Multiparametric MRI reporting using Prostate Imaging Reporting and Data System version 2.0 (PI-RADSv2) retains clinical efficacy in a predominantly post-biopsy patient population

doi:10.1016/j.ajur.2018.05.008

Asian Journal of Urology, 2019, 6 (3): 256-263 doi: 10.1016/j.ajur.2018.05.008

Original Articles

Multiparametric MRI reporting using Prostate Imaging Reporting and Data System version 2.0 (PI-RADSv2) retains clinical efficacy in a predominantly post-biopsy patient population

Edwin Jonathan Aslim^a,Yan Mee Law^b,Puay Hoon Tan^c,John Carson Allen Jr^d,Lionel Tim-Ee Cheng^b,Viswanath Anand Chidambaram^b,Li Yan Khor^e,Benjamin Yongcheng Tan^e,Ernest Wencong Eu^a,Christopher Wai Sam Cheng^a,John Shyi Peng Yuen^a,Henry Sun Sien Ho^a,Lui Shiong Lee^a,*(

)

^aDepartment of Urology, Singapore General Hospital, Singapore
^bDepartment of Diagnostic Radiology, Singapore General Hospital, Singapore
^cDivision of Pathology, Singapore General Hospital, Singapore
^dCentre of Quantitative Medicine, DUKE-NUS Medical School, Singapore
^eDepartment of Anatomical Pathology, Singapore General Hospital, Singapore

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Abstract

Objective: To evaluate the efficacy of multiparametric magnetic resonance imaging (mp-MRI) using Prostate Imaging Reporting and Data System version 2.0 (PI-RADSv2) definitions in detecting organ-confined prostate cancer. Methods: All patients who underwent radical prostatectomy between January 1, 2014 and December 30, 2014 were identified. All underwent mp-MRI within 180 days before surgery. Those with prior pelvic irradiation or androgen deprivation therapy were excluded. Fully embedded, whole-mount histopathology was centrally reviewed and correlated with imaging for tumour location, Gleason score (GS) and stage. Results: There were 39 patients included, of which 35 (90%) had mp-MRI done post-biopsy. A total of 93 cancer foci were identified on whole-mount pathology, of which mp-MRI detected 63 (68%). Of those detected by mp-MRI, 14 were PI-RADS 3 (n = 6 for GS 6, n = 8 for GS 7, no GS ≥ 8) and 49 were PI-RADS 4-5 (n = 7 for GS 6, n = 33 for GS 7, and n = 9 for GS ≥ 8). There were 30 (32%) cancer foci missed by mp-MRI (n = 15 for GS 6, n = 13 for GS 7 and n = 2 for GS ≥ 8). A lesion classified as PI-RADS 4-5 predicted a higher grade cancer on pathology as compared to PI-RADS 3 (for GS 7 lesions, odds ratio [OR] = 3.53, 95% CI: 0.93-13.45, p = 0.064). The mp-MRI size detection limit was 20 mm ² and 100 mm ² for 50% and 75% probability of cancer, respectively. In associating with radiological and pathologic stage, the weighted Kappa value was 0.69 (p < 0.0001). The sensitivity and positive predictive values for this study were 68% (95% CI: 57%-77%) and 78% (95% CI: 67%-86%), respectively. Conclusion: In this predominantly post-biopsy cohort, mp-MRI using PI-RADSv2 reporting has a reasonably high diagnostic accuracy in detecting clinically significant prostate cancer.

Key words： Gleason score Histopathology Magnetic resonance imaging Prostatectomy Prostatic cancer

Received: 07 March 2017 Available online: 01 June 2018

Corresponding Authors: Lui Shiong Lee E-mail: lee.lui.shiong@singhealth.com.sg

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	Edwin Jonathan Aslim
	Yan Mee Law
	Puay Hoon Tan
	John Carson Allen Jr
	Lionel Tim-Ee Cheng
	Viswanath Anand Chidambaram
	Li Yan Khor
	Benjamin Yongcheng Tan
	Ernest Wencong Eu
	Christopher Wai Sam Cheng
	John Shyi Peng Yuen
	Henry Sun Sien Ho
	Lui Shiong Lee

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Cite this article:

Edwin Jonathan Aslim,Yan Mee Law,Puay Hoon Tan, et al. Multiparametric MRI reporting using Prostate Imaging Reporting and Data System version 2.0 (PI-RADSv2) retains clinical efficacy in a predominantly post-biopsy patient population[J]. Asian Journal of Urology, 2019, 6(3): 256-263.

