Dataset Information

Equivocal PI-RADS Three Lesions on Prostate Magnetic Resonance Imaging: Risk Stratification Strategies to Avoid MRI-Targeted Biopsies.

ABSTRACT: We aimed to investigate the relation between largest lesion diameter, prostate-specific antigen density (PSA-D), age, and the detection of clinically significant prostate cancer (csPCa) using first-time targeted biopsy (TBx) in men with Prostate Imaging-Reporting and Data System (PI-RADS) 3 index lesions. A total of 292 men (2013-2019) from two referral centers were included. A multivariable logistic regression analysis was performed. The discrimination and clinical utility of the built model was assessed by the area under the receiver operation curve (AUC) and decision curve analysis, respectively. A higher PSA-D and higher age were significantly related to a higher risk of detecting csPCa, while the largest index lesion diameter was not. The discrimination of the model was 0.80 (95% CI 0.73-0.87). When compared to a biopsy-all strategy, decision curve analysis showed a higher net benefit at threshold probabilities of ?2%. Accepting a missing ?5% of csPCa diagnoses, a risk-based approach would result in 34% of TBx sessions and 23% of low-risk PCa diagnoses being avoided. In men with PI-RADS 3 index lesions scheduled for first-time TBx, the balance between the number of TBx sessions, the detection of low-risk PCa, and the detection of csPCa does not warrant a biopsy-all strategy. To minimize the risk of missing the diagnosis of csPCa but acknowledging the need of avoiding unnecessary TBx sessions and overdiagnosis, a risk-based approach is advisable.

SUBMITTER: Osses DF

PROVIDER: S-EPMC7768373 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Equivocal PI-RADS Three Lesions on Prostate Magnetic Resonance Imaging: Risk Stratification Strategies to Avoid MRI-Targeted Biopsies.

Osses Daniël F DF Arsov Christian C Schimmöller Lars L Schoots Ivo G IG van Leenders Geert J L H GJLH Esposito Irene I Remmers Sebastiaan S Albers Peter P Roobol Monique J MJ

Journal of personalized medicine 20201210 4

We aimed to investigate the relation between largest lesion diameter, prostate-specific antigen density (PSA-D), age, and the detection of clinically significant prostate cancer (csPCa) using first-time targeted biopsy (TBx) in men with Prostate Imaging-Reporting and Data System (PI-RADS) 3 index lesions. A total of 292 men (2013-2019) from two referral centers were included. A multivariable logistic regression analysis was performed. The discrimination and clinical utility of the built model wa ...[more]

PMID: 33321791

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Project description:Despite the key-role of the Prostate Imaging and Reporting and Data System (PI-RADS) in the diagnosis and characterization of prostate cancer (PCa), this system remains to be affected by several limitations, primarily associated with the interpretation of equivocal PI-RADS 3 lesions and with the debated role of Dynamic Contrast Enhanced-Magnetic Resonance Imaging (DCE-MRI), which is only used to upgrade peripheral PI-RADS category 3 lesions to PI-RADS category 4 if enhancement is focal. We aimed at investigating the usefulness of radiomics for detection of PCa lesions (Gleason Score ≥ 6) in PI-RADS 3 lesions and in peripheral PI-RADS 3 upgraded to PI-RADS 4 lesions (upPI-RADS 4). Multiparametric MRI (mpMRI) data of patients who underwent prostatic mpMRI between April 2013 and September 2018 were retrospectively evaluated. Biopsy results were used as gold standard. PI-RADS 3 and PI-RADS 4 lesions were re-scored according to the PI-RADS v2.1 before and after DCE-MRI evaluation. Radiomic features were extracted from T2-weighted MRI (T2), Apparent diffusion Coefficient (ADC) map and DCE-MRI subtracted images using PyRadiomics. Feature selection was performed using Wilcoxon-ranksum test and Minimum Redundancy Maximum Relevance (mRMR). Predictive models were constructed for PCa detection in PI-RADS 3 and upPI-RADS 4 lesions using at each step an imbalance-adjusted bootstrap resampling (IABR) on 1000 samples. 41 PI-RADS 3 and 32 upPI-RADS 4 lesions were analyzed. Among 293 radiomic features, the top selected features derived from T2 and ADC. For PI-RADS 3 stratification, second order model showed higher performances (Area Under the Receiver Operating Characteristic Curve-AUC- = 80%), while for upPI-RADS 4 stratification, first order model showed higher performances respect to superior order models (AUC = 89%). Our results support the significant role of T2 and ADC radiomic features for PCa detection in lesions scored as PI-RADS 3 and upPI-RADS 4. Radiomics models showed high diagnostic efficacy in classify PI-RADS 3 and upPI-RADS 4 lesions, outperforming PI-RADS v2.1 performance.

