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Predictive effect of the dual-parametric MRI modified maximum diameter of the lesions with PI-RADS 4 and 5 on the clinically significant prostate cancer
Received date: 2024-03-20
Online published: 2024-07-23
Supported by
the National High Level Hospital Clinical Research Funding (Interdepartmental Clinical Research Project of Peking University First Hospital)(2022CR16)
Objective: To assess the rationality of the maximum lesion diameter of 15 mm in prostate imaging reporting and data system (PI-RADS) as a criterion for upgrading a lesion from category 4 to 5 and improve it to enhance the prediction of clinically significant prostate cancer (csPCa). Methods: In this study, the patients who underwent prostate magnetic resonance imaging (MRI) and prostate biopsy at Peking University First Hospital from 2019 to 2022 as a development cohort, and the patients in 2023 as a validation cohort were reviewed. The localization and maximum diameter of the lesion were fully evaluated. The area under the curve (AUC) and the cut-off value of the maximum diameter of the lesion to predict the detection of csPCa were calculated from the receiver operating characteristics (ROC) curve. Confounding factors were reduced by propensity score matching (PSM). Diagnostic efficacy was compared in the validation cohort. Results: Of the 589 patients in the development cohort, 358 (60.8%) lesions were located in the peripheral zone and 231 (39.2%) were located in the transition zone, and 496 (84.2%) patients detected csPCa. The median diameter of the lesions in the peripheral zone was smaller than that in the transition zone (14 mm vs. 19 mm, P < 0.001). In the ROC analysis of the maximal diameter on the csPCa prediction, there was no statistically significant difference between the peri-pheral zone (AUC=0.709) and the transition zone (AUC=0.673, P=0.585), and the cut-off values were calculated to be 11.5 mm for the peripheral zone and 16.5 mm for the migrating zone. By calcula-ting the Youden index for the cut-off values in the validation cohort, we found that the categorisation by lesion location led to better predictive results. Finally, the net reclassification index (NRI) was 0.170. Conclusion: 15 mm as a criterion for upgrading the PI-RADS score from 4 to 5 is reasonable but too general. The cut-off value for peripheral zone lesions is smaller than that in transitional zone. In the future consideration could be given to setting separate cut-off values for lesions in different locations.
Yuxuan TIAN , Mingjian RUAN , Yi LIU , Derun LI , Jingyun WU , Qi SHEN , Yu FAN , Jie JIN . Predictive effect of the dual-parametric MRI modified maximum diameter of the lesions with PI-RADS 4 and 5 on the clinically significant prostate cancer[J]. Journal of Peking University(Health Sciences), 2024 , 56(4) : 567 -574 . DOI: 10.19723/j.issn.1671-167X.2024.04.004
| 1 | Sung H , Ferlay J , Siegel RL , et al. Global cancer statistics 2020: Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71 (3): 209- 249. |
| 2 | Culp MB , Soerjomataram I , Efstathiou JA , et al. Recent global patterns in prostate cancer incidence and mortality rates[J]. Eur Urol, 2020, 77 (1): 38- 52. |
| 3 | Schaeffer EM , Srinivas S , Adra N , et al. Prostate cancer, version 4.2023, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2023, 21 (10): 1067- 1096. |
| 4 | Elkhoury FF , Felker ER , Kwan L , et al. Comparison of targeted vs systematic prostate biopsy in men who are biopsy naive: The prospective assessment of image registration in the diagnosis of prostate cancer (PAIREDCAP) study[J]. JAMA Surg, 2019, 154 (9): 811- 818. |
| 5 | Mehralivand S , Bednarova S , Shih JH , et al. Prospective evaluation of PI-RADSTM version 2 using the International Society of Urological Pathology prostate cancer grade group system[J]. J Urol, 2017, 198 (3): 583- 590. |
| 6 | Turkbey B , Rosenkrantz AB , Haider MA , et al. Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2[J]. Eur Urol, 2019, 76 (3): 340- 351. |
| 7 | Weinreb JC , Barentsz JO , Choyke PL , et al. PI-RADS Prostate Imaging: Reporting and data system: 2015, version 2[J]. Eur Urol, 2016, 69 (1): 16- 40. |
| 8 | Borkowetz A , Platzek I , Toma M , et al. Direct comparison of multiparametric magnetic resonance imaging (MRI) results with final histopathology in patients with proven prostate cancer in MRI/ultrasonography-fusion biopsy[J]. BJU Int, 2016, 118 (2): 213- 220. |
