MP17-14 UTILITY OF PREOPERATIVE 3 TESLA MULTIPARAMETRIC PELVIC PHASED-ARRAY MAGNETIC RESONANCE IMAGING IN PREDICTION OF EXTRACAPSULAR EXTENSION OF PROSTATE CANCER AND ITS IMPACT ON SURGICAL MARGIN STATUS: EXPERIENCE AT A CANADIAN TERTIARY ACADEMIC HEALTH CENTER

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology III1 Apr 2015MP17-14 UTILITY OF PREOPERATIVE 3 TESLA MULTIPARAMETRIC PELVIC PHASED-ARRAY MAGNETIC RESONANCE IMAGING IN PREDICTION OF EXTRACAPSULAR EXTENSION OF PROSTATE CANCER AND ITS IMPACT ON SURGICAL MARGIN STATUS: EXPERIENCE AT A CANADIAN TERTIARY ACADEMIC HEALTH CENTER Jen Hoogenes, Ian Wright, Colm Boylan, and Bobby Shayegan Jen HoogenesJen Hoogenes More articles by this author , Ian WrightIan Wright More articles by this author , Colm BoylanColm Boylan More articles by this author , and Bobby ShayeganBobby Shayegan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.856AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Magnetic resonance imaging (MRI) is rapidly gaining ground in the preoperative planning for radical prostatectomy (RP). Reports of its predictive ability to detect extracapsular extension (ECE) have varied significantly in the literature. We evaluated the ability of 3 Tesla (3T) pelvic phased-array (PPA) multiparametric MRI (mpMRI) to predict ECE and its subsequent effect on surgical margin status in a patient cohort treated by a single urologic oncologist. METHODS We retrospectively evaluated 48 preoperative RP patients who underwent 3T PPA mpMRI based on clinical probability of adverse pathological features. T1- and T2-weighted sequences, diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) mpMRI was used in all cases, each read by an expert genitourinary radiologist. Tumor stage based on mpMRI was compared to pathological stage. Specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in predicting ECE were calculated. Positive surgical margin rates of patients with positive ECE on mpMRI were compared to those patients with negative ECE on mpMRI. RESULTS Forty-two (88%) patients were intermediate or high risk based on D'Amico criteria. The mpMRI reports predicted 19 (40%) patients to be positive for ECE, while final pathology revealed that nine of these patients were actually ECE positive, with two having positive surgical margins. Of the 29 (60%) patients who were not predicted to have ECE based on mpMRI, 14 had positive ECE on pathology, 12 of whom had positive surgical margins. Preoperative 3T PPA mpMRI using T1- and T2-weighted sequences with DWI and DCE achieved a sensitivity of only 44% and a specificity of 61% in predicting ECE on surgical pathology. The PPV and NPV were 55% and 50%, respectively. Of the patients with ECE reported on mpMRI, 11% had positive surgical margins compared to 41% of those patients without ECE on mpMRI. CONCLUSIONS At our center, the use of preoperative 3T PPA mpMRI using T1- and T2-weighted sequences with DWI and DCE in predicting pathological ECE and surgical margin status is of questionable benefit. Our findings suggest that preoperative mpMRI reports of organ-confined disease may result in closer surgical dissection and subsequent positive surgical margins, regardless of true pathological staging. As such, caution should be exercised when basing intraoperative decisions on mpMRI findings. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e181 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jen Hoogenes More articles by this author Ian Wright More articles by this author Colm Boylan More articles by this author Bobby Shayegan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...