Comparing Prostate Imaging-Reporting and Data System Version 2 (PI-RADSv2) Category 1 and 2 Groups: Clinical Implication of Negative Multiparametric Magnetic Resonance Imaging.

Jung Kwon Kim,Sung Kyu Hong,Sung Il Hwang,Hak Jong Lee,Gheeyoung Choe

doi:10.1155/2020/2819701

Abstract

Objectives To evaluate the clinicopathological differences between Prostate Imaging-Reporting and Data System (PI-RADS) version 2 (v2) category 1 and 2 groups. Materials and Methods. We retrospectively reviewed our two institutional clinical databases: (1) transrectal ultrasound (TRUS)/magnetic resonance imaging (MRI) fusion biopsy cohort (n = 706) and (2) radical prostatectomy (RP) cohort (n = 1403). Subsequently, we performed comparative analyses between PI-RADSv2 category 1 and 2 groups. Clinically significant prostate cancer (csPCa) was defined as the presence of Gleason score (GS) ≥ 3 + 4 in a single biopsy core, and adverse pathology (AP) was defined as high-grade (primary Gleason pattern 4 or any pattern 5) and/or non-organ-confined disease (pT3/N1). We also performed multivariate logistic regression analyses for AP. Results In the TRUS/MRI fusion biopsy cohort, no significant differences in detection rates of all cancer (18.2% vs. 29.0%, respectively, P = 0.730) or csPCa (9.1% vs. 9.9%, respectively, P = 0.692) were observed between PI-RADSv2 category 1 and 2 groups. There were no significant differences in pathologic outcomes including Gleason score (≥4 + 3, 21.2% vs. 29.9%, respectively, P = 0.420) or detection rate of AP (27.3% vs. 33.8%, respectively, P = 0.561) between the two groups in the RP cohort either. PI-RADSv2 category 1 or 2 had no significant association with AP, even in univariate analysis (P = 0.299). Conclusions PI-RADSv2 categories 1 and 2 had similar performance to predict clinicopathological outcomes. Consequently, these two categories may be unified into a single category. Negative mpMRI does not guarantee the absence of AP, as with csPCa.

Highlights

In the past decade, there has been growing body of evidence that suggests a role of multiparametric magnetic resonance imaging in the detection and management of prostate cancer (PCa)
There were significant (P < 0:001) differences in PCa/clinically significant PCa (csPCa) detection rates between groups stratified by PI-RADSv2 category
We found that there was no significant difference in PCa/csPCa detection rate between PI-RADSv2 category 1 and 2 groups after transrectal ultrasound (TRUS)/magnetic resonance imaging (MRI) fusion biopsy (Figure 1)

Summary

Introduction

There has been growing body of evidence that suggests a role of multiparametric magnetic resonance imaging (mpMRI) in the detection and management of prostate cancer (PCa). In a previous meta-analysis, Woo et al [4] have reported that PI-RADSv2 has high pooled sensitivity of 89% and specificity of 73%. They demonstrated that there was significant variability in published results. Negative predictive value (NPV) to exclude clinically significant PCa (csPCa) was highly variable, ranging from 63% to 98% [5]. These variable results could be explained by differences in patient populations, reference standards, image acquisition techniques, image quality, interpretation criteria, reader experience, and interreader variability [4, 6]

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Discussion

Conclusion