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Negative predictive value for cancer in patients with “Gray‐Zone” PSA level and prior negative biopsy: Preliminary results with multiparametric 3.0 tesla MR
Author(s) -
Girometti Rossano,
Bazzocchi Massimo,
Como Giuseppe,
Brondani Giovanni,
Del Pin Matteo,
Frea Bruno,
Martinez Guillermo,
Zuiani Chiara
Publication year - 2012
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.23703
Subject(s) - medicine , biopsy , radiology , malignancy , magnetic resonance imaging , predictive value , nuclear medicine , positive predicative value , intraepithelial neoplasia , prostate cancer , cancer , pathology
Purpose: To investigate the negative predictive value (NPV) for malignancy of 3.0 Tesla (T) MRI in patients with “gray zone” PSA level and prior negative biopsies. Materials and Methods: We enrolled 26 patients with PSA level between 2.5 and 10 ng/mL and no cancer at previous biopsies. Examinations were performed on a 3.0T system using T2‐weighted imaging, diffusion‐weighted imaging, spectroscopy, and postcontrast dynamic study. A regional scheme was used to record MRI findings and to perform subsequent transrectal‐ultrasonography‐guided biopsy. Based on the matching between imaging and biopsy findings we estimated MRI predictive values, sensitivity, specificity and accuracy on a per‐patient and per‐region basis. Results: On a per patient basis, MRI had five true‐positive (5/26; 19.2%), eight true‐negative (8/26; 30.8%) and no false‐negative cases, corresponding to a NPV and sensitivity of 100% each. Thirteen patients were assessed as false‐positive cases (13/26; 50.0%) (specificity of 38.1%). Five of them (5/26; 19.2%) showed high‐grade prostatic intraepithelial neoplasia (HGPIN) and atypical small‐acinar proliferation (ASAP) at biopsy. T2‐weighted imaging alone showed per‐region NPV (96.8%). Conclusion: Because of the high NPV, MRI had the potential to avoid unnecessary biopsy in approximately one‐third of “gray‐zone” patients with a negative examination. Additionally, MRI was useful to address to biopsy more than one‐third of patients with cancer or high‐risk lesions as HGPIN and ASAP. J. Magn. Reson. Imaging 2012;36:943–950. © 2012 Wiley Periodicals, Inc.