David Bonekamp1, Patrick Schelb2, Manuel Wiesenfarth3, Tristan Anselm Kuder4, Fenja Deister4, Albrecht Stenzinger5, Joanne Nyarangi-Dix6, Matthias Röthke2, Markus Hohenfellner6, Heinz-Peter Schlemmer2, Jan Philipp Radtke2,6. 1. Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. d.bonekamp@dkfz-heidelberg.de. 2. Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. 3. Division of Statistics, German Cancer Research Center (DKFZ), Heidelberg, Germany. 4. Department of Medical Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany. 5. Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany. 6. Department of Urology, University of Heidelberg Medical Center, Heidelberg, Germany.
Abstract
PURPOSE: MRI has limited ability to detect multifocal disease or the full extent of prostate involvement with clinically significant prostate cancer (sPC). We compare the spatial co-localization at sextant resolution of MRI lesions and histopathological mapping by combined targeted and extended systematic biopsies. MATERIALS AND METHODS: Sextants were mapped for sPC (ISUP group ≥ 2) by 24-core transperineal systematic biopsies in 316 patients with suspicion for sPC and by MR lesions of PI-RADS score of ≥ 3. The gold standard is combined systematic (median 23 cores) and targeted biopsies. RESULTS: Of 316 men, 121 (38%) harbored sPC. Of these 121 patients, 4 (3%) had a negative MRI. MRI correctly identified 117/121 (97%) patients with sPC. In these patients, mpMRI missed no additional sPC in 96 (82%), while MRI-negative sPC lesions were present in 21 patients (18%). Of 1896 sextants, 379 (20%) harbored sPC. MR-positive sextants contained sPC in 26% (337/1275), compared to 7% (42/621) in MR-negative sextants. On a patient basis, sensitivity was 0.97, specificity 0.22, positive predictive value 0.43, and negative predictive value 0.91. On a sextant basis, sensitivity was 0.73, specificity 0.38, positive predictive value 0.26, and negative predictive value 0.93. CONCLUSION: MpMRI mapping agreed well with histopathology with, at the observed sPC prevalence and on a patient basis, excellent sensitivity and negative predictive value, and acceptable specificity and positive predictive value for sPC. However, 18% of sPC was outside the mpMRI mapped region, quantifying limitations of MRI for complete localization of disease extent. KEY POINTS: • Currently, exclusive MRI mapping of the prostate for focal treatment planning cannot be recommended, as significant prostate cancer may remain untreated in a substantial number of cases. • At the observed sPC prevalence and on a patient basis, mpMRI has excellent sensitivity and NPV, and acceptable specificity and PPV for detection of prostate cancer, supporting its use to detect suspicious lesions before biopsy. • Despite the excellent global performance, 18% of sPC was outside the mpMRI mapped region even when a security margin of 10 mm was considered, indicating that prostate MRI has limited ability to completely map all cancer foci within the prostate.
PURPOSE: MRI has limited ability to detect multifocal disease or the full extent of prostate involvement with clinically significant prostate cancer (sPC). We compare the spatial co-localization at sextant resolution of MRI lesions and histopathological mapping by combined targeted and extended systematic biopsies. MATERIALS AND METHODS: Sextants were mapped for sPC (ISUP group ≥ 2) by 24-core transperineal systematic biopsies in 316 patients with suspicion for sPC and by MR lesions of PI-RADS score of ≥ 3. The gold standard is combined systematic (median 23 cores) and targeted biopsies. RESULTS: Of 316 men, 121 (38%) harbored sPC. Of these 121 patients, 4 (3%) had a negative MRI. MRI correctly identified 117/121 (97%) patients with sPC. In these patients, mpMRI missed no additional sPC in 96 (82%), while MRI-negative sPC lesions were present in 21 patients (18%). Of 1896 sextants, 379 (20%) harbored sPC. MR-positive sextants contained sPC in 26% (337/1275), compared to 7% (42/621) in MR-negative sextants. On a patient basis, sensitivity was 0.97, specificity 0.22, positive predictive value 0.43, and negative predictive value 0.91. On a sextant basis, sensitivity was 0.73, specificity 0.38, positive predictive value 0.26, and negative predictive value 0.93. CONCLUSION: MpMRI mapping agreed well with histopathology with, at the observed sPC prevalence and on a patient basis, excellent sensitivity and negative predictive value, and acceptable specificity and positive predictive value for sPC. However, 18% of sPC was outside the mpMRI mapped region, quantifying limitations of MRI for complete localization of disease extent. KEY POINTS: • Currently, exclusive MRI mapping of the prostate for focal treatment planning cannot be recommended, as significant prostate cancer may remain untreated in a substantial number of cases. • At the observed sPC prevalence and on a patient basis, mpMRI has excellent sensitivity and NPV, and acceptable specificity and PPV for detection of prostate cancer, supporting its use to detect suspicious lesions before biopsy. • Despite the excellent global performance, 18% of sPC was outside the mpMRI mapped region even when a security margin of 10 mm was considered, indicating that prostate MRI has limited ability to completely map all cancer foci within the prostate.
Entities:
Keywords:
Image-guided biopsy; Magnetic resonance imaging; Male; Prostate cancer
Authors: Tae Il Noh; Jong Hyun Tae; Hyung Keun Kim; Ji Sung Shim; Sung Gu Kang; Deuk Jae Sung; Jun Cheon; Jeong Gu Lee; Seok Ho Kang Journal: Cancer Res Treat Date: 2020-02-10 Impact factor: 4.679
Authors: Magdalena Görtz; Joanne Nyaboe Nyarangi-Dix; Lars Pursche; Viktoria Schütz; Philipp Reimold; Constantin Schwab; Albrecht Stenzinger; Holger Sültmann; Stefan Duensing; Heinz-Peter Schlemmer; David Bonekamp; Markus Hohenfellner; Jan Philipp Radtke Journal: Cancers (Basel) Date: 2022-02-10 Impact factor: 6.639