Stefano Luzzago1, Giuseppe Petralia2, Gennaro Musi3, Michele Catellani4, Sarah Alessi5, Ettore Di Trapani3, Francesco A Mistretta4, Alessandro Serino4, Andrea Conti4, Paola Pricolo5, Sebastiano Nazzani6, Vincenzo Mirone7, Deliu-Victor Matei3, Emanuele Montanari8, Ottavio de Cobelli9. 1. Department of Urology, Istituto Europeo di Oncologia, Milan, Italy; Università degli Studi di Milano, Milan, Italy; Department of Urology, IRCCS Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: stefanoluzzago@gmail.com. 2. Department of Radiology, Istituto Europeo di Oncologia, Milan, Italy; Università degli Studi di Milano, Milan, Italy. 3. Department of Urology, Istituto Europeo di Oncologia, Milan, Italy. 4. Department of Urology, Istituto Europeo di Oncologia, Milan, Italy; Università degli Studi di Milano, Milan, Italy. 5. Department of Radiology, Istituto Europeo di Oncologia, Milan, Italy. 6. Università degli Studi di Milano, Milan, Italy; IRCCS Policlinico San Donato, Milan, Italy. 7. Department of Urology, Università Federico II, Naples, Italy. 8. Università degli Studi di Milano, Milan, Italy; Department of Urology, IRCCS Ospedale Maggiore Policlinico, Milan, Italy. 9. Department of Urology, Istituto Europeo di Oncologia, Milan, Italy; Università degli Studi di Milano, Milan, Italy; Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, Milan, Italy.
Abstract
PURPOSE: To understand the multiparametric magnetic resonance imaging (mpMRI) interreader agreement between radiologists of peripheral and academic centers and the possibility to avoid prostate biopsies according to magnetic resonance imaging second opinion. PATIENTS AND METHODS: This prospective observational study enrolled 266 patients submitted to mpMRI at nonacademic centers for cancer detection or at active surveillance begin. Images obtained were reviewed by 2 unblinded radiologists with 8 and 5 years' experience on mpMRI, respectively. We recorded Prostate Imaging Reporting and Data System (PI-RADS) v2 categories and management strategy changes after mpMRI rereadings. Interreader agreement was assessed by the Cohen kappa. For mpMRI second opinion, positive predictive value and negative predictive value were calculated. RESULTS: In the original readings, no lesions (ie, PI-RADS < 2) were observed in 17 cases (6.5%). Reported index lesion (IL) PI-RADS category was 2 in 23 (8.5%), 3 in 85 (32%), 4 in 98 (37%), and 5 in 13 (5%) men, respectively. It is noteworthy that in 30 examinations (11%), an IL was recognized by radiologists, but a suspicious score was not assigned. According to first reading of mpMRI, initial clinical strategy included performing a targeted (226; 85%) or a systematic biopsy (8; 3%), scheduling the patient to an active surveillance program without repeat biopsy (10; 4%), or monitoring prostate-specific antigen without prostate sampling (22; 8%). The mpMRI rereads did not change IL PI-RADS category in 91 cases (38.5%), although in 20 (8.5%) and 125 (53%) IL PI-RADS was upgraded or downgraded, respectively (κ = 0.23). The clinical management changed in 113 patients (48%) (κ = 0.2). Overall, 102 targeted biopsies (51%) were avoided and 72 men (34.5%) were not submitted to biopsy after mpMRI second opinion. Positive predictive value and negative predictive value of the mpMRI rereading were 58% and 91%, respectively. Major limitations of the study are limited-time follow-up and the lack of a standard of reference for some men, who were not submitted to biopsy according to mpMRI second opinion. CONCLUSION: There is an important level of discordance between mpMRI reports. According to imaging second opinion, roughly half of targeted biopsies could be avoidable and 34.5% of men could skipped prostate sampling. Prospective randomized trials are needed to confirm our findings.
PURPOSE: To understand the multiparametric magnetic resonance imaging (mpMRI) interreader agreement between radiologists of peripheral and academic centers and the possibility to avoid prostate biopsies according to magnetic resonance imaging second opinion. PATIENTS AND METHODS: This prospective observational study enrolled 266 patients submitted to mpMRI at nonacademic centers for cancer detection or at active surveillance begin. Images obtained were reviewed by 2 unblinded radiologists with 8 and 5 years' experience on mpMRI, respectively. We recorded Prostate Imaging Reporting and Data System (PI-RADS) v2 categories and management strategy changes after mpMRI rereadings. Interreader agreement was assessed by the Cohen kappa. For mpMRI second opinion, positive predictive value and negative predictive value were calculated. RESULTS: In the original readings, no lesions (ie, PI-RADS < 2) were observed in 17 cases (6.5%). Reported index lesion (IL) PI-RADS category was 2 in 23 (8.5%), 3 in 85 (32%), 4 in 98 (37%), and 5 in 13 (5%) men, respectively. It is noteworthy that in 30 examinations (11%), an IL was recognized by radiologists, but a suspicious score was not assigned. According to first reading of mpMRI, initial clinical strategy included performing a targeted (226; 85%) or a systematic biopsy (8; 3%), scheduling the patient to an active surveillance program without repeat biopsy (10; 4%), or monitoring prostate-specific antigen without prostate sampling (22; 8%). The mpMRI rereads did not change IL PI-RADS category in 91 cases (38.5%), although in 20 (8.5%) and 125 (53%) IL PI-RADS was upgraded or downgraded, respectively (κ = 0.23). The clinical management changed in 113 patients (48%) (κ = 0.2). Overall, 102 targeted biopsies (51%) were avoided and 72 men (34.5%) were not submitted to biopsy after mpMRI second opinion. Positive predictive value and negative predictive value of the mpMRI rereading were 58% and 91%, respectively. Major limitations of the study are limited-time follow-up and the lack of a standard of reference for some men, who were not submitted to biopsy according to mpMRI second opinion. CONCLUSION: There is an important level of discordance between mpMRI reports. According to imaging second opinion, roughly half of targeted biopsies could be avoidable and 34.5% of men could skipped prostate sampling. Prospective randomized trials are needed to confirm our findings.
Authors: Anwar R Padhani; Ivo G Schoots; Baris Turkbey; Gianluca Giannarini; Jelle O Barentsz Journal: Eur Radiol Date: 2020-11-25 Impact factor: 5.315
Authors: Anwar R Padhani; Jelle Barentsz; Geert Villeirs; Andrew B Rosenkrantz; Daniel J Margolis; Baris Turkbey; Harriet C Thoeny; François Cornud; Masoom A Haider; Katarzyna J Macura; Clare M Tempany; Sadhna Verma; Jeffrey C Weinreb Journal: Radiology Date: 2019-06-11 Impact factor: 11.105