Keywords:
Oncology, Pelvis, Genital / Reproductive system male, MR, Staging, Diagnostic procedure, Imaging sequences, Neoplasia
Authors:
B. Yagci, F. Ufuk, E. Sağtaş, P. Cakmak, D. HEREK, A. E. Zumrutbas, N. Sen Turk; Denizli/TR
DOI:
10.1594/ecr2018/C-0800
Conclusion
In the PI-RADS v2 document,
MRI is useful for distinguishing ≥T3 disease (extending beyond the gland) from ≤T2 disease (confined to the gland) [4].
In this study,
we found that mp-MRI with PI-RADS v2 has an accuracy of 81%,
with sensitivity of 86%,
specificity of 79%,
negative predictive value of 93%,
positive predictive value of 66%,
for determining presence of ECE.
De Rooij et al.
[1] performed a meta-analysis with a large number of studies and concluded that MRI has high specificity (91%) but poor and heterogeneous sensitivity (57%) for local prostate cancer staging.
They also reported that 3 T MR systems have higher sensitivity and use of endorectal coil is useful for 1.5 T MR systems [1].
Matsuoka et al.
[5] reported that predictive performance of MRI for ECE using PI-RADS v2 was as follows: Sensitivity 93% - 95%,
specificity of 64% - 67%.
They concluded that PI-RADS v2 reduces understaging and improves inter-observer agreement in ECE assessment,
however overstaging is a concern,
and the biopsy Gleason score may have a complementary role in reducing overstaging [5].
Raskolnikov et al.
[6] reported that MRI/TRUS fusion-guided biopsy Gleason score can help identify which men with prostate cancer have ECE that may not be detectable by imaging.
In a clinical study,
Kundu et al.
[2] concluded that PSA density is useful in helping to determine the aggressiveness of clinically localized prostate cancer.
In another clinical study,
Nowroozi et al.
[3] concluded that PSA,
PSA density,
and Gleason score should be considered together in order to more accurately predict the adverse pathologic features of prostate cancer.
In the current study,
we found that combined use of mpMRI with PI-RADSv2,
PSA density and preoperative biopsy Gleason score shows significantly high ECE rate (91%) in patients with all risk factors and significantly low ECE rate (5%) in patients without any risk factor.
We have some limitations.
This is a retrospective single reader study with limited number of patients,
and inter-observer or intra-observer variability was not evaluated.
In this study,
most of patients had a previous biopsy history,
and pre-biopsy MRI was not available in all cases.
Post-biopsy changes can mask a significant cancer or cause overestimation of disease extent.
In conclusion,
mpMRI with PIRADS v2,
using a 1.5T MRI system with a torso coil,
shows good performance for the diagnosis of ECE in prostate cancer.
Combined use of preoperative biopsy Gleason score,
PSA density and PI-RADS v2 criteria may improve the stratification of patients to predict ECE.