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Taya M, Behr SC, Westphalen AC. Perspectives on technology: Prostate Imaging-Reporting and Data System (PI-RADS) interobserver variability. BJU Int 2024. [PMID: 38923789 DOI: 10.1111/bju.16452] [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: 06/28/2024]
Abstract
OBJECTIVES To explore the topic of Prostate Imaging-Reporting and Data System (PI-RADS) interobserver variability, including a discussion of major sources, mitigation approaches, and future directions. METHODS A narrative review of PI-RADS interobserver variability. RESULTS PI-RADS was developed in 2012 to set technical standards for prostate magnetic resonance imaging (MRI), reduce interobserver variability at interpretation, and improve diagnostic accuracy in the MRI-directed diagnostic pathway for detection of clinically significant prostate cancer. While PI-RADS has been validated in selected research cohorts with prostate cancer imaging experts, subsequent prospective studies in routine clinical practice demonstrate wide variability in diagnostic performance. Radiologist and biopsy operator experience are the most important contributing drivers of high-quality care among multiple interrelated factors including variability in MRI hardware and technique, image quality, and population and patient-specific factors such as prostate cancer disease prevalence. Iterative improvements in PI-RADS have helped flatten the curve for novice readers and reduce variability. Innovations in image quality reporting, administrative and organisational workflows, and artificial intelligence hold promise in improving variability even further. CONCLUSION Continued research into PI-RADS is needed to facilitate benchmark creation, reader certification, and independent accreditation, which are systems-level interventions needed to uphold and maintain high-quality prostate MRI across entire populations.
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Affiliation(s)
- Michio Taya
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Spencer C Behr
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Antonio C Westphalen
- Departments of Radiology, Urology, and Radiation Oncology, University of Washington, Seattle, WA, USA
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Ayranci A, Caglar U, Meric A, Gelmis M, Sarilar O, Ozgor F. Effects of the lesion size on clinically significant prostate cancer detection rates in PI-RADS category 3-5 lesions. Actas Urol Esp 2024:S2173-5786(24)00020-9. [PMID: 38369287 DOI: 10.1016/j.acuroe.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Prostate cancer (PCa) ranks second among prevalent cancers in men, necessitating effective screening tools such as multiparametric magnetic resonance imaging (mpMRI) with the prostate imaging reporting and data system (PI-RADS) classification. This study explores the impact of lesion volume on clinically significant prostate cancer (csPCa) detection rates in PI-RADS 3-5 lesions, aiming to contribute insights into the underexplored relationship between lesion size and csPCa detection. MATERIALS AND METHODS A retrospective analysis was conducted on data from 754 patients undergoing mpMRI-guided transrectal ultrasound (TRUS) prostate biopsy between January 2016 and 2023. Patients with PI-RADS 3, 4, and 5 lesions were included. Lesion size and PI-RADS categories were assessed through mpMRI, followed by MR fusion biopsy. RESULTS Of the patients, 33.7%, 52.3%, and 14.1% had PI-RADS 3, 4, and 5 lesions, respectively. Lesion sizes correlated significantly with csPCa detection in PI-RADS 4 and 5 categories. For PI-RADS 3 lesions, no significant differences in csPCa rates were observed based on lesion size. However, in PI-RADS 4 and 5 groups, larger lesions showed higher csPCa rates. CONCLUSION This study suggests that subgroup categorizations based on lesion volume could predict clinically significant PCa with high accuracy, potentially reducing unnecessary biopsies and associated overtreatment. Future research should further explore the relationship between lesion size and csPCa, clarifying discussions regarding the inclusion of systematic biopsies in diagnostic protocols.
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Affiliation(s)
- A Ayranci
- Servicio de Urología, Hospital de Formación e Investigación Haseki, Estambul, Turkey.
