) 2021; 46:5647-5658. [PMID: 34467426 DOI: 10.1007/s00261-021-03235-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/31/2021] [Accepted: 07/31/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate if machine learning (ML) of radiomic features extracted from apparent diffusion coefficient (ADC) and T2-weighted (T2W) MRI can predict prostate cancer (PCa) diagnosis in Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1 category 3 lesions. METHODS This multi-institutional review board-approved retrospective case-control study evaluated 158 men with 160 PI-RADS category 3 lesions (79 peripheral zone, 81 transition zone) diagnosed at 3-Tesla MRI with histopathology diagnosis by MRI-TRUS-guided targeted biopsy. A blinded radiologist confirmed PI-RADS v2.1 score and segmented lesions on axial T2W and ADC images using 3D Slicer, extracting radiomic features with an open-source software (Pyradiomics). Diagnostic accuracy for (1) any PCa and (2) clinically significant (CS; International Society of Urogenital Pathology Grade Group ≥ 2) PCa was assessed using XGBoost with tenfold cross -validation. RESULTS From 160 PI-RADS 3 lesions, there were 50.0% (80/160) PCa, including 36.3% (29/80) CS-PCa (63.8% [51/80] ISUP 1, 23.8% [19/80] ISUP 2, 8.8% [7/80] ISUP 3, 3.8% [3/80] ISUP 4). The remaining 50.0% (80/160) lesions were benign. ML of all radiomic features from T2W and ADC achieved area under receiver operating characteristic curve (AUC) for diagnosis of (1) CS-PCa 0.547 (95% Confidence Intervals 0.510-0.584) for T2W and 0.684 (CI 0.652-0.715) for ADC and (2) any PCa 0.608 (CI 0.579-0.636) for T2W and 0.642 (CI 0.614-0.0.670) for ADC. CONCLUSION Our results indicate ML of radiomic features extracted from T2W and ADC achieved at best moderate accuracy for determining which PI-RADS category 3 lesions represent PCa.
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Affiliation(s)
- Christopher S Lim
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Rm AB 279, Toronto, ON, M4N 3M5, Canada.
| | - Jorge Abreu-Gomez
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, Joint Department of Medical Imaging, University of Toronto, 585 University Avenue PMB-298, Toronto, ON, M5G2N2, Canada
| | - Rebecca Thornhill
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, 1053 Carling Ave, Civic Campus C1, Ottawa, ON, K1Y 4E9, Canada
| | - Nick James
- Software Solutions, The Ottawa Hospital, Ottawa, Canada
| | - Ahmed Al Kindi
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Rm AB 279, Toronto, ON, M4N 3M5, Canada
| | - Andrew S Lim
- Department of Radiation Oncology, Seattle Cancer Care Alliance, University of Washington, 825 Eastlake Ave. E, Seattle Washington, 98109-1023, USA
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, 1053 Carling Ave, Civic Campus C1, Ottawa, ON, K1Y 4E9, Canada
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Li W, Sun Y, Wu Y, Lu F, Xu H. The Quantitative Assessment of Using Multiparametric MRI for Prediction of Extraprostatic Extension in Patients Undergoing Radical Prostatectomy: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:771864. [PMID: 34881183 PMCID: PMC8645791 DOI: 10.3389/fonc.2021.771864] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate the diagnostic performance of using quantitative assessment with multiparametric MRI (mpMRI) for prediction of extraprostatic extension (EPE) in patients with prostate cancer (PCa). METHODS We performed a computerized search of MEDLINE, Embase, Cochrane Library, Web of Science, and Google Scholar from inception until July 31, 2021. Summary estimates of sensitivity and specificity were pooled with the bivariate model, and quality assessment of included studies was performed with the Quality Assessment of Diagnostic Accuracy Studies-2. We plotted forest plots to graphically present the results. Multiple subgroup analyses and meta-regression were performed to explore the variate clinical settings and heterogeneity. RESULTS A total of 23 studies with 3,931 participants were included. The pooled sensitivity and specificity for length of capsular contact (LCC) were 0.79 (95% CI 0.75-0.83) and 0.77 (95% CI 0.73-0.80), for apparent diffusion coefficient (ADC) were 0.71 (95% CI 0.50-0.86) and 0.71 (95% CI 059-0.81), for tumor size were 0.62 (95% CI 0.57-0.67) and 0.75 (95% CI 0.67-0.82), and for tumor volume were 0.77 (95% CI 0.68-0.84) and 0.72 (95% CI 0.56-0.83), respectively. Substantial heterogeneity was presented among included studies, and meta-regression showed that publication year (≤2017 vs. >2017) was the significant factor in studies using LCC as the quantitative assessment (P=0.02). CONCLUSION Four quantitative assessments of LCC, ADC, tumor size, and tumor volume showed moderate to high diagnostic performance of predicting EPE. However, the optimal cutoff threshold varied widely among studies and needs further investigation to establish.
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Affiliation(s)
- Wei Li
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Yuan Sun
- Department of Burn and Plastic Surgery, 71st Group Army Hospital of People’s Liberation Army of China, Xuzhou, China
| | - Yiman Wu
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Feng Lu
- Department of Radiology, Wuxi No. 2 People’s Hospital, Wuxi, China
| | - Hongtao Xu
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
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Shaish H, Casals R, Ahmed F, Makkar J, Wenske S. Impact of mandated prospectively reported apparent diffusion coefficient values on the rates of positivity for clinically significant prostate cancer by PI-RADS score. Acta Radiol 2021; 62:139-144. [PMID: 32312102 DOI: 10.1177/0284185120915617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prior research has shown that retrospectively measured apparent diffusion coefficient (ADC) of prostate magnetic resonance imaging (MRI) lesions is associated with clinically significant prostate cancer (csPCa) on targeted biopsy suggesting that ADC should be measured and reported prospectively. PURPOSE To assess the impact of mandatory prospective measurement of ADC on the rates of positivity across PI-RADS scores for csPCa. MATERIAL AND METHODS Consecutive patients who underwent ultrasound (US)-MRI fusion prostate biopsy from August 2018 to July 2019 and who had prospectively reported ADC were compared to control patients who did not. Rates of positivity by PI-RADS category were computed and compared using Chi-square. Multivariable regression was performed. RESULTS In total, 126 patients (median age 65 years) with 165 prostate lesions (19, 51, 70, and 25 PI-RADS 2, 3, 4, and 5, respectively) and prospectively reported ADC values were compared to 113 control patients (median age 66 years) with 157 prostate lesions (17, 42, 64, and 34 PI-RADS 2, 3, 4, and 5, respectively). Rates of positivity across PI-RADS scores were similar between the two cohorts; 11%, 25%, 55%, and 76% and 0%, 21%, 56%, and 62% for PI-RADS 2, 3, 4, and 5 in the test and control cohorts, respectively (Chi-square P = 0.78). Multivariate logistic regression showed no significant association between the presence of prospectively measured ADC and csPCa (odds ratio 1.1, 95% confidence interval 0.7-1.7, P = 0.82). CONCLUSION Prospective ADC measurement may not impact PI-RADS category assignments or positivity rates for csPCa under current guidelines. Future versions of PI-RADS may need to incorporate ADC into scoring rules to realize their potential.
