Abstract
BackgroundProstate cancer (PCa) diagnosis by means of multiparametric magnetic resonance imaging (mpMRI) is a current challenge for the development of computer-aided detection (CAD) tools. An innovative CAD-software (Watson Elementary™) was proposed to achieve high sensitivity and specificity, as well as to allege a correlate to Gleason grade.Aim/ObjectiveTo assess the performance of Watson Elementary™ in automated PCa diagnosis in our hospital´s database of MRI-guided prostate biopsies.MethodsThe evaluation was retrospective for 104 lesions (47 PCa, 57 benign) from 79, 64.61±6.64 year old patients using 3T T2-weighted imaging, Apparent Diffusion Coefficient (ADC) maps and dynamic contrast enhancement series. Watson Elementary™ utilizes signal intensity, diffusion properties and kinetic profile to compute a proportional Gleason grade predictor, termed Malignancy Attention Index (MAI). The analysis focused on (i) the CAD sensitivity and specificity to classify suspect lesions and (ii) the MAI correlation with the histopathological ground truth.ResultsThe software revealed a sensitivity of 46.80% for PCa classification. The specificity for PCa was found to be 75.43% with a positive predictive value of 61.11%, a negative predictive value of 63.23% and a false discovery rate of 38.89%. CAD classified PCa and benign lesions with equal probability (P 0.06, χ2 test).Accordingly, receiver operating characteristic analysis suggests a poor predictive value for MAI with an area under curve of 0.65 (P 0.02), which is not superior to the performance of board certified observers. Moreover, MAI revealed no significant correlation with Gleason grade (P 0.60, Pearson´s correlation).ConclusionThe tested CAD software for mpMRI analysis was a weak PCa biomarker in this dataset. Targeted prostate biopsy and histology remains the gold standard for prostate cancer diagnosis.
Highlights
Prostate cancer (PCa) is the third most common cancer in the total population, representing approximately 11% of all cancer diagnoses [1]. 55–60% of prostate cancer patients are men over 65 years of age
Targeted prostate biopsy and histology remains the gold standard for prostate cancer diagnosis
PI-RADS 2 lesions were not subjected to a biopsy, some were included in the analyzed database
Summary
Prostate cancer (PCa) is the third most common cancer in the total population, representing approximately 11% of all cancer diagnoses [1]. 55–60% of prostate cancer patients are men over 65 years of age. In spite of being faced with criticism [3,4,5,6], the prostate-specific antigen (PSA) assay [7,8] has been, and continues to be the most popular and widely applied PCa screening method in practice for the last 30 years Invasive methods such as prostate biopsy still prevail as the gold standard for preoperative evaluation, risk-assessment and decision-making between active surveillance, new evolving tissue-preserving strategies and more radical approaches for aggressive disease such as whole-gland radiation, chemotherapy and radical prostatectomy [7,8,9,10,11,12]. An innovative CAD-software (Watson ElementaryTM) was proposed to achieve high sensitivity and specificity, as well as to allege a correlate to Gleason grade
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