Filippo Russo1, Daniele Regge1, Enrico Armando1, Valentina Giannini1, Anna Vignati1, Simone Mazzetti1, Matteo Manfredi2, Enrico Bollito3, Loredana Correale4, Francesco Porpiglia2. 1. Department of Radiology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy. 2. Division of Urology, Department of Clinical and Biological Science, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Orbassano, Italy. 3. Division of Pathology, Department of Clinical and Biological Science, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Orbassano, Italy. 4. im3D S.p.A. Medical Imaging Lab, Torino, Italy.
Abstract
OBJECTIVE: To evaluate the sensitivity of multiparametric magnetic resonance imaging (mp-MRI) for detecting prostate cancer foci, including the largest (index) lesions. PATIENTS AND METHODS: In all, 115 patients with biopsy confirmed prostate cancer underwent mp-MRI before radical prostatectomy. A single expert radiologist recorded all prostate cancer foci including the index lesion 'blinded' to the pathologist's biopsy report. Stained whole-mount histological sections were used as the reference standard. All lesions were contoured by an experienced uropathologist who assessed their volume and pathological Gleason score. All lesions with a volume of >0.5 mL and/or pathological Gleason score of >6 were defined as clinically significant prostate cancer. Multivariate analysis was used to ascertain the characteristics of lesions identified by MRI. RESULTS: In all, 104 of 115 index lesions were correctly diagnosed by mp-MRI (sensitivity 90.4%; 95% confidence interval [CI] 83.5-95.1%), including 98/105 clinically significant index lesions (93.3%; 95% CI 86.8-97.3%), among which three of three lesions had a volume of <0.5 mL and Gleason score of >6. Overall, mp-MRI detected 131/206 lesions including 13 of 68 'insignificant' prostate cancers. The multivariate logistic regression modelling showed that pathological Gleason score (odds ratio [OR] 11.7, 95% CI 2.3-59.8; P = 0.003) and lesion volume (OR 4.24, 95% CI 1.3-14.7; P = 0.022) were independently associated with the detection of index lesions at MRI. CONCLUSIONS: This study shows that mp-MRI has a high sensitivity for detecting clinically significant prostate cancer index lesions, while having disappointing results for the detection of small-volume, low Gleason score prostate cancer foci. Thus, mp-MRI could be used to stratify patients according to risk, allowing better treatment selection.
OBJECTIVE: To evaluate the sensitivity of multiparametric magnetic resonance imaging (mp-MRI) for detecting prostate cancer foci, including the largest (index) lesions. PATIENTS AND METHODS: In all, 115 patients with biopsy confirmed prostate cancer underwent mp-MRI before radical prostatectomy. A single expert radiologist recorded all prostate cancer foci including the index lesion 'blinded' to the pathologist's biopsy report. Stained whole-mount histological sections were used as the reference standard. All lesions were contoured by an experienced uropathologist who assessed their volume and pathological Gleason score. All lesions with a volume of >0.5 mL and/or pathological Gleason score of >6 were defined as clinically significant prostate cancer. Multivariate analysis was used to ascertain the characteristics of lesions identified by MRI. RESULTS: In all, 104 of 115 index lesions were correctly diagnosed by mp-MRI (sensitivity 90.4%; 95% confidence interval [CI] 83.5-95.1%), including 98/105 clinically significant index lesions (93.3%; 95% CI 86.8-97.3%), among which three of three lesions had a volume of <0.5 mL and Gleason score of >6. Overall, mp-MRI detected 131/206 lesions including 13 of 68 'insignificant' prostate cancers. The multivariate logistic regression modelling showed that pathological Gleason score (odds ratio [OR] 11.7, 95% CI 2.3-59.8; P = 0.003) and lesion volume (OR 4.24, 95% CI 1.3-14.7; P = 0.022) were independently associated with the detection of index lesions at MRI. CONCLUSIONS: This study shows that mp-MRI has a high sensitivity for detecting clinically significant prostate cancer index lesions, while having disappointing results for the detection of small-volume, low Gleason score prostate cancer foci. Thus, mp-MRI could be used to stratify patients according to risk, allowing better treatment selection.
Authors: R Diamand; M Oderda; W Al Hajj Obeid; S Albisinni; R Van Velthoven; G Fasolis; G Simone; M Ferriero; J-B Roche; T Piechaud; A Pastore; A Carbone; G Fiard; J-L Descotes; G Marra; P Gontero; E Altobelli; R Papalia; P Kumar; D Eldred-Evans; A Giacobbe; G Muto; V Lacetera; V Beatrici; T Roumeguere; A Peltier Journal: World J Urol Date: 2019-01-16 Impact factor: 4.226
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