Abstract
PurposeTo assess the value of the PI-RADS 2.1 scoring system in the detection of prostate cancer on multiparametric MRI in comparison to the standard PI-RADS 2.0 system and to assess its inter-reader variability.Materials and methodsThis IRB-approved study included 229 patients undergoing multiparametric prostate MRI prior to MRI-guided TRUS-based biopsy, which were retrospectively recruited from our prospectively maintained institutional database. Two readers with high (reader 1, 6 years) and low (reader 2, 2 years) level of expertise identified the lesion with the highest PI-RADS score for both version 2.0 and 2.1 for each patient. Inter-reader agreement was estimated, and diagnostic accuracy analysis was performed.ResultsInter-reader agreement on PI-RADS scores was fair for both version 2.0 (kappa: 0.57) and 2.1 (kappa: 0.51). Detection rates for prostate cancer (PCa) and clinically significant prostate cancer (csPCa) were almost identical for both PI-RADS versions and higher for the more experienced reader (AUC, Reader 1: PCa, 0.881–0.887, csPCa, 0.874–0.879; Reader 2: PCa, 0.765, csPCa, 0.746–0.747; both p > 0.05), both when using a PI-RADS score of ≥ 4 and ≥3 as indicators for positivity for cancer.ConclusionsThe new PI-RADS 2.1 scoring system showed comparable diagnostic performance and inter-reader variability compared to version 2.0. The introduced changes in the version 2.1 seem only to take effect in a very small number of patients.
Highlights
Multiparametric prostate MRI is part of the standard clinical work-up for patients with elevated PSA at many institutions, as it has shown to improve detection rates of clinically-significant prostate cancer in patients who subsequently undergo targeted biopsy, with fewer biopsy cores necessary [1,2,3,4,5,6]
The new PI-RADS 2.1 scoring system showed comparable diagnostic performance and inter-reader variability compared to version 2.0
An almost identical performance of the PI-RADS 2.1 scoring system compared to the version 2.0 was seen for two different thresholds for indicating positivity for prostate cancer (PI-RADS score of 4–5 or 3–5)
Summary
Multiparametric prostate MRI is part of the standard clinical work-up for patients with elevated PSA at many institutions, as it has shown to improve detection rates of clinically-significant prostate cancer in patients who subsequently undergo targeted biopsy, with fewer biopsy cores necessary [1,2,3,4,5,6]. In addition to clarification of technical aspects, the revised guidelines induce subtle changes to the scoring of indeterminate lesions in the transitional zone (TZ) and an update to the scoring of lesions on diffusion-weighted sequences (DWI), seeking to reduce the number of lesions scored “indeterminate” and further increase diagnostic accuracy of prostate MRI. This is of particular importance, as indeterminate lesions pose a clinical challenge regarding patient management and further course of action (e.g. whether a biopsy is required or not in these patients). A higher precision of the PI-RADS 2.1 guidelines could lead to a reduction in unnecessary biopsies, missing clinically significant cancers that could affect patient outcome needs to be avoided
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