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Diagnostic accuracy of a five‐point Likert scoring system for magnetic resonance imaging (MRI) evaluated according to results of MRI/ultrasonography image‐fusion targeted biopsy of the prostate
Author(s) -
Shin Toshitaka,
Smyth Thomas B.,
Ukimura Osamu,
Ahmadi Nariman,
Castro Abreu Andre Luis,
Ohe Chisato,
Oishi Masakatsu,
Mimata Hiromitsu,
Gill Inderbir S.
Publication year - 2018
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.13972
Subject(s) - medicine , magnetic resonance imaging , likert scale , biopsy , prostate cancer , radiology , nuclear medicine , prostate , cancer , statistics , mathematics
Objective To evaluate the accuracy of a magnetic resonance imaging (MRI)‐based Likert scoring system in the detection of clinically significant prostate cancer (CSPC), using MRI/ultrasonography (US) image‐fusion targeted biopsy (FTB) as a reference standard. Patients and Methods We retrospectively reviewed 1218 MRI‐detected lesions in 629 patients who underwent subsequent MRI/US FTB between October 2012 and August 2015. 3‐Tesla MRI was independently reported by one of eight radiologists with varying levels of experience and scored on a five‐point Likert scale. All lesions with Likert scores 1–5 were prospectively defined as targets for MRI/US FTB. CSPC was defined as Gleason score ≥7. Results The median patient age was 64 years, PSA level 6.97 ng/mL and estimated prostate volume 52.2 mL. Of 1218 lesions, 48% ( n = 581) were rated as Likert 1–2, 35% ( n = 428) were Likert 3 and 17% ( n = 209) were Likert 4–5. For Likert scores 1–5, the overall cancer detection rates were 12%, 13%, 22%, 50% and 59%, respectively, and the CSPC detection rates were 4%, 4%, 12%, 33% and 48%, respectively. Grading using the five‐point scale showed strong positive correlation with overall cancer detection rate ( r = 0.949, P = 0.05) and CSPC detection rate ( r = 0.944, P = 0.05). By comparison, in Likert 4–5 lesions, significant differences were noted in overall cancer detection rate (63% vs 35%; P = 0.001) and CSPC detection rate (47% vs 29%; P = 0.027) for the more experienced vs the less experienced radiologists. Conclusions The detection rates of overall cancer and CSPC strongly correlated with the five‐point grading of the Likert scale. Among radiologists with different levels of experience, there were significant differences in these cancer detection rates.