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Borofsky S, George AK, Gaur S, Bernardo M, Greer MD, Mertan FV, Taffel M, Moreno V, Merino MJ, Wood BJ, Pinto PA, Choyke PL, Turkbey B. What Are We Missing? False-Negative Cancers at Multiparametric MR Imaging of the Prostate. Radiology 2017; 286:186-195. [PMID: 29053402 DOI: 10.1148/radiol.2017152877] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To characterize clinically important prostate cancers missed at multiparametric (MP) magnetic resonance (MR) imaging. Materials and Methods The local institutional review board approved this HIPAA-compliant retrospective single-center study, which included 100 consecutive patients who had undergone MP MR imaging and subsequent radical prostatectomy. A genitourinary pathologist blinded to MP MR findings outlined prostate cancers on whole-mount pathology slices. Two readers correlated mapped lesions with reports of prospectively read MP MR images. Readers were blinded to histopathology results during prospective reading. At histopathologic examination, 80 clinically unimportant lesions (<5 mm; Gleason score, 3+3) were excluded. The same two readers, who were not blinded to histopathologic findings, retrospectively reviewed cancers missed at MP MR imaging and assigned a Prostate Imaging Reporting and Data System (PI-RADS) version 2 score to better understand false-negative lesion characteristics. Descriptive statistics were used to define patient characteristics, including age, prostate-specific antigen (PSA) level, PSA density, race, digital rectal examination results, and biopsy results before MR imaging. Student t test was used to determine any demographic differences between patients with false-negative MP MR imaging findings and those with correct prospective identification of all lesions. Results Of the 162 lesions, 136 (84%) were correctly identified with MP MR imaging. Size of eight lesions was underestimated. Among the 26 (16%) lesions missed at MP MR imaging, Gleason score was 3+4 in 17 (65%), 4+3 in one (4%), 4+4 in seven (27%), and 4+5 in one (4%). Retrospective PI-RADS version 2 scores were assigned (PI-RADS 1, n = 8; PI-RADS 2, n = 7; PI-RADS 3, n = 6; and PI-RADS 4, n = 5). On a per-patient basis, MP MR imaging depicted clinically important prostate cancer in 99 of 100 patients. At least one clinically important tumor was missed in 26 (26%) patients, and lesion size was underestimated in eight (8%). Conclusion Clinically important lesions can be missed or their size can be underestimated at MP MR imaging. Of missed lesions, 58% were not seen or were characterized as benign findings at second-look analysis. Recognition of the limitations of MP MR imaging is important, and new approaches to reduce this false-negative rate are needed. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Samuel Borofsky
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Arvin K George
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Sonia Gaur
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Marcelino Bernardo
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Matthew D Greer
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Francesca V Mertan
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Myles Taffel
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Vanesa Moreno
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Maria J Merino
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Bradford J Wood
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Peter A Pinto
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Peter L Choyke
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Baris Turkbey
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
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Kitamura K, Muto S, Yokota I, Hoshimoto K, Kaminaga T, Noguchi T, Sugiura SI, Ide H, Yamaguchi R, Furui S, Horie S. Feasibility of multiparametric prostate magnetic resonance imaging in the detection of cancer distribution: histopathological correlation with prostatectomy specimens. Prostate Int 2014; 2:188-95. [PMID: 25599075 PMCID: PMC4286731 DOI: 10.12954/pi.14067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/19/2014] [Indexed: 11/16/2022] Open
Abstract
Purpose To prevent overtreatment, it is very important to diagnose the precise distribution and characteristics of all cancer lesions, including small daughter tumors. The purpose of this study was to evaluate the efficacy of T2-weighted magnetic resonance imaging (T2W), diffusion-weighted magnetic resonance imaging (DWI), magnetic resonance spectroscopy (1H-MRS), and prostate biopsy (PBx) in the detection of intraprostatic cancer distribution. Methods All patients underwent T2W, DWI, 1H-MRS, and PBx followed by radical prostatectomy (RP). Individual prostates were divided into 12 segmental regions, each of which was examined for the presence or absence of malignancy on the basis of T2W, DWI, 1H-MRS, and PBx, respectively. These results were compared with the histopathological findings for RP specimens. Results We included 54 consecutive patients with biopsy-proven prostate cancer (mean age, 62.7 years; median prostate-specific antigen level, 5.7 ng/mL) in this study. We could detect cancer in 247 of 540 evaluable lesions. The area under the receiver operator characteristic curve analysis yielded a higher value for DWI (0.68) than for T2W (0.65), 1H-MRS (0.54), or PBx (0.56). In 180 cancerous regions of RP specimens with false-negative PBx results, T2W+DWI had the highest positive rate (53.3%) compared with that of each sequence alone, including T2W (45.6%), DWI (41.1%), and 1H-MRS (30.0%). Conclusions Multiparametric magnetic resonance imaging (T2W, 1H-MRS, DWI) enables the detection of prostate cancer distribution with reasonable sensitivity and specificity. T2W+DWI was particularly effective in detecting cancer distribution with false-negative PBx results.
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Affiliation(s)
- Kosuke Kitamura
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan ; Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Satoru Muto
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Isao Yokota
- School of Integrated Health Science, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazutane Hoshimoto
- Departments of Pathology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tatsuro Kaminaga
- Departments of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Takahiro Noguchi
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | | | - Hisamitsu Ide
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Raizo Yamaguchi
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shigeru Furui
- Departments of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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