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Affiliation(s)
- Hiram Shaish
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Randy Casals
- Medical School, Columbia University Medical Center, New York, NY, USA
| | - Firas Ahmed
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Jasnit Makkar
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Sven Wenske
- Department of Urology, Columbia University Medical Center, New York, NY, USA
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Shieh AC, Guler E, Ojili V, Paspulati RM, Elliott R, Ramaiya NH, Tirumani SH. Extraprostatic extension in prostate cancer: primer for radiologists. Abdom Radiol (NY) 2020; 45:4040-4051. [PMID: 32390076 DOI: 10.1007/s00261-020-02555-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The presence of extraprostatic extension (EPE) on multiparametric MRI (mpMRI) is an important factor in determining the management of prostate cancer. EPE is an established risk factor for biochemical recurrence of prostate cancer after radical prostatectomy (RP) and patients with EPE may be considered for wider resection margins, non-nerve-sparing surgery, adjuvant radiation therapy (RT), or androgen deprivation therapy (ADT). Several statistical nomograms and scoring systems have been developed to predict pathological stage at time of RP but with varying accuracies. Using the current PI-RADS v2 mpMRI staging guidelines results in high specificity but lacks in sensitivity. These findings reveal the need for more standardization and further refinement of existing MRI protocols and prostate cancer prediction tools. Current studies have looked into indirect additional imaging criteria such as index tumor volume, length of capsular contact, and apparent diffusion coefficient. Measuring for these features can improve the robustness of mpMRI in staging prostate cancer, as they have been shown to be independent predictors of EPE. MRI/ultrasound fusion-guided targeted biopsy can detect EPE not found on standard biopsy. Collectively, these measurements and imaging techniques can augment the detection of EPE and subsequent risk stratification.
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Affiliation(s)
- Alice C Shieh
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ezgi Guler
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
- Department of Radiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Raj Mohan Paspulati
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Robin Elliott
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Nikhil H Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Sree Harsha Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
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Lim CS, Abreu-Gomez J, Leblond MA, Carrion I, Vesprini D, Schieda N, Klotz L. When to biopsy Prostate Imaging and Data Reporting System version 2 (PI-RADSv2) assessment category 3 lesions? Use of clinical and imaging variables to predict cancer diagnosis at targeted biopsy. Can Urol Assoc J 2020; 15:115-121. [PMID: 33007183 DOI: 10.5489/cuaj.6781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION We aimed to determine if clinical and imaging features can stratify men at higher risk for clinically significant (CS, International Society of Urological Pathology [ISUP] grade group ≥2) prostate cancer (PCa) in equivocal Prostate Imaging and Data Reporting System (PI-RADS) category 3 lesions on magnetic resonance imaging (MRI). METHODS Approved by the institutional review board, this retrospective study involved 184 men with 198 lesions who underwent 3T-MRI and MRI-directed transrectal ultrasound biopsy for PI-RADS 3 lesions. Men were evaluated including clinical stage, prostate-specific antigen density (PSAD), indication, and MRI lesion size. Diagnoses for all men and by indication (no cancer, any PCa, CSPCa) were compared using multivariate logistic regression, including stage, PSAD, and lesion size. RESULTS We found an overall PCa rate of 31.8% (63/198) and 10.1% (20/198) CSPCa (13 grade group 2, five group 3, and two group 4). Higher stage (p=0.001), PSAD (p=0.007), and lesion size (p=0.015) were associated with CSPCa, with no association between CSPCa and age, PSA, or prostate volume (p>0.05). PSAD modestly predicted CSPCa area under the curve (AUC) 0.66 (95% confidence interval [CI] 0.518-0.794) in all men and 0.64 (0.487-0.799) for those on active surveillance (AS). Model combining clinical stage, PSAD, and lesion size improved accuracy for all men and AS (AUC 0.82 [0.736-0.910], p<0.001 and 0.785 [0.666-0.904], p<0.001). In men with prior negative biopsy and persistent suspicion, PSAD (0.90 [0.767-1.000]) was not different from the model (p>0.05), with optimal cutpoint of ≥0.215 ng/mL/cc achieving sensitivity/specificity of 85.7/84.4%. CONCLUSIONS PI-RADSv2 category 3 lesions are often not CSPCa. PSAD predicted CSPCa in men with a prior negative biopsy; however, PSAD alone had limited value, and accuracy improved when using a model incorporating PSAD with clinical stage and MRI lesion size.
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Affiliation(s)
- Christopher S Lim
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Jorge Abreu-Gomez
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michel-Alexandre Leblond
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Ivan Carrion
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Danny Vesprini
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Nicola Schieda
- Department of Radiology, The Ottawa Hospital, The University of Ottawa, Ottawa, ON, Canada
| | - Laurence Klotz
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Xu N, Ke ZB, Chen YH, Wu YP, Chen SH, Wei Y, Zheng QS, Huang JB, Li XD, Xue XY. Risk Factors for Pathologically Confirmed Lymph Nodes Metastasis in Patients With Clinical T2N0M0 Stage Prostate Cancer. Front Oncol 2020; 10:1547. [PMID: 32923401 PMCID: PMC7456999 DOI: 10.3389/fonc.2020.01547] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 07/20/2020] [Indexed: 01/03/2023] Open
Abstract
Objective To explore the risk factors for postoperatively pathological lymph node metastasis in patients with clinical T2N0M0 stage prostate cancer (PCa). Methods We retrospectively analyzed clinicopathological data of 316 patients with clinical T2 stage PCa and preoperative negative lymph nodes [LN(−)] indicated by imaging (cT2N0M0) between January 2014 and May 2019. Multivariate logistic regression analysis was performed to determine risk factors for postoperatively pathological pLN(+) in patients with cT2N0M0 stage PCa. Spearman correlation analysis was used to explore the relationship between tumor burden and Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score. Results A total of 45 patients (14.2%) were confirmed by postoperative pathology to have LN metastasis. Univariate analysis indicated that total prostate-specific antigen (tPSA), PI-RADS v2 score, postoperative Gleason grade group (GGG), intraductal carcinoma of the prostate (IDC-P), clinical T2 substaging, and postoperative pathological tumor burden were risk factors for pLN(+) in all patients. Multivariate analysis showed that tPSA and postoperative GGG were risk factors for pLN(+) in all patients. Univariate analysis revealed that tPSA, PIRADS v2 score, clinical T2 substaging, IDC-P, postoperative pathological tumor burden, and postoperative GGG were risk factors for pLN(+) in patients with GGG ≥ 3. Multivariate analysis suggested that tPSA, PI-RADS v2 score, clinical T2 substaging, postoperative pathological tumor burden, and GGG were risk factors for pLN (+) in patients with GGG ≥ 3. Spearman correlation analysis showed that PI-RADS v2 score was positively correlated with clinical T2 substaging and postoperative pathological tumor burden. Conclusion There was a high risk of LN metastasis in patients with cT2 PCa if they had high preoperative tPSA or high postoperative GGG. Patients with cT2 PCa and GGG ≥ 3 had a high risk of LN metastasis if they had high PI-RADS v2 score, high preoperative clinical stage or high postoperative pathological tumor burden. PI-RADS v2 score predicted tumor burden well in patients with GGG ≥ 3.
