Diagnostic accuracy of magnetic resonance imaging (MRI) prostate imaging reporting and data system (PI‐RADS) scoring in a transperineal prostate biopsy setting. (22nd October 2014)

• Record Type: Journal Article
• Authors: Grey, Alistair D.R.; Chana, Manik S.; Popert, Rick; Wolfe, Konrad; Liyanage, Sidath H.; Acher, Peter L.
• Is Part Of: BJU international. Volume 115:Number 5(2015:May)
• Page Start: 728
• Page End: 735
• Publication Date: 2014-10-22
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12862
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12862-sec-0001" sec-type="section"> <title>Objectives</title> <p>To determine the sensitivity and specificity of multiparametric magnetic resonance imaging (mpMRI) for significant prostate cancer with transperineal sector biopsy (TPSB) as the reference standard.</p> </sec> <sec id="bju12862-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p>The study included consecutive patients who presented for TPSB between July 2012 and November 2013 after mpMRI (T2‐ and diffusion‐weighted images, 1.5 Tesla scanner, 8‐channel body coil). A specialist uro‐radiologist, blinded to clinical details, assigned qualitative prostate imaging reporting and data system (PI‐RADS) scores on a Likert‐type scale, denoting the likelihood of significant prostate cancer as follows: 1, highly unlikely; 3, equivocal; and 5, highly likely. TPSBs sampled 24–40 cores (depending on prostate size) per patient. Significant prostate cancer was defined as the presence of Gleason pattern 4 or cancer core length ≥6 mm.</p> </sec> <sec id="bju12862-sec-0003" sec-type="section"> <title>Results</title> <p>A total of 201 patients were included in the analysis. Indications were: a previous negative transrectal biopsy with continued suspicion of prostate cancer (<italic>n</italic> = 103); primary biopsy (<italic>n</italic> = 83); and active surveillance (<italic>n</italic> = 15). Patients' mean (±<sc>sd</sc>) age, prostate‐specific antigen and prostate volumes were 65 (±7) years, 12.8 (±12.4) ng/mL and 62 (±36) mL, respectively. Overall, biopsies were benign, clinically insignificant and clinically significant in 124 (62%), 20 (10%) and 57 (28%) patients, respectively. Two of 88 men with a PI‐RADS score of 1 or 2 had significant prostate cancer, giving a sensitivity of 97% (95% confidence interval [CI] 87–99) and a specificity of 60% (95% CI 51–68) at this threshold. Receiver–operator curve analysis gave an area under the curve of 0.89 (95% CI 0.82–0.92). The negative predictive value of a PI‐RADS score of ≤2 for clinically significant prostate cancer was 97.7%</p> </sec> <sec id="bju12862-sec-0004" sec-type="section"> <title>Conclusion</title> <p>We found that PI‐RADS scoring performs well as a predictor for biopsy outcome and could be used in the decision‐making process for prostate biopsy.</p> </sec> </abstract>