Learning objectives
Toreview and evaluate multiparametric magnetic resonance imaging (MP-MRI) prostate scans and identify the false negative and false positive outcomes.
To correlate the MRI findings of these discrepant cases with the pathological results,
in order to aid learning and improve clinical accuracy when reporting these scans.
To consolidate this information with the aim of identifying common pitfalls in image interpretation that give rise to false positive or false negative results.
Background
In the UK,
prostate cancer is the most common cancer in men and the 2nd most common cause of cancer death1.
Previously,
tissue biopsy was the standard for diagnosing prostate cancer2.
However,
advances in imaging techniques,
especially MRI,
have improved diagnostic precision in identifying prostate malignancy2.
MP-MRI provides information on prostate volume,
vascularity and cellularity in addition to anatomical information2.
The PROMIS trial investigated whether MP-MRI could be used as the initial diagnostic tool to discriminate between men with clinically significant prostate cancer and those...
Findings and procedure details
In this work the key imaging findings of our false negative and false positive outcomes are revised.
False Negative Findings:
Of the 296 patients,
123 (42%) were allocated PIRADS 1 or 2 on MRI.
We reviewed these cases to identify patients subsequently shown to have cancer on biopsy.
A total of 15 patients were identified,
6 of which had Gleason 3+3 cancer which is not deemed clinically significant by PROMIS criteria.
The remaining 9 patients had at least Gleason 3+4 disease,
clinically significant prostate cancer...
Conclusion
In our retrospective review of MP MRI prostate scans performed over a 3-month period,
the number of false negative and false positive cases are few.
By correlating MRI findings in these cases with the pathology results,
we identified several potential pitfalls in image interpretation that can lead to discrepant results,
especially false positive results.
Knowledge of these pitfalls can help improve clinical accuracy for Radiologists in this area and positively impact on patient management.
Personal information
Dr J Ash-Miles,
Consultant Radiologist,
North Bristol NHS FoundationTrust,
UK.
Dr H O'Brien,
Radiology Registrar,
University Hospital Bristol NHS Foundation Trust,
UK.
Dr P Charters,
Radiology Registrar,
University Hospital Bristol NHS Foundation Trust,
UK.
Dr S Haldar,
Clinical Fellow Radiology,
North Bristol NHS FoundationTrust,
UK.
Dr Jon Oxley,
Consultant Pathologist,
Dept of Cellular Pathology,
Pathology Sciences Building North Bristol NHS Trust.
References
Cancer Research UK.
Prostate Cancer statistics.
Available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer/incidence [Accessed on 10/11/2018].
Sarkar S,
Das S.
(2016) A review of Imaging Methods for Prostate Cancer Detection.
Biomed Eng.
Comput.
Biol. 7(suppl 1): 1-15.
Ahmed H,
Basaily A,
Brown L,
Gabe R Kaplan R,
Parmar M,
et al. 2017.
Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study.
The Lancet. Volume 389,
ISSUE 10071,
P815-822
Sah V, Wang L,Min X, Feng Z, Rizal R, Li L, Deng M....