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Affiliation(s)
- Ning Xu
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhi-Bin Ke
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ye-Hui Chen
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yu-Peng Wu
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shao-Hao Chen
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yong Wei
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qing-Shui Zheng
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jin-Bei Huang
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiao-Dong Li
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xue-Yi Xue
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Schieda N, Lim CS, Zabihollahy F, Abreu-Gomez J, Krishna S, Woo S, Melkus G, Ukwatta E, Turkbey B. Quantitative Prostate MRI. J Magn Reson Imaging 2020; 53:1632-1645. [PMID: 32410356 DOI: 10.1002/jmri.27191] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/17/2022] Open
Abstract
Prostate MRI is reported in clinical practice using the Prostate Imaging and Data Reporting System (PI-RADS). PI-RADS aims to standardize, as much as possible, the acquisition, interpretation, reporting, and ultimately the performance of prostate MRI. PI-RADS relies upon mainly subjective analysis of MR imaging findings, with very few incorporated quantitative features. The shortcomings of PI-RADS are mainly: low-to-moderate interobserver agreement and modest accuracy for detection of clinically significant tumors in the transition zone. The use of a more quantitative analysis of prostate MR imaging findings is therefore of interest. Quantitative MR imaging features including: tumor size and volume, tumor length of capsular contact, tumor apparent diffusion coefficient (ADC) metrics, tumor T1 and T2 relaxation times, tumor shape, and texture analyses have all shown value for improving characterization of observations detected on prostate MRI and for differentiating between tumors by their pathological grade and stage. Quantitative analysis may therefore improve diagnostic accuracy for detection of cancer and could be a noninvasive means to predict patient prognosis and guide management. Since quantitative analysis of prostate MRI is less dependent on an individual users' assessment, it could also improve interobserver agreement. Semi- and fully automated analysis of quantitative (radiomic) MRI features using artificial neural networks represent the next step in quantitative prostate MRI and are now being actively studied. Validation, through high-quality multicenter studies assessing diagnostic accuracy for clinically significant prostate cancer detection, in the domain of quantitative prostate MRI is needed. This article reviews advances in quantitative prostate MRI, highlighting the strengths and limitations of existing and emerging techniques, as well as discussing opportunities and challenges for evaluation of prostate MRI in clinical practice when using quantitative assessment. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Christopher S Lim
- Department of Medical Imaging, Sunnybrook Health Sciences, Toronto, Ontario, Canada
| | | | - Jorge Abreu-Gomez
- Department of Medical Imaging, Sunnybrook Health Sciences, Toronto, Ontario, Canada
| | - Satheesh Krishna
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gerd Melkus
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Eran Ukwatta
- Faculty of Engineering, Guelph University, Guelph, Ontario, Canada
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute NIH, Bethesda, Maryland, USA
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Abreu-Gomez J, Walker D, Alotaibi T, McInnes MDF, Flood TA, Schieda N. Effect of observation size and apparent diffusion coefficient (ADC) value in PI-RADS v2.1 assessment category 4 and 5 observations compared to adverse pathological outcomes. Eur Radiol 2020; 30:4251-4261. [PMID: 32211965 DOI: 10.1007/s00330-020-06725-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/03/2019] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare observation size and apparent diffusion coefficient (ADC) values in Prostate Imaging Reporting and Data System (PI-RADS) v2.1 category 4 and 5 observations to adverse pathological features. MATERIALS AND METHODS With institutional review board approval, 267 consecutive men with 3-T MRI before radical prostatectomy (RP) between 2012 and 2018 were evaluated by two blinded radiologists who assigned PI-RADS v2.1 scores. Discrepancies were resolved by consensus. A third blinded radiologist measured observation size and ADC (ADC.mean, ADC.min [lowest ADC within an observation], ADC.ratio [ADC.mean/ADC.peripheral zone {PZ}]). Size and ADC were compared to pathological stage and Gleason score (GS) using t tests, ANOVA, Pearson correlation, and receiver operating characteristic (ROC) analysis. RESULTS Consensus review identified 267 true positive category 4 and 5 observations representing 83.1% (222/267) PZ and 16.9% (45/267) transition zone (TZ) tumors. Inter-observer agreement for PI-RADS v2.1 scoring was moderate (K = 0.45). Size was associated with extra-prostatic extension (EPE) (19 ± 8 versus 14 ± 6 mm, p < 0.001) and seminal vesicle invasion (SVI) (24 ± 9 versus 16 ± 7 mm, p < 0.001). Size ≥ 15 mm optimized the accuracy for EPE with area under the ROC curve (AUC) and sensitivity/specificity of 0.68 (CI 0.62-0.75) and 63.2%/65.6%. Size ≥ 19 mm optimized the accuracy for SVI with AUC/sensitivity/specificity of 0.75 (CI 0.66-0.83)/69.4%/70.6%. ADC metrics were not associated with pathological stage. Larger observation size (p = 0.032), lower ADC.min (p = 0.010), and lower ADC.ratio (p = 0.010) were associated with higher GS. Size correlated better to higher Gleason scores (p = 0.002) compared to ADC metrics (p = 0.09-0.11). CONCLUSION Among PI-RADS v2.1 category 4 and 5 observations, size was associated with higher pathological stage whereas ADC metrics were not. Size, ADC.minimum, and ADC.ratio differed in tumors stratified by Gleason score. KEY POINTS • Among PI-RADS category 4 and 5 observations, size but not ADC can differentiate between tumors by pathological stage. • An observation size threshold of 15 mm and 19 mm optimized the accuracy for diagnosis of extra-prostatic extension and seminal vesicle invasion. • Among PI-RADS category 4 and 5 observations, size, ADC.minimum, and ADC.ratio differed comparing tumors by Gleason score.
