Multiparametric magnetic resonance imaging (mpMRI) is now gaining widespread use amongst urologists for the diagnosis, surveillance and staging of patients with prostate cancer. As per Epstein's criteria, 4 (4.3%) of the biopsied lesions represented clinically significant disease. Those with benign pathology had a higher prevalence of inflammation (31.4 vs. 0.08) than those without malignant disease. 6.4 ng/ml) and higher median PSA density (0.12 vs. Those with malignant disease had a higher median PSA (8.1 vs. PIRADS 3 lesions within the peripheral zone were more likely to be associated with malignant disease compared with lesions identified within the transition zone (10.8 vs. Of the 86 non-malignant lesions, 1 (1.2%) represented high-grade prostate intraepithelial neoplasia and 2 (2.4%) represented atypical small acinar proliferation. Of these 6 malignant lesions, 4 (66%) were Gleason score 6 (3 + 3) and 2 (33%) were Gleason score 7 (3 + 4). Eightysix (93.5%) of biopsied PIRADS 3 lesions were benign and 6 (6.5%) lesions were found to be malignant. Median prostate specific antigen (PSA) was 6.5 ng/ml and median prostate size was 78.4 ml. The mean age of patients in this cohort was 62.6 years. Amongst this cohort, 92 PIRADS 3 lesions were identified and biopsied. One hundred and eighteen patients comprising a total of 215 lesions were reviewed. All core biopsy samples were sent to one of two pathology laboratories where they were processed and reported as per the International Society of Urological Pathology protocols. Needle position targeting the lesion was recorded prior to each biopsy. Subsequently, all the lesions marked PIRADS 3 or above were targeted with 18G core biopsy using DynaTrim in-gantry MRI guidance system. A single experienced radiologist reported all the studies from this series using a modified PIRADS scoring system. The MRI data was sent to Dynacad software for analysis. The same 3T MRI without the use of an endo-rectal coil was employed to assess each patient, obtaining high resolution T2 weighted images, diffusion weighted imaging and dynamic contrast enhancement. Demographic, clinical, MRI and biopsy data were reviewed and compared. Lesion shape and peripheral zone sparing in general do not predict Gleason 7+ cancer within PI-RADS 4 observations.ĭiagnostic accuracy PI-RADS Positive predictive value Prostate cancer Risk stratification.A retrospective review was performed on a series of consecutive patients who underwent MRI guided biopsy of the prostate for clinical suspicion of prostate cancer between January 2013 and March 2014. Lesions overcalled as PI-RADS 4 have PPV similar to published PI-RADS 3 data. Peripheral zone PI-RADS 4 lesions with a DWI score of 4 are more likely Gleason 7+ cancer than those with a DWI score of 3. Lesions scored as "not meeting PI-RADS 4 criteria" had significantly lower PPV (p = 0.016-0.003 Reader 1 PPV: 14%, Reader 2 PPV: 16%). Pattern of peripheral zone sparing and most lesion shapes were not predictive (p > 0.05) however, oval lesions were predictive for Reader 1 (PPV = 59%, p = 0.03) and lentiform lesions were predictive for Reader 2 (PPV = 74%, p = 0.01). PI-RADS 4 lesions with a DWI score of 4 were more likely to represent Gleason 7+ prostate cancer (p = 0.008-0.01 Reader 1 PPV: 53% Reader 2 PPV: 48%). Predictors were assessed with binary logistic regression. Positive predictive values (PPVs) were calculated. Reference standard was targeted MR-ultrasound fusion biopsy and detection of Gleason 7+ prostate cancer. Peripheral zone PI-RADS 4 observations prospectively identified at the study institution from to (n = 170 in 149 mpMRIs) were reviewed independently by two blinded genitourinary radiologists on the basis of (a) PI-RADS v2 shape, (b) pattern of peripheral zone sparing, and (c) rationale for PI-RADS 4 designation. This was an IRB-approved HIPAA-compliant retrospective diagnostic accuracy study. To determine whether peripheral zone PI-RADS 4 observations can be further risk-stratified.
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