Premium
Diagnostic accuracy of magnetic resonance imaging (MRI) prostate imaging reporting and data system (PI‐RADS) scoring in a transperineal prostate biopsy setting
Author(s) -
Grey Alistair D.R.,
Chana Manik S.,
Popert Rick,
Wolfe Konrad,
Liyanage Sidath H.,
Acher Peter L.
Publication year - 2015
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12862
Subject(s) - medicine , prostate , prostate cancer , magnetic resonance imaging , biopsy , confidence interval , prostate biopsy , radiology , bi rads , cancer , prostate specific antigen , urology , nuclear medicine , mammography , breast cancer
Objectives To determine the sensitivity and specificity of multiparametric magnetic resonance imaging ( mpMRI ) for significant prostate cancer with transperineal sector biopsy ( TPSB ) as the reference standard. Patients and Methods The study included consecutive patients who presented for TPSB between J uly 2012 and N ovember 2013 after mpMRI ( T 2‐ and diffusion‐weighted images, 1.5 T esla scanner, 8‐channel body coil). A specialist uro‐radiologist, blinded to clinical details, assigned qualitative prostate imaging reporting and data system ( PI‐RADS ) scores on a L ikert‐type scale, denoting the likelihood of significant prostate cancer as follows: 1, highly unlikely; 3, equivocal; and 5, highly likely. TPSBs sampled 24–40 cores (depending on prostate size) per patient. Significant prostate cancer was defined as the presence of G leason pattern 4 or cancer core length ≥6 mm. Results A total of 201 patients were included in the analysis. Indications were: a previous negative transrectal biopsy with continued suspicion of prostate cancer ( n = 103); primary biopsy ( n = 83); and active surveillance ( n = 15). Patients' mean (± sd ) age, prostate‐specific antigen and prostate volumes were 65 (±7) years, 12.8 (±12.4) ng/mL and 62 (±36) mL, respectively. Overall, biopsies were benign, clinically insignificant and clinically significant in 124 (62%), 20 (10%) and 57 (28%) patients, respectively. Two of 88 men with a PI‐RADS score of 1 or 2 had significant prostate cancer, giving a sensitivity of 97% (95% confidence interval [ CI ] 87–99) and a specificity of 60% (95% CI 51–68) at this threshold. Receiver–operator curve analysis gave an area under the curve of 0.89 (95% CI 0.82–0.92). The negative predictive value of a PI‐RADS score of ≤2 for clinically significant prostate cancer was 97.7% Conclusion We found that PI‐RADS scoring performs well as a predictor for biopsy outcome and could be used in the decision‐making process for prostate biopsy.