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http://www.ajurology.com/EN/10.1016/j.ajur.2018.05.008 OR http://www.ajurology.com/EN/Y2019/V6/I3/256

Prostate Imaging Reporting and Data System Version 2 (PI-RADSv2) grading method.

Summary of patient demographics and lesion characteristics.

Size detection limits of cancer by multi-parametric magnetic imaging resonance (mp-MRI). Probability of tumour detection was calculated using binary logistics regression. Tumour size was defined as the largest cross sectional areas of cancer foci on pathology in square millimeters.

Characteristics of missed large lesions.

Persistent haemorrhagic changes on magnetic resonance imaging obtained 51 days post transrectal ultrasound needle biopsy. (A) Axial T2-weighted image of prostate at the level of the mid-gland demonstrating an ill-defined, mildly hypointense lesion in the right posterior peripheral zone (arrow). (B) Axial apparent diffusion coefficient map of the prostate at the same level demonstrating the lesion as a mildly hypointense signal (arrow). The lesion was isointense on diffusion weighted images (not shown). (C) Axial T1-weighted image demonstrates hemorrhage appearing as a hyperintense signal (arrow), limiting the assessment of dynamic contrast enhanced images. Histology showed a corresponding Gleason score 6 (3 + 3) lesion.

Disc-shaped tumour lesion missed on multiparametric-magnetic resonance imaging. (A) Wholemount histopathology section at the level of mid-gland, showing a tumour focus at the peripheral zone in the left lateral position measuring 18 mm × 4 mm (black arrow); (B) Histology revealed Gleason score 7 (3 + 4) cancer (Haemotoxylin and Eosin [H&E] stain, × 40 magnification); (C) and (D) Axial T2-weighted and diffusion-weighted images of the same prostate gland at the same level did not demonstrate the lesion seen on histology.