| 9 | Cash H , Maxeiner A , Stephan C , et al. The detection of significant prostate cancer is correlated with the prostate imaging reporting and data system (PI-RADS) in MRI/transrectal ultrasound fusion biopsy[J]. World J Urol, 2016, 34 (4): 525- 532. |
| 10 | Kasivisvanathan V , Rannikko AS , Borghi M , et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis[J]. N Engl J Med, 2018, 378 (19): 1767- 1777. |
| 11 | Radtke JP , Schwab C , Wolf MB , et al. Multiparametric magnetic resonance imaging (MRI) and MRI-transrectal ultrasound fusion biopsy for index tumor detection: correlation with radical prostatectomy specimen[J]. Eur Urol, 2016, 70 (5): 846- 853. |
| 12 | Turkbey B , Mani H , Aras O , et al. Correlation of magnetic resonance imaging tumor volume with histopathology[J]. J Urol, 2012, 188 (4): 1157- 1163. |
| 13 | Nelson BA , Shappell SB , Chang SS , et al. Tumour volume is an independent predictor of prostate-specific antigen recurrence in patients undergoing radical prostatectomy for clinically localized prostate cancer[J]. BJU Int, 2006, 97 (6): 1169- 1172. |
| 14 | Ploussard G , Beauval JB , Renard-Penna R , et al. Assessment of the minimal targeted biopsy core number per MRI lesion for improving prostate cancer grading prediction[J]. J Clin Med, 2020, 9 (1): 225. |
| 15 | Rais-Bahrami S , Türkbey B , Rastinehad AR , et al. Natural history of small index lesions suspicious for prostate cancer on multiparametric MRI: Recommendations for interval imaging follow-up[J]. Diagn Interv Radiol, 2014, 20 (4): 293- 298. |
| 16 | Wolters T , Roobol MJ , van Leeuwen PJ , et al. A critical analysis of the tumor volume threshold for clinically insignificant prostate cancer using a data set of a randomized screening trial[J]. J Urol, 2011, 185 (1): 121- 125. |
| 17 | Johnson DC , Raman SS , Mirak SA , et al. Detection of individual prostate cancer foci via multiparametric magnetic resonance imaging[J]. Eur Urol, 2019, 75 (5): 712- 720. |
| 18 | Matoso A , Epstein JI . Defining clinically significant prostate cancer on the basis of pathological findings[J]. Histopathology, 2019, 74 (1): 135- 145. |
| 19 | Mahjoub S , Baur ADJ , Lenk J , et al. Optimizing size thresholds for detection of clinically significant prostate cancer on MRI: Peripheral zone cancers are smaller and more predictable than transition zone tumors[J]. Eur J Radiol, 2020, 129, 109071. |
| 20 | Sakala MD , Dyer RB , Tappouni R . The "erased charcoal" sign[J]. Abdom Radiol (NY), 2017, 42 (3): 981- 982. |
| 21 | Alanee S , Deebajah M , Dabaja A , et al. Utilizing lesion diameter and prostate specific antigen density to decide on magnetic resonance imaging guided confirmatory biopsy of prostate imaging reporting and data system score three lesions in African American prostate cancer patients managed with active surveillance[J]. Int Urol Nephrol, 2022, 54 (4): 799- 803. |
| 22 | Kilic M , Madendere S , Vural M , et al. The role of the size and number of index lesion in the diagnosis of clinically significant prostate cancer in patients with PI-RADS 4 lesions who underwent in-bore MRI-guided prostate biopsy[J]. World J Urol, 2023, 41 (2): 449- 454. |
| 23 | Park MY , Park KJ , Lim B , et al. Comparison of biopsy strategies for prostate biopsy according to lesion size and PSA density in MRI-directed biopsy pathway[J]. Abdom Radiol (NY), 2020, 45 (12): 4166- 4177. |
| 24 | Senel S , Koudonas A , Uzun E , et al. The value of prostate-specific antigen density in combination with lesion diameter for the accuracy of prostate cancer prediction in prostate imaging-reporting and data system 3 prostate lesions[J]. Urol Int, 2023, 107 (10/11/12): 965- 970. |
| 25 | Costa DN , Goldberg K , Leon AD , et al. Magnetic resonance imaging-guided in-bore and magnetic resonance imaging-transrectal ultrasound fusion targeted prostate biopsies: An adjusted comparison of clinically significant prostate cancer detection rate[J]. Eur Urol Oncol, 2019, 2 (4): 397- 404. |
| 26 | Schoots IG , Padhani AR , Rouvière O , et al. Analysis of magnetic resonance imaging-directed biopsy strategies for changing the paradigm of prostate cancer diagnosis[J]. Eur Urol Oncol, 2020, 3 (1): 32- 41. |
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