Project description:BackgroundProstate Imaging Reporting and Data System version 2 (PI-RADS V2) 3 category lesions are of intermediate status with an equivocal risk of presenting clinically significant prostate cancer (csPCa). How to avoid excessive biopsies while improving the csPCa detection rate in these lesions has always been a clinical problem that needed to be solved. The purpose of this study is to explore the csPCa diagnostic value of clinical and magnetic resonance imaging (MRI) data for peripheral and transitional zone (PZ and TZ, respectively) PI-RADS 3 lesions to aid in clinical decision-making and reduce excessive biopsies.MethodsFrom March 2016 to October 2018, a total of 629 men who underwent a prostate MRI and subsequently biopsy were enrolled. Two radiologists (with 3 and 7 years of experience, respectively) independently reviewed and scored all images using the PI-RADS V2 scoring criteria. Clinical and MRI data of men with PI-RADS 3 index lesions were collected by another radiologist. Univariate and multivariate analyses were performed to identify the risk factors of csPCa.ResultsIn a subset of 121 men with 121 PI-RADS 3 index lesions, 25.6% of the lesions (31/121) were PCa (Gleason score ≥6), and 11.6% (14/121) were csPCa (Gleason score ≥7). Further, 44.6% of lesions (54/121) were located in the PZ and 55.4% (67/121) in the TZ. For PZ lesions, 18.5% of the lesions (10/54) were csPCa. Prostate-specific antigen density (PSAD) (P=0.024) and age (P=0.026) were independent risk factors for csPCa in the multivariate logistic analysis. The combination of PSAD and age yielded an area under the curve (AUC) value of 0.816 for predicting csPCa. If biopsy had been restricted to patients with a PSAD ≥0.15 ng/mL2 or an age >68 years, 24.1% (13/54) of patients would have avoided biopsy but only 1 (10%) csPCa would have been missed, with a sensitivity of 80.0% and negative predictive value (NPV) of 92.3%. For TZ lesions, only 6.0% of the lesions (4/67) were csPCa. The PSA and PSAD values in the PI-RADS 3 TZ lesions were higher in the csPCa group (45.07 and 0.47 ng/mL2, respectively) than in the non-csPCa group (10.03 and 0.17 ng/mL2, respectively).ConclusionsCsPCa was detected at a relatively high rate in PI-RADS 3 PZ lesions. Combining PSAD and age could help to reduce excessive biopsies of such lesions. CsPCa is unlikely to be detected in PI-RADS 3 TZ lesions; thus, active surveillance may be an optimal choice for these lesions, especially among patients without high-risk factors.

Project description:Rationale and objectiveThe Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) published a set of minimum technical standards (MTS) to improve image quality and reduce variability in multiparametric prostate MRI. The effect of PIRADSv2 MTS on image quality has not been validated. We aimed to determine whether adherence to PI-RADSv2 MTS improves study adequacy and perceived quality.Materials and methodsSixty-two prostate MRI examinations including T2 weighted (T2W) and diffusion weighted image (DWI) consecutively referred to our center from 62 different institutions within a 12-month period (September 2017 to September 2018) were included. Six readers assessed images as adequate or inadequate for use in PCa detection and a numerical image quality ranking was given using a 1-5 scale. The PI-RADSv2 MTS were synthesized into sets of seven and 10 rules for T2W and DWI, respectively. Image adherence was assessed using Digital Imaging and Communications in Medicine (DICOM) metadata. Statistical analysis of survey results and image adherence was performed based on reader quality scoring (Kendall Rank tau-b) and reader adequate scoring (Wilcoxon test for association) for T2 and DWI quality assessment.ResultsOut of 62 images, 52 (83%) T2W and 38 (61%) DWIs were rated to be adequate by a majority of readers. Reader adequacy scores showed no significant association with adherence to PI-RADSv2. There was a weak (tau-b = 0.22) but significant (p value = 0.01) correlation between adherence to PIRADSv2 MTS and image quality for T2W. Studies following all PI-RADSv2 T2W rules achieved a higher median average quality score (3.58 for 7/7 vs. 3.0 for <7/7, p = 0.012). No statistical relationship with PI-RADSv2 MTS adherence and DWI quality was found.ConclusionAmong 62 sites performing prostate MRI, few were considered of high quality, but the majority were considered adequate. DWI showed considerably lower rates of adequate studies in the sample. Adherence to PI-RADSv2 MTS did not increase the likelihood of having a qualitatively adequate T2W or DWI.

Dataset Information

Equivocal PI-RADS Three Lesions on Prostate Magnetic Resonance Imaging: Risk Stratification Strategies to Avoid MRI-Targeted Biopsies.

Publications

Equivocal PI-RADS Three Lesions on Prostate Magnetic Resonance Imaging: Risk Stratification Strategies to Avoid MRI-Targeted Biopsies.

Similar Datasets

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