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Affiliation(s)
- Jorge Abreu-Gomez
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, C1 Radiology, Ottawa, Ontario, K1Y 4E9, Canada
| | - Daniel Walker
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, C1 Radiology, Ottawa, Ontario, K1Y 4E9, Canada
| | - Tareq Alotaibi
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, C1 Radiology, Ottawa, Ontario, K1Y 4E9, Canada
| | - Matthew D F McInnes
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, C1 Radiology, Ottawa, Ontario, K1Y 4E9, Canada
| | - Trevor A Flood
- Department of Anatomical Pathology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, C1 Radiology, Ottawa, Ontario, K1Y 4E9, Canada.
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Reisæter LAR, Halvorsen OJ, Beisland C, Honoré A, Gravdal K, Losnegård A, Monssen J, Akslen LA, Biermann M. Assessing Extraprostatic Extension with Multiparametric MRI of the Prostate: Mehralivand Extraprostatic Extension Grade or Extraprostatic Extension Likert Scale? Radiol Imaging Cancer 2020; 2:e190071. [PMID: 33778694 DOI: 10.1148/rycan.2019190071] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/04/2019] [Accepted: 10/21/2019] [Indexed: 01/22/2023]
Abstract
Purpose To validate the MRI grading system proposed by Mehralivand et al in 2019 (the "extraprostatic extension [EPE] grade") in an independent cohort and to compare the Mehralivand EPE grading system with EPE interpretation on the basis of a five-point Likert score ("EPE Likert"). Materials and Methods A total of 310 consecutive patients underwent multiparametric MRI according to a standardized institutional protocol before radical prostatectomy was performed by using the same 1.5-T MRI unit at a single institution between 2010 and 2012. Two radiologists blinded to clinical information assessed EPE according to standardized criteria. On the basis of the readings performed until 2017, the diagnostic performance of EPE Likert and Mehralivand EPE score were compared using receiver operating characteristics (ROC) and decision curve methodology against histologic EPE as standard of reference. Prediction of biochemical recurrence-free survival (BRFS) was assessed by Kaplan-Meier analysis and log rank test. Results Of the 310 patients, 80 patients (26%) had EPE, including 33 with radial distance 1.1 mm or greater. Interrater reliability was fair (weighted κ 0.47 and 0.45) for both EPE grade and EPE Likert. Sensitivity for identifying EPE using EPE grade versus EPE Likert was 0.83 versus 0.86 and 0.86 versus 0.91 for radiologist 1 and 2, respectively. Specificity was 0.48 versus 0.58 and 0.39 versus 0.70 (P < .05 for radiologist 2). There were no significant differences in the ROC area under the curve or on decision curve analysis. Both EPE grade and EPE Likert were significant predictors of BRFS. Conclusion Mehralivand EPE grade and EPE Likert have equivalent diagnostic performance for predicting EPE and BRFS with a similar degree of observer dependence.© RSNA, 2020Keywords: MR-Imaging, Neoplasms-Primary, Observer Performance, Outcomes Analysis, Prostate, StagingSupplemental material is available for this article.See also the commentary by Choyke in this issue.
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Affiliation(s)
- Lars A R Reisæter
- Departments of Radiology (L.A.R.R., A.L., J.M., M.B.), Pathology (O.J.H., K.G., L.A.A.), and Urology (C.B., A.H.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (L.A.R.R., C.B., A.L., M.B.) and Centre for Cancer Biomarkers CCBIO (O.J.H., L.A.A.), University of Bergen, Jonas Liesvei 65, N-5021 Bergen, Norway
| | - Ole J Halvorsen
- Departments of Radiology (L.A.R.R., A.L., J.M., M.B.), Pathology (O.J.H., K.G., L.A.A.), and Urology (C.B., A.H.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (L.A.R.R., C.B., A.L., M.B.) and Centre for Cancer Biomarkers CCBIO (O.J.H., L.A.A.), University of Bergen, Jonas Liesvei 65, N-5021 Bergen, Norway
| | - Christian Beisland
- Departments of Radiology (L.A.R.R., A.L., J.M., M.B.), Pathology (O.J.H., K.G., L.A.A.), and Urology (C.B., A.H.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (L.A.R.R., C.B., A.L., M.B.) and Centre for Cancer Biomarkers CCBIO (O.J.H., L.A.A.), University of Bergen, Jonas Liesvei 65, N-5021 Bergen, Norway
| | - Alfred Honoré
- Departments of Radiology (L.A.R.R., A.L., J.M., M.B.), Pathology (O.J.H., K.G., L.A.A.), and Urology (C.B., A.H.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (L.A.R.R., C.B., A.L., M.B.) and Centre for Cancer Biomarkers CCBIO (O.J.H., L.A.A.), University of Bergen, Jonas Liesvei 65, N-5021 Bergen, Norway
| | - Karsten Gravdal
- Departments of Radiology (L.A.R.R., A.L., J.M., M.B.), Pathology (O.J.H., K.G., L.A.A.), and Urology (C.B., A.H.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (L.A.R.R., C.B., A.L., M.B.) and Centre for Cancer Biomarkers CCBIO (O.J.H., L.A.A.), University of Bergen, Jonas Liesvei 65, N-5021 Bergen, Norway
| | - Are Losnegård
- Departments of Radiology (L.A.R.R., A.L., J.M., M.B.), Pathology (O.J.H., K.G., L.A.A.), and Urology (C.B., A.H.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (L.A.R.R., C.B., A.L., M.B.) and Centre for Cancer Biomarkers CCBIO (O.J.H., L.A.A.), University of Bergen, Jonas Liesvei 65, N-5021 Bergen, Norway
| | - Jan Monssen
- Departments of Radiology (L.A.R.R., A.L., J.M., M.B.), Pathology (O.J.H., K.G., L.A.A.), and Urology (C.B., A.H.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (L.A.R.R., C.B., A.L., M.B.) and Centre for Cancer Biomarkers CCBIO (O.J.H., L.A.A.), University of Bergen, Jonas Liesvei 65, N-5021 Bergen, Norway
