Clement Orczyk1,2,3,4, Arnauld Villers5, Henry Rusinek6, Vincent Lepennec7, Céline Bazille8, Francesco Giganti1,9, Artem Mikheev6, Myriam Bernaudin3, Mark Emberton1,2, Audrey Fohlen3,7, Samuel Valable3. 1. Division of Surgery and Interventional Sciences, University College London, London, UK. 2. Department of Urology, University College London Hospitals, London, UK. 3. ISTCT/CERVOxy Group, GIP CYCERON, Normandie Université, UNICAEN, CEA, CNRS, Caen, France. 4. Department of Urology, University Hospital of Caen, Caen, France. 5. Department of Urology, University Hospital of Lille, Nord de France, Lille, France. 6. Department of Radiology, New York University Medical Center, New York, NY, USA. 7. Department of Radiology, University Hospital of Caen, Caen, France. 8. Department of Pathology, University Hospital of Caen, Caen, France. 9. Department of Radiology, University College London Hospitals, London, UK.
Abstract
OBJECTIVE: To undertake an early proof-of-concept study on a novel, semi-automated texture-based scoring system in order to enhance the association between magnetic resonance imaging (MRI) lesions and clinically significant prostate cancer (SPCa). PATIENTS AND METHODS: With ethics approval, 536 imaging volumes were generated from 20 consecutive patients who underwent multiparametric MRI (mpMRI) at time of biopsy. Volumes of interest (VOIs) included zonal anatomy segmentation and suspicious MRI lesions for cancer (Likert Scale score >2). Entropy (E), measuring heterogeneity, was computed from VOIs and plotted as a multiparametric score defined as the entropy score (ES) = E ADC + E Ktrans + E Ve + E T2WI. The reference test that was used to define the ground truth comprised systematic saturation biopsies coupled with MRI-targeted sampling. This generated 422 cores in all that were individually labelled and oriented in three-dimensions. Diagnostic accuracy for detection of SPCa, defined as Gleason score ≥3 + 4 or >3 mm of any grade of cancer on a single core, was assessed using receiver operating characteristics, correlation, and descriptive statistics. The proportion of cancerous lesions detected by ES and visual scoring (VS) were statistically compared using the paired McNemar test. RESULTS: Any cancer (Gleason score 6-8) was found in 12 of the 20 (60%) patients, with a median PSA level of 8.22 ng/mL. SPCa (mean [95% confidence interval, CI] ES = 17.96 [0.72] NATural information unit [NAT]) had a significantly higher ES than non-SPCa (mean [95% CI] ES = 15.33 [0.76] NAT). The ES correlated with Gleason score (rs = 0.568, P = 0.033) and maximum cancer core length (ρ = 0.781; P < 0.001). The area under the curve for the ES (0.89) and VS (0.91) were not significantly different (P = 0.75) for the detection of SPCa amongst MRI lesions. Best ES estimated numerical threshold of 16.61 NAT led to a sensitivity of 100% and negative predictive value of 100%. The proportion of MRI lesions that were found to be positive for SPCa using this ES threshold (54%) was significantly higher (P < 0.001) than using the VS (24% of score 3, 4, 5) in a paired analysis using the McNemar test. In all, 53% of MRI lesions would have avoided biopsy sampling without missing significant disease. CONCLUSION: Capturing heterogeneity of prostate cancer across multiple MRI sequences with the ES yielded high performances for the detection and stratification of SPCa. The ES outperformed the VS in predicting positivity of lesions, holding promise in the selection of targets for biopsy and calling for further understanding of this association.
OBJECTIVE: To undertake an early proof-of-concept study on a novel, semi-automated texture-based scoring system in order to enhance the association between magnetic resonance imaging (MRI) lesions and clinically significant prostate cancer (SPCa). PATIENTS AND METHODS: With ethics approval, 536 imaging volumes were generated from 20 consecutive patients who underwent multiparametric MRI (mpMRI) at time of biopsy. Volumes of interest (VOIs) included zonal anatomy segmentation and suspicious MRI lesions for cancer (Likert Scale score >2). Entropy (E), measuring heterogeneity, was computed from VOIs and plotted as a multiparametric score defined as the entropy score (ES) = E ADC + E Ktrans + E Ve + E T2WI. The reference test that was used to define the ground truth comprised systematic saturation biopsies coupled with MRI-targeted sampling. This generated 422 cores in all that were individually labelled and oriented in three-dimensions. Diagnostic accuracy for detection of SPCa, defined as Gleason score ≥3 + 4 or >3 mm of any grade of cancer on a single core, was assessed using receiver operating characteristics, correlation, and descriptive statistics. The proportion of cancerous lesions detected by ES and visual scoring (VS) were statistically compared using the paired McNemar test. RESULTS: Any cancer (Gleason score 6-8) was found in 12 of the 20 (60%) patients, with a median PSA level of 8.22 ng/mL. SPCa (mean [95% confidence interval, CI] ES = 17.96 [0.72] NATural information unit [NAT]) had a significantly higher ES than non-SPCa (mean [95% CI] ES = 15.33 [0.76] NAT). The ES correlated with Gleason score (rs = 0.568, P = 0.033) and maximum cancer core length (ρ = 0.781; P < 0.001). The area under the curve for the ES (0.89) and VS (0.91) were not significantly different (P = 0.75) for the detection of SPCa amongst MRI lesions. Best ES estimated numerical threshold of 16.61 NAT led to a sensitivity of 100% and negative predictive value of 100%. The proportion of MRI lesions that were found to be positive for SPCa using this ES threshold (54%) was significantly higher (P < 0.001) than using the VS (24% of score 3, 4, 5) in a paired analysis using the McNemar test. In all, 53% of MRI lesions would have avoided biopsy sampling without missing significant disease. CONCLUSION: Capturing heterogeneity of prostate cancer across multiple MRI sequences with the ES yielded high performances for the detection and stratification of SPCa. The ES outperformed the VS in predicting positivity of lesions, holding promise in the selection of targets for biopsy and calling for further understanding of this association.
Authors: Saleh T Alanezi; Frank Sullivan; Christoph Kleefeld; John F Greally; Marcin J Kraśny; Peter Woulfe; Declan Sheppard; Niall Colgan Journal: Cancers (Basel) Date: 2022-03-23 Impact factor: 6.639
Authors: Matteo Ferro; Ottavio de Cobelli; Gennaro Musi; Francesco Del Giudice; Giuseppe Carrieri; Gian Maria Busetto; Ugo Giovanni Falagario; Alessandro Sciarra; Martina Maggi; Felice Crocetto; Biagio Barone; Vincenzo Francesco Caputo; Michele Marchioni; Giuseppe Lucarelli; Ciro Imbimbo; Francesco Alessandro Mistretta; Stefano Luzzago; Mihai Dorin Vartolomei; Luigi Cormio; Riccardo Autorino; Octavian Sabin Tătaru Journal: Ther Adv Urol Date: 2022-07-04