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Performance characteristics of multiparametric-MRI at a non-academic hospital using transperineal template mapping biopsy as a reference standard

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Title: Performance characteristics of multiparametric-MRI at a non-academic hospital using transperineal template mapping biopsy as a reference standard
Authors: Chau, EM
Arya, M
Petrides, N
Aldin, Z
Mckenzie, J
Emberton, M
Virdi, J
Ahmed, HU
Kasivisvanathan, V
Item Type: Journal Article
Abstract: Objectives To evaluate diagnostic accuracy of mpMRI in a non-academic hospital using transperineal template prostate mapping (TPM) biopsy as a reference standard. Secondary objectives included evaluating why mpMRI missed significant cancer. Materials and methods 101 men received pre-biopsy mpMRI and TPM-biopsy over 16 months. Disease status was assigned at hemigland level. Primary histological definition of clinical significance was Gleason grade >/ = 4 + 3 or maximum cancer core length (MCCL) >/ = 6 mm. Positive mpMRI was defined as Prostate Imaging Reporting and Data System (PI-RADS) score >/ = 3. Results Median age 69 (IQR 62–76). Median PSA 7 ng/ml (IQR 4.6–9.8). mpMRI had sensitivity 76.9%, specificity 60.7%, PPV 40.4% and NPV 88.3% at primary definitions. For detecting any Gleason >/ = 7 mpMRI had sensitivity 73.2%, specificity 60.3%, PPV 41.4% and NPV 85.4%. Mean MCCL was lower where significant cancer was missed compared to those correctly identified (5.8 mm versus 7.7 mm respectively, p = 0.035). Conclusion mpMRI performance characteristics were very encouraging when compared to contemporary clinical trials. In a non-academic hospital setting, negative mpMRI was just as good at ruling-out significant disease, though the ability of positive mpMRI to accurately detect significant disease was lower. An mpMRI-guided diagnostic pathway should be accompanied by appropriate mpMRI protocol optimisation, training, and quality control.
Issue Date: 31-Jan-2018
Date of Acceptance: 7-Jan-2018
URI: http://hdl.handle.net/10044/1/60790
DOI: https://dx.doi.org/10.1016/j.ijso.2018.01.002
ISSN: 2405-8572
Publisher: Elsevier
Start Page: 66
End Page: 71
Journal / Book Title: International Journal of Surgery Open
Volume: 10
Copyright Statement: © 2018 The Authors. Published by Elsevier Ltd on behalf of Surgical Associates Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Sponsor/Funder: Wellcome Trust
University College London Hospitals Charity
Funder's Grant Number: 204998/Z/16/Z
Keywords: Science & Technology
Life Sciences & Biomedicine
Magnetic resonance imaging
Needle biopsy
Prostatic neoplasm
Predictive value of tests
Publication Status: Published
Online Publication Date: 2018-01-31
Appears in Collections:Department of Surgery and Cancer