| | - Lars A Akslen
- Departments of Radiology (L.A.R.R., A.L., J.M., M.B.), Pathology (O.J.H., K.G., L.A.A.), and Urology (C.B., A.H.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (L.A.R.R., C.B., A.L., M.B.) and Centre for Cancer Biomarkers CCBIO (O.J.H., L.A.A.), University of Bergen, Jonas Liesvei 65, N-5021 Bergen, Norway
| | - Martin Biermann
- Departments of Radiology (L.A.R.R., A.L., J.M., M.B.), Pathology (O.J.H., K.G., L.A.A.), and Urology (C.B., A.H.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (L.A.R.R., C.B., A.L., M.B.) and Centre for Cancer Biomarkers CCBIO (O.J.H., L.A.A.), University of Bergen, Jonas Liesvei 65, N-5021 Bergen, Norway
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Dynamic Contrast-Enhanced MRI-Upgraded Prostate Imaging Reporting and Data System Version 2 Category 3 Peripheral Zone Observations Stratified by a Size Threshold of 15 mm. AJR Am J Roentgenol 2019; 213:836-843. [PMID: 31120786 DOI: 10.2214/ajr.18.21005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE. The purpose of this study is to evaluate dynamic contrast-enhanced (DCE) MRI (DCE-MRI)-upgraded Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) peripheral zone (PZ) observations stratified by a size threshold of 15 mm. MATERIALS AND METHODS. Two blinded radiologists independently assessed 301 patients with 326 clinically significant tumors (Gleason score [GS] ≥ 7) using multiparametric MRI performed before radical prostatectomy (RP) between 2012 and 2017 and then assigned PI-RADSv2 scores for the tumors. PI-RADSv2 category 3 PZ observations upgraded on the basis of abnormal DCE-MRI findings were tabulated, agreement was calculated, and discrepancies were resolved by consensus. The rate of detection of clinically significant cancer among upgraded observations was calculated. Size was measured at consensus review and was compared with pathologic outcomes on the basis of the PI-RADSv2 size threshold of 15 mm or more, with the use of chi-square tests. RESULTS. Reader 1 identified 5.2% (17/326) of DCE-MRI-upgraded PZ observations, and reader 2 identified 8.3% (27/326) of such observations. Interobserver agreement for PI-RADSv2 scoring was moderate (κ = 0.42) overall, but it was fair (κ = 0.23) when only DCE-MRI-upgraded observations were considered. Of the upgraded observations, which had a mean (± SD) size of 14 ± 6 mm (range, 6-29 mm), 10.4% (34/326) were agreed on after consensus review. Size smaller than 15 mm was noted for 61.8% (21/34) of observations. Among DCE-MRI-upgraded PZ observations, true- and false-positive detection rates for significant cancer were 91.2% (31/34) and 8.8% (3/34), respectively. Observations 15 mm or larger had no false-positive diagnoses and higher rates of extraprostatic extension (84.6% [11/13] vs 38.1% [8/21]; p = 0.016); however, there was no difference in GS (p = 0.354) compared with observations less than 15 mm in size. CONCLUSION. PZ observations upgraded on the basis of abnormal DCE-MRI findings have a high likelihood of being clinically significant cancer; however, agreement between readers was low. DCE-MRI-upgraded tumors of 15 mm or larger had no false-positive diagnoses and higher rates of extraprostatic extension, suggesting that they could be assigned to PI-RADSv2 assessment category 5.
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Bai K, Sun Y, Li W, Zhang L. Apparent diffusion coefficient in extraprostatic extension of prostate cancer: a systematic review and diagnostic meta-analysis. Cancer Manag Res 2019; 11:3125-3137. [PMID: 31114355 PMCID: PMC6489658 DOI: 10.2147/cmar.s191738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/07/2019] [Indexed: 12/30/2022] Open
Abstract
Objective: To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) for local staging of prostate cancer. Methods: Databases of Web of Science, MEDLINE (Ovid and PubMed), Cochrane Library, EMBASE, and Google Scholar were searched up to May 31, 2018, with language restricted to English. All studies concerning multiparametric magnet resonance imaging (mpMRI) with ADC for detection of extracapsular extension (ECE, T3a) and/or extraprostatic extension (EPE, overall stage of T3) were identified by two reviewers independently, and quality of included studies was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2 tool. True positive, false positive, false negative and true negative of each study were extracted to reconstruct the 2×2 tables for evaluating diagnostic accuracy. Summary estimates of sensitivity, specificity, and corresponding 95% CIs were calculated with bivariate model and hierarchical summary receiver operating characteristic model, then presented in forest plots. Multiple subgroup analyses and meta-regression were performed, and publication bias was evaluated with Deeks funnel. Results: A total of 18 studies were included, with 6 involved ECE and 12 for EPE. Pooled sensitivity was 80.5% (95% CI 76.5-83.9%) with specificity of 69.1% (95% CI 62.3-75.2%). Multiple subgroup analyses showed that if ADC and length of capsular contact are regarded as independent predictors, pooled sensitivity was 85% (95% CI 77-90%) and 81.1% (95% CI 76.0-85.3%), with specificity of 70.8% (95% CI 56.3-82.0%) and 66.6% (95% CI 57.6-74.5%), respectively. Meta-regression demonstrated that there was no substantially significant difference in types of coil, magnet field strength (1.5T versus 3.0T), and analysis method (per-lesion versus per-patient). Conclusion: By introducing ADC to MRI, we could obtain favorable sensitivity for diagnostic performance of EPE, but with a little decreased specificity.
