Characterizing indeterminate (Likert-score 3/5) peripheral zone prostate lesions with PSA density, PI-RADS scoring and qualitative descriptors on multiparametric MRI.
| Autor: | Brizmohun Appayya M; 1 Centre for Medical Imaging, University College London, Wolfson House , London , UK., Sidhu HS; 1 Centre for Medical Imaging, University College London, Wolfson House , London , UK.; 2 Department of Radiology, University College London Hospital , London , UK., Dikaios N; 1 Centre for Medical Imaging, University College London, Wolfson House , London , UK., Johnston EW; 1 Centre for Medical Imaging, University College London, Wolfson House , London , UK.; 2 Department of Radiology, University College London Hospital , London , UK., Simmons LA; 3 Division of Surgery and Interventional Science, University College London , London , UK., Freeman A; 4 Department of Pathology, University College London Hospital , London , UK., Kirkham AP; 2 Department of Radiology, University College London Hospital , London , UK., Ahmed HU; 3 Division of Surgery and Interventional Science, University College London , London , UK., Punwani S; 1 Centre for Medical Imaging, University College London, Wolfson House , London , UK.; 2 Department of Radiology, University College London Hospital , London , UK. |
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| Jazyk: | angličtina |
| Zdroj: | The British journal of radiology [Br J Radiol] 2018 Feb; Vol. 91 (1083), pp. 20170645. Date of Electronic Publication: 2017 Dec 15. |
| DOI: | 10.1259/bjr.20170645 |
| Abstrakt: | Objective: To determine whether indeterminate (Likert-score 3/5) peripheral zone (PZ) multiparametric MRI (mpMRI) studies are classifiable by prostate-specific antigen (PSA), PSA density (PSAD), Prostate Imaging Reporting And Data System version 2 (PI-RADS_v2) rescoring and morphological MRI features. Methods: Men with maximum Likert-score 3/5 within their PZ were retrospectively selected from 330 patients who prospectively underwent prostate mpMRI (3 T) without an endorectal coil, followed by 20-zone transperineal template prostate mapping biopsies ＋/- focal lesion-targeted biopsy. PSAD was calculated using pre-biopsy PSA and MRI-derived volume. Two readers A and B independently assessed included men with both Likert-assessment and PI-RADS_v2. Both readers then classified mpMRI morphological features in consensus. Men were divided into two groups: significant cancer (≥ Gleason 3 ＋ 4) or insignificant cancer (≤ Gleason 3 ＋ 3)/no cancer. Comparisons between groups were made separately for PSA & PSAD using Mann-Whitney test and morphological descriptors with Fisher's exact test. PI-RADS_v2 and Likert-assessment were descriptively compared and percentage inter-reader agreement calculated. Results: 76 males were eligible for PSA & PSAD analyses, 71 for PI-RADS scoring, and 67 for morphological assessment (excluding significant image artefacts). Unlike PSA (p = 0.915), PSAD was statistically different (p = 0.004) between the significant [median: 0.19 ng ml - 2 (interquartile range: 0.13-0.29)] and non-significant/no cancer [median: 0.13 ng ml - 2 (interquartile range: 0.10-0.17)] groups. Presence of mpMRI morphological features was not significantly different between groups. Subjective Likert-assessment discriminated patients with significant cancer better than PI-RADS_v2. Inter-reader percentage agreement was 83% for subjective Likert-assessment and 56% for PI-RADS_v2. Conclusion: PSAD may categorize presence of significant cancer in patients with Likert-scored 3/5 PZ mpMRI findings. Advances in knowledge: PSAD may be used in indeterminate PZ mpMRI to guide decisions between biopsy vs monitoring. |
| Databáze: | MEDLINE |
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