Yuval Freifeld1, Alberto Diaz de Leon2, Yin Xi2, Ivan Pedrosa1,2, Claus G Roehrborn1, Yair Lotan1, Franto Francis3, Daniel N Costa2. 1. 1 Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX. 2. 2 Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Clements Imaging Bldg (NE2.210), 2201 Inwood Rd, Dallas, TX 75390-9061. 3. 3 Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX.
Abstract
OBJECTIVE: The objective of this study was to determine the diagnostic performance of a prospectively assigned 5-point Likert scale for determination of extraprostatic extension (EPE) and seminal vesicle invasion (SVI). MATERIALS AND METHODS: This study was a single-center, retrospective analysis of prospectively collected data including all men with abnormal 3-T multiparametric MRI and subsequent radical prostatectomy between November 1, 2016, and September 30, 2017. Scores from a 5-point subjective Likert scale (1 = highly unlikely, 5 = highly likely) for the likelihood of EPE and SVI were prospectively assigned during clinical MRI interpretation. EPE and SVI status at whole-mount prostatectomy specimen served as the standard of reference. RESULTS: Among the 89 eligible men, whole-mount histopathology revealed organ-confined prostate cancer, EPE, and SVI in 49% (44/89), 46% (41/89), and 18% (16/89) of patients, respectively. Of the pathologically proven cases of EPE, 18% (2/11), 17% (4/24), 65% (17/26), 46% (6/13) and 80% (12/15) were assigned Likert scores of 1-5, respectively. Of the pathologically proven cases of SVI, 5% (3/58), 11% (2/18), 66% (2/3), 66% (2/3) and 100% (7/7) were assigned Likert scores of 1-5, respectively. The positive predictive values for scores of 4 or 5 were 64% for EPE and 90% for SVI. The negative predictive values for scores of 1 or 2 were 87% for EPE and 93% for SVI. Likert scores for EPE (odds ratio, 2.1; 95% CI, 1.3-3.4) and for SVI (odds ratio, 4.7; 95% CI, 2.3-9.6) were both associated with EPE and SVI on multivariate analysis. CONCLUSION: A 5-point Likert scale can effectively convey the degree of suspicion of EPE and SVI on multiparametric MRI of the prostate, facilitating informed decision-making.
OBJECTIVE: The objective of this study was to determine the diagnostic performance of a prospectively assigned 5-point Likert scale for determination of extraprostatic extension (EPE) and seminal vesicle invasion (SVI). MATERIALS AND METHODS: This study was a single-center, retrospective analysis of prospectively collected data including all men with abnormal 3-T multiparametric MRI and subsequent radical prostatectomy between November 1, 2016, and September 30, 2017. Scores from a 5-point subjective Likert scale (1 = highly unlikely, 5 = highly likely) for the likelihood of EPE and SVI were prospectively assigned during clinical MRI interpretation. EPE and SVI status at whole-mount prostatectomy specimen served as the standard of reference. RESULTS: Among the 89 eligible men, whole-mount histopathology revealed organ-confined prostate cancer, EPE, and SVI in 49% (44/89), 46% (41/89), and 18% (16/89) of patients, respectively. Of the pathologically proven cases of EPE, 18% (2/11), 17% (4/24), 65% (17/26), 46% (6/13) and 80% (12/15) were assigned Likert scores of 1-5, respectively. Of the pathologically proven cases of SVI, 5% (3/58), 11% (2/18), 66% (2/3), 66% (2/3) and 100% (7/7) were assigned Likert scores of 1-5, respectively. The positive predictive values for scores of 4 or 5 were 64% for EPE and 90% for SVI. The negative predictive values for scores of 1 or 2 were 87% for EPE and 93% for SVI. Likert scores for EPE (odds ratio, 2.1; 95% CI, 1.3-3.4) and for SVI (odds ratio, 4.7; 95% CI, 2.3-9.6) were both associated with EPE and SVI on multivariate analysis. CONCLUSION: A 5-point Likert scale can effectively convey the degree of suspicion of EPE and SVI on multiparametric MRI of the prostate, facilitating informed decision-making.
Entities:
Keywords:
MRI; imaging-pathology correlation; local staging; prostate cancer; risk stratification