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Affiliation(s)
- Koudi Bai
- Department of Radiology, Yancheng First Peoples’ Hospital, Yancheng City, People’s Republic of China
| | - Yuan Sun
- Department of Orthopedics, No.97 Hospital of People’s Liberation Army of China, Xuzhou City, People’s Republic of China
| | - Wei Li
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng City, People’s Republic of China
| | - Lanlan Zhang
- Department of Pediatrics, Yancheng Maternal and Child Health Hospital, Yancheng City, People’s Republic of China
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Abstract
Accurate tumor detection and establishment of disease extent are important for optimal management of prostate cancer. Disease stage, beginning with identification of the index prostate lesion, followed by primary tumor, lymph node, and distant metastasis evaluation, provide crucial clinical information that not only have prognostic and predictive value, but guide patient management. A wide array of radiological imaging modalities including ultrasound, computed tomography, and magnetic resonance imaging have been used for the purpose of prostate cancer staging with variable diagnostic performance. Especially, the last years have seen remarkable technological advances in magnetic resonance imaging technology, enabling referring clinicians and radiologists to obtain even more valuable data regarding staging of prostate cancer. Marked improvements have been seen in detection of the index prostate lesion and evaluation of extraprostatic extension while further improvements are still needed in identifying metastatic lymph nodes. Novel approaches such as whole-body MRI are emerging for more accurate and reproducible assessment of bone metastasis. Post-treatment assessment of prostate cancer using radiological imaging is a topic with rapidly changing clinical context and special consideration is needed for the biochemical setting, that is, the relatively high serum prostate-specific antigen levels in studies assessing the value of radiological imaging for post-treatment assessment and emerging therapeutic approaches such as early salvage radiation therapy. The scope of this review is to provide the reader insight into the various ways radiology contribute to staging of prostate cancer in the context of both primary staging and post-treatment assessment. The strengths and limitations of each imaging modality are highlighted as well as topics that warrant future research.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Soleen Ghafoor
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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ADC Metrics From Multiparametric MRI: Histologic Downgrading of Gleason Score 9 or 10 Prostate Cancers Diagnosed at Nontargeted Transrectal Ultrasound–Guided Biopsy. AJR Am J Roentgenol 2018; 211:W158-W165. [DOI: 10.2214/ajr.17.18958] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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John S, Cooper S, Breau RH, Flood TA, Cagiannos I, Lavallee LT, Morash C, O'sullivan J, Schieda N. Multiparametric magnetic resonance imaging - Transrectal ultrasound-guided cognitive fusion biopsy of the prostate: Clinically significant cancer detection rates stratified by the Prostate Imaging and Data Reporting System version 2 assessment category. Can Urol Assoc J 2018; 12:401-406. [PMID: 29940139 DOI: 10.5489/cuaj.5254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION We aimed to report the clinically significant prostate cancer (PCa) detection rate in men undergoing magnetic resonance imaging-transrectal ultrasound (MRI-TRUS)-cognitive fusion (CF) targeted biopsies stratified by the Prostate Imaging and Data Reporting System (PI-RADS) version 2 (v2) scores. METHODS With a quality assurance waiver from the IRB, we identified a cohort of men who underwent MRI-TRUS-CF and synchronous template biopsy from 2015-2017. MRI (PI-RADS v2 score, lesion size, lesion location [peripheral or transition zone (PZ/TZ)]), and CF-TRUS biopsy (operator experience, TRUS visibility, and number of biopsies) features were extracted. The primary outcome was diagnosis of clinically significant (Gleason score ≥3+4=7 or International Society of Urological Pathology (ISUP) grade group ≥2) PCa. RESULTS During the study period, 131 men (with 142 PIRADS v2 score ≥3 lesions) met inclusion criteria; 98 men had previously negative template biopsy and 33 were on active surveillance for previously detected low-grade PCa. In total, 41.9% (55/131) men had clinically significant PCa - 17.6% (23/131) detected on targeted biopsy only, 8.4% (11/131) on template biopsy only, and 16.0% (21/131) on both targeted and template biopsy. Clinically significant PCa detection stratified by PI-RADS v2 scores were: 11.1% (3/27) for score 3 (indeterminate), 42.9% (24/56) for score 4 (significant cancer likely), and 35.6% (21/59) for score 5 (significant cancer very likely). Clinically significant PCa detection rates in targeted biopsies were better among PZ (41.8% [33/79]) compared to TZ (23.8% [15/63]) lesions (p=0.025) in TRUS visible lesions (p=0.033) and in the most experienced radiologists (p=0.05), with no difference by lesion size or number of additional core biopsies performed (all p>0.05). CONCLUSIONS Cognitive fusion MRI-TRUS-guided targeted biopsy yielded substantially lower rates of clinically significant cancer in PI-RADS v2 score 4 and 5 lesions when compared to published results using in-bore MR-guided or automated MRI-TRUS fusion guidance systems. Cancer detection was worst for TZ lesions.
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Affiliation(s)
- Susan John
- The University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Steven Cooper
- The University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Rodney H Breau
- The University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Trevor A Flood
- The University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Ilias Cagiannos
- The University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Luke T Lavallee
- The University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | | | | | - Nicola Schieda
- The University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
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Sasaki T, Kim J, Moritani T, Capizzano AA, Sato SP, Sato Y, Kirby P, Ishitoya S, Oya A, Toda M, Yuzawa S, Takahashi K. Roles of the apparent diffusion coefficient and tumor volume in predicting tumor grade in patients with choroid plexus tumors. Neuroradiology 2018; 60:479-486. [DOI: 10.1007/s00234-018-2008-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/27/2018] [Indexed: 12/24/2022]
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Jäderling F, Nyberg T, Öberg M, Carlsson S, Skorpil M, Blomqvist L. Accuracy in local staging of prostate cancer by adding a three-dimensional T2-weighted sequence with radial reconstructions in magnetic resonance imaging. Acta Radiol Open 2018; 7:2058460118754607. [PMID: 29456872 PMCID: PMC5810977 DOI: 10.1177/2058460118754607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 12/17/2017] [Indexed: 11/16/2022] Open
Abstract
Background The evidence supporting the use of magnetic resonance imaging (MRI) in prostate cancer detection has been established, but its accuracy in local staging is questioned. Purpose To investigate the additional value of multi-planar radial reconstructions of a three-dimensional (3D) T2-weighted (T2W) MRI sequence, intercepting the prostate capsule perpendicularly, for improving local staging of prostate cancer. Material and Methods Preoperative, bi-parametric prostate MRI examinations in 94 patients operated between June 2014 and January 2015 where retrospectively reviewed by two experienced abdominal radiologists. Each patient was presented in two separate sets including diffusion-weighted imaging, without and with the 3D T2W set that included radial reconstructions. Each set was read at least two months apart. Extraprostatic tumor extension (EPE) was assessed according to a 5-point grading scale. Sensitivity and specificity for EPE was calculated and presented as receiver operating characteristics (ROC) with area under the curve (AUC), using histology from whole-mount prostate specimen as gold standard. Inter-rater agreement was calculated for the two different reading modes using Cohen's kappa. Results The AUC for detection of EPE for Readers 1 and 2 in the two-dimensional (2D) set was 0.70 and 0.68, respectively, and for the 2D + 3D set 0.62 and 0.65, respectively. Inter-rater agreement (Reader 1 vs. Reader 2) on EPE using Cohen's kappa for the 2D and 2D + 3D set, respectively, was 0.42 and 0.17 (i.e. moderate and poor agreement, respectively). Conclusion The addition of 3D T2W MRI with radial reconstructions did not improve local staging in prostate cancer.
