In prostatic transition zone lesions (PI-RADS v2.1): which subgroup should be biopsied?

Jihae An,Cheol Mog Hwang,Jae Young Seo,Young Joong Kim,Dong Hyun Oh,Mu-Sik Lee,Keum Won Kim

doi:10.1186/s43055-021-00543-9

Jihae An, Cheol Mog Hwang + Show 5 more

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https://doi.org/10.1186/s43055-021-00543-9

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Abstract

BackgroundThe study aimed to compare the diagnostic performance of T2-weighted imaging (T2WI) score 3 transition zone (TZ) lesions between Prostate Imaging and Reporting Data System (PI-RADS) v2.1 and modified PI-RADS v2.1-B.ResultsAmong TZ lesions (n = 78), 47 (60.0%) had T2WI score of 3, and 16 of the 47 (34.0%) were malignant. The rate of malignancy was 8.8% in PI-RADS category 3A, 100% in PI-RADS category 3B, and 100% in PI-RADS category 4. The apparent diffusion coefficient value of PI-RADS category 3B (0.934 ± 0.158 × 10−3 mm2/s) showed significant difference with that of PI-RADS category 3A (1.098 ± 0.146 × 10−3 mm2/s) but none with PI-RADS category 4 (0.821 ± 0.091 × 10−3 mm2/s). There was no significant difference in the sensitivity and negative predictive value of PI-RADS v2.1 and PI-RADS v2.1-B. Specificity and positive predictive value of modified PI-RADS v2.1-B were much higher than those of PI-RADS v2.1 for both readers (p < .001). The area under the receiver operating characteristic curve tended to be higher with PI-RADS v2.1-B than with PI-RADS v2.1.ConclusionBiopsy for PI-RADS 3B lesion is necessary due to its superior malignancy potential than that of PI-RADS 3A lesion.

Highlights

The study aimed to compare the diagnostic performance of T2-weighted imaging (T2WI) score 3 transition zone (TZ) lesions between Prostate Imaging and Reporting Data System (PI-RADS) v2.1 and modified PIRADS v2.1-B
Despite the majority of prostate cancer occurring in the peripheral zone (PZ), up to 30% of prostate cancer occurs in the transition zone (TZ) [5]
After comparing the diagnostic performances of the two readers for TZ prostate cancer (TZPC) detection using PI-RADS v2.1 and PI-RADS v2.1B, we found that PI-RADS v2.1-B had a higher specificity and positive predictive value for both readers; these differences were statistically significant

Summary

Introduction

The study aimed to compare the diagnostic performance of T2-weighted imaging (T2WI) score 3 transition zone (TZ) lesions between Prostate Imaging and Reporting Data System (PI-RADS) v2.1 and modified PIRADS v2.1-B. The incidence of prostate cancer has increased since the 1990s due to the implementation of prostate-specific antigen (PSA) testing and development of a cancer registration system [3]. According to a recent meta-analysis, the sensitivity and specificity of mpMRI reached 0.87 and 0.68, respectively, and especially accessing highly malignant lesion, mpMRI had better diagnostic accuracy compared to biparametric MRI [6, 7]. The application of mpMRI for diagnosing prostate cancer has been recommended in the National Comprehensive Cancer Network, European Association of Urology, and European Society of Urogenital Radiology guidelines [8]

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