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Characterizing indeterminate (Likert-scored 3/5) peripheral zone prostate lesions with PSA density, PI-RADS scoring and qualitative descriptors on multi-parametric MRI

Title: Characterizing indeterminate (Likert-scored 3/5) peripheral zone prostate lesions with PSA density, PI-RADS scoring and qualitative descriptors on multi-parametric MRI
Authors: Brizmohun Appayya, M
Sidhu, HS
Dikaios, N
Johnston, EW
Simmons, LA
Freeman, A
Kirkham, AP
Ahmed, HU
Punwani, S
Item Type: Journal Article
Abstract: OBJECTIVE: To determine whether indeterminate (Likert-score 3/5) peripheral zone (PZ) multi-parametric MRI (mpMRI) studies are classifiable by Prostate-Specific Antigen (PSA), PSA density (PSAD), PI-RADS_v2 rescoring and morphological MRI features. METHODS: Men with maximum Likert-score 3/5 within their PZ were retrospectively selected from 330 men who prospectively underwent prostate mpMRI (3T) without an endorectal coil, followed by twenty-zone trans-perineal template prostate mapping biopsies ± focal lesion-targeted biopsy. PSAD was calculated using pre-biopsy PSA and MRI-derived volume. Two readers A and B independently assessed included men with both subjective Likert-score and PI-RADS_v2. Both readers then classified mpMRI morphological features in consensus. Men were divided into two groups: significant cancer (≥Gleason 3+4) or insignificant cancer (≤Gleason 3+3)/no cancer. Comparisons between groups were made separately for PSA&PSAD using Mann-Whitney test and morphological descriptors with Fisher's exact test. PI-RADS_v2 and subjective Likert assessment were descriptively compared and percentage inter-reader agreement calculated. RESULTS: 76 men were eligible for PSA&PSAD analyses, 71 for PI-RADS scoring, and 67 for morphological assessment (excluding significant image artefacts). Unlike PSA (p=0.915), PSAD was statistically different (p=0.004) between the significant 0.19 ng/ml2 (IQR: 0.13-0.29) and non-significant/no cancer 0.13 ng/ml2 (IQR: 0.10-0.17) groups. Presence of mpMRI morphological features wasn't significantly different between groups. Subjective Likert assessment discriminated patients with significant cancer better than PI-RADS_v2. Inter-reader percentage agreement was 83% for subjective Likert-scoring and 56% for PI-RADS_v2. CONCLUSION: PSAD may categorize presence of significant cancer in patients with Likert-scored 3/5 PZ mpMRI findings. Advances in knowledge: PSAD may be used in indeterminate PZ mpMRI to guide decisions between biopsy versus monitoring.
Issue Date: 15-Dec-2017
Date of Acceptance: 27-Nov-2017
URI: http://hdl.handle.net/10044/1/55334
DOI: https://dx.doi.org/10.1259/bjr.20170645
ISSN: 0007-1285
Publisher: British Institute of Radiology
Journal / Book Title: British Journal of Radiology
Volume: 91
Issue: 1083
Copyright Statement: © 2017 The Authors. Published by the British Institute of Radiology
Sponsor/Funder: Wellcome Trust
Funder's Grant Number: 204998/Z/16/Z
Keywords: Adult
Aged, 80 and over
Biomarkers, Tumor
Image-Guided Biopsy
Magnetic Resonance Imaging
Middle Aged
Prostate-Specific Antigen
Prostatic Neoplasms
Retrospective Studies
1103 Clinical Sciences
Nuclear Medicine & Medical Imaging
Publication Status: Published
Conference Place: England
Article Number: 20170645
Appears in Collections:Department of Surgery and Cancer