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Affiliation(s)
- Fredrik Jäderling
- 1Department of Radiology, Karolinska University Hospital, Solna, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Tommy Nyberg
- Department of Oncology and Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Michael Öberg
- 1Department of Radiology, Karolinska University Hospital, Solna, Sweden
| | - Stefan Carlsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Urology Karolinska University Hospital, Solna, Sweden
| | - Mikael Skorpil
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
| | - Lennart Blomqvist
- 1Department of Radiology, Karolinska University Hospital, Solna, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Radiation Sciences, Umeå University, Umeå, Sweden
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A prospective study evaluating indirect MRI-signs for the prediction of extraprostatic disease in patients with prostate cancer: tumor volume, tumor contact length and tumor apparent diffusion coefficient. World J Urol 2018; 36:629-637. [PMID: 29349572 DOI: 10.1007/s00345-018-2171-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate three indirect MRI signs for predicting extraprostatic disease in patients referred to radical prostatectomy: index tumor volume (MTV), apparent diffusion coefficient (ADC) and tumor contact length (TCL). MATERIALS AND METHODS This prospective study included 183 patients with biopsy proven prostate cancer. In all patients the MTV (ml), ADC (× 10-5 mm2/s) and TCL (mm) of the index tumor were registered at the preoperative MRI. Whole-mounted microscopical examination classified each patient as having either localized- or extraprostatic disease. The Youden index was used to identify the optimal cut-off values for predicting extraprostatic disease. Univariate regression analyses were conducted to estimate the odds ratio (OR) with 95% confidence intervals (CI). Results were stratified upon zonal location of the index tumor. RESULTS Extraprostatic disease was identified in 103 (56%) patients. The risk of extraprostatic disease was nine times higher in peripheral zone tumors with ADC ≤ 89 (OR 9.1, 95% CI 4.2-19.6), five times higher in MTV ≥ 0.9 ml (OR 5.5, 95% CI 2.6-11.4) and five times higher in case of TCL ≥ 14 mm (OR 4.9, 95% CI 2.3-10.2). None of the indirect MRI signs could predict extraprostatic disease for transition zone tumors. CONCLUSION The MTV, ADC and TCL are all significant predictors of extraprostatic disease for peripheral zone tumors, while none of the indirect signs were useful for transition zone tumors.
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Hoffmann R, Logan C, O’Callaghan M, Gormly K, Chan K, Foreman D. Does the Prostate Imaging-Reporting and Data System (PI-RADS) version 2 improve accuracy in reporting anterior lesions on multiparametric magnetic resonance imaging (mpMRI)? Int Urol Nephrol 2017; 50:13-19. [DOI: 10.1007/s11255-017-1753-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/17/2017] [Indexed: 12/26/2022]
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Krishna S, Lim CS, McInnes MDF, Flood TA, Shabana WM, Lim RS, Schieda N. Evaluation of MRI for diagnosis of extraprostatic extension in prostate cancer. J Magn Reson Imaging 2017; 47:176-185. [PMID: 28387981 DOI: 10.1002/jmri.25729] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/23/2017] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To assess the ability of magnetic resonance imaging (MRI) to diagnose extraprostatic extension (EPE) in prostate cancer. MATERIALS AND METHODS With Institutional Review Board (IRB) approval, 149 men with 170 ≥0.5 mL tumors underwent preoperative 3T MRI followed by radical prostatectomy (RP) between 2012-2015. Two blinded radiologists (R1/R2) assessed tumors using Prostate Imaging Reporting and Data System (PI-RADS) v2, subjectively evaluated for the presence of EPE, measured tumor size, and length of capsular contact (LCC). A third blinded radiologist, using MRI-RP-maps, measured whole-lesion: apparent diffusion coefficient (ADC) mean/centile and histogram features. Comparisons were performed using chi-square, logistic regression, and receiver operator characteristic (ROC) analysis. RESULTS The subjective EPE assessment showed high specificity (SPEC = 75.4/91.3% [R1/R2]), low sensitivity (SENS = 43.3/43.6% [R1/R2]), and area-under (AU) ROC curve = 0.67 (confidence interval [CI] 0.61-0.73) R1 and 0.61 (CI 0.53-0.70) R2; (k = 0.33). PI-RADS v2 scores were strongly associated with EPE (P < 0.001 / P = 0.008; R1/R2) with AU-ROC curve = 0.72 (0.64-0.79) R1 and 0.61 (0.53-0.70) R2; (k = 0.44). Tumors with EPE were larger (18.8 ± 7.8 [median 17, range 6-51] vs. 18.8 ± 4.9 [12, 6-28] mm) and had greater LCC (21.1 ± 14.9 [16, 1-85] vs. 13.6 ± 6.1 [11.5, 4-30] mm); P < 0.001 and 0.002, respectively. AU-ROC for size was 0.73 (0.64-0.80) and LCC was 0.69 (0.60-0.76), respectively. Optimal SENS/SPEC for diagnosis of EPE were: size ≥15 mm = 67.7/66.7% and LCC ≥11 mm = 84.9/44.8%. 10th -centile ADC and ADC entropy were both associated with EPE (P = 0.02 and < 0.001), with AU-ROC = 0.56 (0.47-0.65) and 0.76 (0.69-0.83), respectively. Optimal SENS/SPEC for diagnosis of EPE with entropy ≥6.99 was 63.3/75.0%. 25th -centile ADC trended towards being significantly lower with EPE (P = 0.06) with no difference in other ADC metrics (P = 0.25-0.88). Size, LCC, and ADC entropy improved sensitivity but reduced specificity compared with subjective analysis with no difference in overall accuracy (P = 0.38). CONCLUSION Measurements of tumor size, capsular contact, and ADC entropy improve sensitivity but reduce specificity for diagnosis of EPE compared to subjective assessment. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:176-185.