[1]	Kitajima K, Kaji Y, Fukabori Y, Yoshida Ki, Suganuma N, Sugimura K . Prostate cancer detection with 3 T MRI: comparison of diffusion-weighted imaging and dynamic contrastenhanced MRI in combination with T2-weighted imaging. J Magn Reson Imag 2010; 31:625-31.
[2]	Dickinson L, Ahmed HU, Allen C, Barentsz JO, Carey B, Futterer JJ , et al. Scoring systems used for the interpretation and reporting of multiparametric MRI for prostate cancer detection, localization, and characterization: could standardization lead to improved utilization of imaging within the diagnostic pathway? J Magn Reson Imag 2013: 3748-58.
[3]	Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G , et al. ESUR prostate MR guidelines 2012. Eur Radiol 2012; 22:746-57.
[4]	Hamoen EH, de Rooij M, Witjes JA, Barentsz JO, Rovers MM . Use of the prostate imaging reporting and data system (PIRADS) for prostate cancer detection with multiparametric magnetic resonance imaging: a diagnostic meta-analysis. Eur Urol 2015; 67:1112-21.
[5]	Barrett T, Turkbey B, Choyke PL . PI-RADS version 2: what you need to know. Clin Radiol 2015; 70:1165-76.
[6]	Auer T, Edlinger M, Bektic J, Nagele U, Herrmann T, Scha¨fer G , et al. Performance of PI-RADS version 1 versus version 2 regarding the relation with histopathological results. World J Urol 2016: 1-7.
[7]	Tan PH, Cheng L, Srigley JR, Griffiths D, Humphrey PA, Van Der Kwast TH , et al. International Society of Urological Pathology (ISUP) consensus conference on handling and staging of radical prostatectomy specimens. Working group 5: surgical margins. Mod Pathol 2011; 24:48-57.
[8]	Roethke MC, Kuru TH, Schultze S, Tichy D, Kopp-Schneider A, Fenchel M , et al. Evaluation of the ESUR PI-RADS scoring system for multiparametric MRI of the prostate with targeted MR/TRUS fusion-guided biopsy at 3.0 Tesla. Eur Radiol 2014; 24:344-52.
[9]	Thompson JE, Moses D, Shnier R, Brenner P, Delprado W, Ponsky L , et al. Multiparametric magnetic resonance imaging guided diagnostic biopsy detects significant prostate cancer and could reduce unnecessary biopsies and over detection: a prospective study. J Urol 2014; 192:67-74.
[10]	Schimmo¨ller L, Quentin M, Arsov C, Hiester A, Buchbender C, Rabenalt R , et al. MR-sequences for prostate cancer diagnostics: validation based on the PI-RADS scoring system and targeted MR-guided in-bore biopsy. Eur Radiol 2014; 24:2582-9.
[11]	Cash H, Maxeiner A, Stephan C, Fischer T, Durmus T, Holzmann J , et al. The detection of significant prostate cancer is correlated with the Prostate Imaging Reporting and Data System (PI-RADS) in MRI/transrectal ultrasound fusion biopsy. World J Urol 2016; 34:525-32.
[12]	Fascelli M, Rais-Bahrami S, Sankineni S, Brown AM, George AK, Ho R , et al. Combined biparametric prostate MRI and prostate specific antigen in the detection of prostate cancer: a validation study in a biopsy naive patient population. Urology 2016; 88:e34.
[13]	Grey ADR, Chana MS, Popert R, Wolfe K, Liyanage SH, Acher PL . Diagnostic accuracy of magnetic resonance imaging (MRI) prostate imaging reporting and data system (PI-RADS) scoring in a transperineal prostate biopsy setting. BJU Int 2015; 115:728-35.
[14]	Radtke JP, Kuru TH, Boxler S, Alt CD, Popeneciu IV, Huettenbrink C , et al. Comparative analysis of transperineal template saturation prostate biopsy versus magnetic resonance imaging targeted biopsy with magnetic resonance imaging-ultrasound fusion guidance. J Urol 2015; 193:87-94.
[15]	Lee DJ, Recabal P, Sjoberg DD, Thong A, Lee JK, Eastham JA , et al. Comparative effectiveness of targeted prostate biopsy using MRI-US fusion software and visual targeting: a prospective study. J Urol 2016; 196:697-702.
[16]	Alvin LW, Gee SH, Hong HH, Christopher CW, Henry HS, Weber LK , et al. Oncological outcomes following roboticassisted radical prostatectomy in a multiracial Asian population. J Robot Surg 2015; 9:201-9.
[17]	Dev HS, Wiklund P, Patel V, Parashar D, Palmer K, Nyberg T , et al. Surgical margin length and location affect recurrence rates after robotic prostatectomy. Urol Oncol 2015; 33.109. e7-13.
[18]	Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ , et al. PI-RADS prostate imagingdreporting and data system: 2015, version 2. Eur Urol 2016; 69:16-40.
[19]	Sharif-Afshar AR, Feng T, Koopman S, Nguyen C, Li Q, Shkolyar E , et al. Impact of post prostate biopsy hemorrhage on multiparametric magnetic resonance imaging. Can J Urol 2015; 22:7698-702.
[20]	Perdonà S, Di Lorenzo G, Autorino R, Buonerba C, De Sio M, Setola SV , et al. Combined magnetic resonance spectroscopy and dynamic contrast-enhanced imaging for prostate cancer detection. Urol Oncol 2013; 31:761-5.
[21]	Fusco R, Sansone M, Petrillo M, Setola SV, Granata V, Botti G , et al. Multiparametric MRI for prostate cancer detection: preliminary results on quantitative analysis of dynamic contrast enhanced imaging, diffusion-weighted imaging and spectroscopy imaging. Magn Reson Imag 2016; 34:839-45.
[22]	Petrillo A, Fusco R, Setola SV, Ronza FM, Granata V, Petrillo M , et al. Multiparametric MRI for prostate cancer detection: performance in patients with prostate-specific antigen values between 2.5 and 10 ng/mL. J Magn Reson Imag 2014; 39:1206-12.
[23]	Kirkham AP, Emberton M, Allen C . How good is MRI at detecting and characterising cancer within the prostate? Eur Urol 2006; 50:1163-75.
[24]	Polanec S, Helbich TH, Bickel H, Pinker-Domenig K, Georg D, Shariat SF , et al. Head-to-head comparison of PI-RADS v2 and PI-RADS v1. Eur J Radiol 2016; 85:1125-31.
[25]	Vargas HA, Hotker AM, Goldman DA, Moskowitz CS, Gondo T, Ehdaie B , et al. Updated prostate imaging reporting and data system (PIRADS v2) recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference. Eur Radiol 2016; 26:1606-12.
[26]	De Visschere PJL, Naesens L, Libbrecht L, Van Praet C, Lumen N, Fonteyne V , et al. What kind of prostate cancers do we miss on multiparametric magnetic resonance imaging? Eur Radiol 2016; 26:1098-107.
[27]	Tan N, Margolis DJ, Lu DY, King KG, Huang J, Reiter RE , et al. Characteristics of detected and missed prostate cancer foci on 3-T multiparametric MRI using an endorectal coil correlated with whole-mount thin-section histopathology. AJR Am J Roentgenol 2015; 205:W87-92.