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The diagnostic accuracy of multiparametric magnetic resonance imaging before biopsy in the detection of prostate cancer
Author(s) -
Otti Vanessa C.,
Miller Catherine,
Powell Roy J.,
Thomas Richard M.,
McGrath John S.
Publication year - 2019
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.14420
Subject(s) - medicine , biopsy , prostate cancer , prostate , transrectal ultrasonography , magnetic resonance imaging , rectal examination , radiology , cancer , cancer detection , prostate biopsy , urology
Objectives To determine the extent to which clinically significant prostate cancer (cs PC a) can be detected in a routine National Health Service setting in men with no previous biopsy, when multiparametric magnetic resonance imaging (mp MRI ) is introduced into the diagnostic pathway. Patients and Methods In all, 1 090 mp MRI s were performed between July 2013 and April 2016 in biopsy‐naïve men with an abnormal prostate‐specific antigen level and/or digital rectal examination. Data were collected from patient records at the Royal Devon and Exeter NHS Foundation Trust. mp MRI Prostate Imaging Reporting and Data System ( PI ‐ RADS ) scores were compared to transperineal or transrectal ultrasonography ( TRUS )‐guided biopsy findings as the reference standard. cs PC a was defined as Gleason score of ≥3+4. The diagnostic accuracy of mp MRI was also assessed. Results The mp MRI was interpretable in 1 023 men and 792 underwent biopsy, of which 106 were transperineal. The median number of cores taken in transperineal and TRUS ‐guided biopsy were 10 and 6, respectively. The detection rate of cs PC a was 37%; cs PC a rose from 15% of PI ‐ RADS 1 and 2 to 86% of PI ‐ RADS 5. The sensitivity, negative predictive value, specificity, and positive predictive value were 82%, 85%, 59% and 54%, respectively. The study is limited by its retrospective nature and lack of reporting of follow‐up for ‘missed cancers’. Men with low mp MRI PI ‐ RADS were also less likely to undergo biopsy. Whilst this selection bias may overestimate the detection rate of cs PC a, this reflects the shared decisions patients and clinicians make in day‐to‐day practice outside of research centres. Conclusion In a routine clinical setting, the higher the mp MRI PI ‐ RADS , the greater the detection rate of cs PC a in biopsy‐naïve men. A normal mp MRI does not exclude cs PC a; however, mp MRI may have utility in informing shared‐decision making on whether to proceed to biopsy and subsequent treatment.