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Affiliation(s)
- Satheesh Krishna
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher S Lim
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Matthew D F McInnes
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor A Flood
- Department of Anatomical Pathology, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Wael M Shabana
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert S Lim
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Prostate Imaging Reporting and Data System, Version 2, Assessment Categories and Pathologic Outcomes in Patients With Gleason Score 3 + 4 = 7 Prostate Cancer Diagnosed at Biopsy. AJR Am J Roentgenol 2017; 208:1037-1044. [PMID: 28267359 DOI: 10.2214/ajr.16.16843] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to assess associations between Prostate Imaging Reporting and Data System, version 2 (PI-RADSv2), categories and the presence of a tumor with a Gleason score (GS) of 4 + 3 = 7 or greater or the presence of extraprostatic extension (EPE) at radical prostatectomy (RP) in patients with a GS 3 + 4 = 7 tumor at biopsy. MATERIALS AND METHODS A total of 81 men with GS 3 + 4 = 7 prostate cancer diagnosed by transrectal ultrasound-guided biopsy underwent multiparametric MRI and RP between 2012 and 2015. Two blinded radiologists assessed multiparametric MR images and assigned PI-RADSv2 assessment categories (categories 1-5) with the use of sector maps, which were compared with regard to the location of the tumor, the GS, and the presence of EPE at RP. Comparisons were performed between groups with the use of chi-square and multivariate analysis. Diagnostic accuracy was assessed using ROC curve analysis, and localization was compared using the Fisher exact test. RESULTS A total of 53.1% of men (43/81) had EPE, and 21.0% (17/81) had GS 4 + 3 = 7 prostate cancer after RP, whereas 2.5% of men (2/81) had their tumors downgraded to GS 3 + 3 = 6. No statistically significant difference in patient age, prostate specific antigen level, or clinical stage existed between groups (p > 0.05). PI-RADSv2 assessment categories were significantly higher for GS 4 + 3 = 7 tumors (p = 0.03). PI-RADSv2 showed moderate accuracy for the diagnosis of GS 4 + 3 = 7 tumors (AUC, 0.65; 95% CI, 0.54-0.77), with a category of 4 or higher having a sensitivity and specificity for diagnosis of 94.1% and 23.4%, respectively. No patient with a PI-RADSv2 category lower than 3 had a GS 4 + 3 = 7 tumor. Accuracy of tumor localization ranged from 86.4% to 92.6%, with 88.2% of errors (15/17) occurring in GS 3 + 3 = 6 or GS 3 + 4 = 7 tumors (p = 0.30). PI-RADSv2 categories were noted to be higher when EPE was present (p < 0.001). Interobserver agreement was moderate (κ = 0.43). CONCLUSION For GS 3 + 4 = 7 cancers detected at transrectal ultrasound-guided biopsy, higher PI-RADSv2 assessment categories are associated with upgrading to GS 4 + 3 = 7 cancer and with the presence of EPE after RP. A PI-RADSv2 score of 3 or higher was 100% sensitive for diagnosing GS 4 + 3 = 7 tumors.
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Lim CS, McInnes MD, Lim RS, Breau RH, Flood TA, Krishna S, Morash C, Shabana WM, Schieda N. Prognostic value of Prostate Imaging and Data Reporting System (PI-RADS) v. 2 assessment categories 4 and 5 compared to histopathological outcomes after radical prostatectomy. J Magn Reson Imaging 2016; 46:257-266. [DOI: 10.1002/jmri.25539] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/19/2016] [Indexed: 01/05/2023] Open
Affiliation(s)
- Christopher S. Lim
- Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
| | - Matthew D.F. McInnes
- Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
| | - Robert S. Lim
- Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
| | - Rodney H. Breau
- Ottawa Hospital, University of Ottawa, Division of Urology, Department of Surgery, General Campus; Ottawa Ontario Canada
| | - Trevor A. Flood
- Ottawa Hospital, University of Ottawa, Department of Anatomical Pathology, General Campus; Ottawa Ontario Canada
| | - Satheesh Krishna
- Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
| | - Christopher Morash
- Ottawa Hospital, University of Ottawa, Division of Urology, Department of Surgery, General Campus; Ottawa Ontario Canada
| | - Wael M. Shabana
- Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
| | - Nicola Schieda
- Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
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Schieda N, Lim CS, Idris M, Lim RS, Morash C, Breau RH, Flood TA, McInnes MDF. MRI assessment of pathological stage and surgical margins in anterior prostate cancer (APC) using subjective and quantitative analysis. J Magn Reson Imaging 2016; 45:1296-1303. [PMID: 27726247 DOI: 10.1002/jmri.25510] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/26/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate magnetic resonance imaging (MRI) for assessment of extraprostatic extension (EPE) and positive surgical margins (PSM) in anterior prostate cancer (APC). MATERIALS AND METHODS With Institutional Review Board approval, 25 APC (>2/3 of tumor anterior to urethra) were assessed using 3T MRI by two blinded radiologists for: size and maximal leading edge of tumor (relative to anterior fibromuscular stroma [AFMS]) on b ≥1000 sec/mm2 echo-planar-MRI fused onto T2 -weighted-MRI, invasion of AFMS and EPE. Comparisons were performed between APCs by EPE/PSM using chi-square, multivariable analysis, and receiver operator characteristic (ROC) analysis. RESULTS The prevalence of EPE and PSM were 52% (13/25) and 36% (9/25). Tumor sizes were larger with EPE (22.5 ± 8.4 vs. 14.7 ± 6.3, P = 0.02) and PSM (23.0 ± 9.3 vs. 16.4 ± 7.0, P = 0.06). Area under ROC curve (AUC-ROC) for the diagnosis of EPE by tumor size was 0.77 (95% confidence interval [CI] 0.58-0.95); ≥16 mm size = sensitivity/specificity 69.2/66.7%. Maximal leading edge of tumor was greater with EPE (2.4 ± 2.2 vs. -0.2 ± 3.0) and PSM (2.8 ± 2.3 vs. -0.3 ± 2.5), (P = 0.023, 0.031). AUC-ROC for diagnosis of EPE/PSM by leading edge was 0.78 (CI 0.57-0.97) and 0.75 (CI 0.56-0.94). A ≥1 mm leading edge yielded sensitivity/specificity of 76.9/75.0% and 77.8/62.5% for diagnosis of EPE/PSM. 60-72% (15-18/25) tumors invaded AFMS (k = 0.74), which was not associated with EPE/PSM (P = 0.12-0.14). Radiologists' assessment of EPE had sensitivity/specificity of 61.5-69.2/50.0-75.0% (k = 0.53). CONCLUSION Tumor size and leading edge of tumor relative to AFMS may enable diagnosis of EPE and positive surgical margins in APC. LEVEL OF EVIDENCE 2 J. MAGN. RESON. IMAGING 2017;45:1296-1303.
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Affiliation(s)
- Nicola Schieda
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher S Lim
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Muhammad Idris
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert S Lim
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher Morash
- Ottawa Hospital, University of Ottawa, Department of Surgery, Division of Urology, Ottawa, Ontario, Canada
| | - Rodney H Breau
- Ottawa Hospital, University of Ottawa, Department of Surgery, Division of Urology, Ottawa, Ontario, Canada
| | - Trevor A Flood
- Ottawa Hospital, University of Ottawa, Department of Anatomical Pathology, Ottawa, Ontario, Canada
| | - Matthew D F McInnes
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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