What Type of Prostate Cancer Is Systematically Overlooked by Multiparametric Magnetic Resonance Imaging? An Analysis from the PROMIS Cohort
Autor: | Maneesh Ghei, Lina M. Carmona Echeverria, Robert Oldroyd, Alex Kirkham, Hashim U. Ahmed, Tim Dudderidge, Mark Emberton, Joseph M. Norris, Louise Brown, Shonit Punwani, Derek J. Rosario, Mathias Winkler, Alastair Henderson, Ahmed El-Shater Bosaily, Hayley C. Whitaker, Alex Freeman, Eleni Frangou, R. Hindley, Nick Burns-Cox, Iqbal S. Shergill, Chris Parker, Richard Kaplan, Simon Bott, Raj Persad, Vasilis Stavrinides |
---|---|
Rok vydání: | 2020 |
Předmět: |
Image-Guided Biopsy
Male medicine.medical_specialty Urology 030232 urology & nephrology Cohort Studies 03 medical and health sciences Prostate cancer 0302 clinical medicine Prostate Biopsy medicine Humans Multiparametric Magnetic Resonance Imaging False Negative Reactions Ultrasonography Interventional Aged medicine.diagnostic_test business.industry Cancer Prostatic Neoplasms Magnetic resonance imaging Middle Aged medicine.disease Confidence interval medicine.anatomical_structure 030220 oncology & carcinogenesis Cohort Transrectal ultrasonography Radiology business |
Zdroj: | European urology. 78(2) |
ISSN: | 1873-7560 |
Popis: | Background All risk stratification strategies in cancer overlook a spectrum of disease. The Prostate MR Imaging Study (PROMIS) provides a unique opportunity to explore cancers that are overlooked by multiparametric magnetic resonance imaging (mpMRI). Objective To summarise attributes of cancers that are systematically overlooked by mpMRI. Design, setting, and participants PROMIS tested performance of mpMRI and transrectal ultrasonography (TRUS)-guided biopsy, using 5 mm template mapping (TPM) biopsy as the reference standard. Outcome measurements and statistical analysis Outcomes were overall and maximum Gleason scores, maximum cancer core length (MCCL), and prostate-specific antigen density (PSAD). Cancer attributes were compared between cancers that were overlooked and those that were detected. Results and limitations Of men with cancer, 7% (17/230; 95% confidence interval [CI] 4.4–12%) had significant disease overlooked by mpMRI according to definition 1 (Gleason ≥ 4 + 3 of any length or MCCL ≥ 6 mm of any grade) and 13% (44/331; 95% CI 9.8–17%) according to definition 2 (Gleason ≥ 3 + 4 of any length or MCCL ≥ 4 mm). In comparison, TRUS-guided biopsy overlooked 52% (119/230; 95% CI 45–58%) of significant disease by definition 1 and 40% (132/331; 95% CI 35–45%) by definition 2. Prostate cancers undetected by mpMRI had significantly lower overall and maximum Gleason scores (p = 0.0007; p 3 + 4 (Gleason Grade Groups 3–5; 95% CI 0–6.4%) or maximum Gleason score > 4 + 3 (Gleason Grade Groups 4–5; 95% CI 0–8.0%) on TPM biopsy were undetected by mpMRI. Application of a PSAD threshold of 0.15 reduced the proportion of men with undetected cancer to 5% (12/230; 95% CI 2.7–8.9%) for definition 1 and 9% (30/331; 95% CI 6.2–13%) for definition 2. Application of a PSAD threshold of 0.10 reduced the proportion of men with undetected disease to 3% (6/230; 95% CI 1.0–5.6%) for definition 1 cancer and to 3% (11/331; 95% CI 1.7–5.9%) for definition 2 cancer. Limitations were post hoc analysis and uncertain significance of undetected lesions. Conclusions Overall, a small proportion of cancers are overlooked by mpMRI, with estimates ranging from 4.4% (lower boundary of 95% CI for definition 1) to 17% (upper boundary of 95% CI for definition 2). Prostate cancers undetected by mpMRI are of lower grade and shorter length than cancers that are detected. Patient summary Prostate cancers that are undetected by magnetic resonance imaging (MRI) are smaller and less aggressive than those that are detected, and none of the most aggressive cancers are overlooked by MRI. |
Databáze: | OpenAIRE |
Externí odkaz: |