| | - U Caglar
- Servicio de Urología, Hospital de Formación e Investigación Haseki, Estambul, Turkey
| | - A Meric
- Servicio de Urología, Hospital de Formación e Investigación Haseki, Estambul, Turkey
| | - M Gelmis
- Servicio de Urología, Hospital de Formación e Investigación Haseki, Estambul, Turkey
| | - O Sarilar
- Servicio de Urología, Hospital de Formación e Investigación Haseki, Estambul, Turkey
| | - F Ozgor
- Servicio de Urología, Hospital de Formación e Investigación Haseki, Estambul, Turkey
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Peng Q, Xu L, Zhang G, Zhang D, Zhang J, Zhang X, Bai X, Chen L, Jin Z, Sun H. Effect of preoperative PI-RADS assessment on pathological outcomes in patients who underwent radical prostatectomy. Cancer Imaging 2023; 23:113. [PMID: 38008745 PMCID: PMC10680237 DOI: 10.1186/s40644-023-00619-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/16/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE To assess the effect of preoperative MRI with standardized Prostate Imaging-Reporting and Data System (PI-RADS) assessment on pathological outcomes in prostate cancer (PCa) patients who underwent radical prostatectomy (RP). PATIENTS AND METHODS This retrospective cohort study included patients who had undergone prostate MRI and subsequent RP for PCa between January 2017 and December 2022. The patients were divided into the PI-RADS group and the non-PI-RADS group according to evaluation scheme of presurgery MRI. The preoperative characteristics and postoperative outcomes were retrieved and analyzed. The pathological outcomes included pathological T stage (pT2 vs. pT3-4) and positive surgical margins (PSMs). Patients were further stratified according to statistically significant preoperative variables to assess the difference in pathological outcomes. A propensity score matching based on the above preoperative characteristics was additionally performed. RESULTS A total of 380 patients were included in this study, with 201 patients in the PI-RADS group and 179 in the non-PI-RADS group. The two groups had similar preoperative characteristics, except for clinical T stage (cT). As for pathological outcomes, the PI-RADS group showed a significantly lower percentage of pT3-4 (21.4% vs. 48.0%, p < 0.001), a lower percentage of PSMs (31.3% vs. 40.9%, p = 0.055), and a higher concordance between the cT and pT (79.1% vs. 64.8%, p = 0.003). The PI-RADS group also showed a lower proportion of pT3-4 (p < 0.001) in the cT1-2 subgroup and the cohort after propensity score matching. The PSM rate of cT3 patients was reduced by 39.2% in the PI-RADS group but without statistical significance (p = 0.089). CONCLUSIONS Preoperative MRI with standardized PI-RADS assessment could benefit the decision-making of patients by reducing the rate of pathologically confirmed non-organ-confined PCa after RP and slightly reducing the PSM rate compared with non-PI-RADS assessment.
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Affiliation(s)
- Qianyu Peng
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Lili Xu
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Gumuyang Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Daming Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Jiahui Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Xiaoxiao Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Xin Bai
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Li Chen
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Zhengyu Jin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
- National Center for Quality Control of Radiology, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
| | - Hao Sun
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
- National Center for Quality Control of Radiology, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
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Bertolo R, Vittori M, Cipriani C, Maiorino F, Forte V, Iacovelli V, Petta F, Sperandio M, Marani C, Panei M, Travaglia S, Bove P. Diagnostic pathway of the biopsy-naïve patient suspected for prostate cancer: Real-life scenario when multiparametric Magnetic Resonance Imaging is not centralized. Prog Urol 2021; 31:739-746. [PMID: 33431200 DOI: 10.1016/j.purol.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/27/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION We aimed to compare the pathway including multi-parametric Magnetic Resonance Imaging (mpMRI) versus the one without mpMRI in detection of prostate cancer (PCa) when mpMRI is not centralized. MATERIALS January 2019-March 2020: prospective data collection of trans-perineal prostate biopsies. Group A: biopsy-naïve patients who underwent mpMRI (at any institution) versus Group B: patients who did not. Within Group A, patients were stratified into those with negative mpMRI (mpMRI-, PIRADS v2.1=1-3, with PSA density <0.15 if PIRADS 3) who underwent standard biopsy (SB), versus those with positive mpMRI (mpMRI+, when PIRADS 3-5, with PSA density>0.15 if PIRADS 3) who underwent cognitive fusion biopsy. RESULTS Two hundred and eighty one biopsies were analyzed. 153 patients underwent mpMRI (Group A). 98 mpMRI+ underwent fusion biopsy; 55 mpMRI- underwent SB. 128 Group B patients underwent SB. Overall PCa detection rate was 52.3% vs. 48.4% (Group A vs. B, P=0.5). Non-clinically-significant PCa was detected in 7.8 vs. 13.3% (Group A vs. B, P=0.1). Among the 98 mpMRI+ Group A patients only 2 had non clinically-significant disease. In 55 mpMRI- patients who underwent SB, 10 (18.2%) had clinically-significant PCa. Prostate volume predicted detection of PCa. In Group B, age and PSA predicted PCa. Sensitivity of mpMRI was 75.0% for all PCa, 85.3% for clinically-significant PCa. CONCLUSION Higher detection of PCa and lower detection of non-clinically-significant PCa favored mpMRI pathway. A consistent number of clinically-significant PCa was diagnosed after a mpMRI-. Thus, in real-life scenario, mpMRI- does not obviate indication to biopsy when mpMRI is not centralized. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- R Bertolo
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy.
| | - M Vittori
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - C Cipriani
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - F Maiorino
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - V Forte
- Department of Radiology, San Carlo di Nancy Hospital, Rome, Italy
| | - V Iacovelli
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - F Petta
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - M Sperandio
- Department of Radiology, San Carlo di Nancy Hospital, Rome, Italy
| | - C Marani
- Department of Anatomo-Pathology, San Carlo di Nancy Hospital, Rome, Italy
| | - M Panei
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - S Travaglia
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - P Bove
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
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