MP58-14 DISCORDANCE BETWEEN PROSTATE IMAGING REPORTING & DATA SYSTEM SCORE AND TARGETED PROSTATE BIOPSY: AN OPPORTUNITY FOR QUALITY IMPROVEMENT

Abstract

You have accessJournal of UrologyCME1 May 2022MP58-14 DISCORDANCE BETWEEN PROSTATE IMAGING REPORTING & DATA SYSTEM SCORE AND TARGETED PROSTATE BIOPSY: AN OPPORTUNITY FOR QUALITY IMPROVEMENT Rohith Arcot, Srinath Kotamarti, Madison Krischak, Zoe Michael, Isaac Alderete, Thomas Polascik, and Rajan Gupta Rohith ArcotRohith Arcot More articles by this author , Srinath KotamartiSrinath Kotamarti More articles by this author , Madison KrischakMadison Krischak More articles by this author , Zoe MichaelZoe Michael More articles by this author , Isaac AldereteIsaac Alderete More articles by this author , Thomas PolascikThomas Polascik More articles by this author , and Rajan GuptaRajan Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002641.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aim to estimate the positive predictive value (PPV) of Prostate Imaging Reporting & Data System (PI-RADS) score to identify any prostate cancer (PCa) and clinically significant prostate cancer (csPCa). Further, we sought to analyze cases of PI-RADS 5 discordance with biopsy pathology to develop a quality improvement protocol. METHODS: We retrospectively reviewed the Duke Prostate Cancer (PCa) registry for men who had a 3T multiparametric magnetic resonance imaging (mpMRI) of the prostate and underwent fusion biopsy by a single surgeon from 11/2015 – 3/2021. PI-RADS version 2-2.1 scores for all mpMRI lesions were compared to corresponding targeted biopsy results. The PPV of PI-RADS lesions was calculated for all PCa and csPCa, defined as Gleason Grade Group (GGG) > 2. The subset of discordant cases (PI-RADS 5 lesions with benign or GGG 1 pathology) were re-reviewed by a radiologist with expertise in prostate mpMRI to determine opportunities for quality improvement. RESULTS: A total of 524 targeted lesions were identified in 392 patients undergoing fusion biopsy of which a PI-RADS score of 5, 4, and 3 was assigned to 121 (23.1%), 310 (59.2%), and 90 (17.2%) lesions, respectively. The PPV of PI-RADS 5, 4, and 3 for all PCa and csPCa was 0.80, 0.55, 0.24, and 0.63, 0.33, and 0.09, respectively. Detection of csPCa was significantly higher for PI-RADS 5 lesions (62.8%) versus PI-RADS 4 lesions (33.2%) (p < 0.001). Still, PIRADS 5, discordant biopsy results were identified for 45 (37.2%) lesions. On mpMRI re-review, 18 (40.0%) lesions were considered “resolved” discordances as their suspicion was downgraded because either the lesion was > 1.5 cm alone without further abnormality (n=13), low signal central zone was mistaken for PCa (n=2), or the mpMRI was generally misread (n=3). The remaining 27 discordant cases had the level of suspicion confirmed on re-review and were classified as “unresolved.” After excluding “resolved” discordant cases, the PPV of PI-RADS 5 lesions improved to 0.74. CONCLUSIONS: Although PIRADS 5 lesions are considered high risk for csPCa, a diagnostic dilemma occurs when targeted biopsy returns benign or low grade cancer. In our cohort, a proportion of discordances were "resolved" by mpMRI re-review. Further work is needed to determine the value of re-biopsy in cases of “unresolved” discordance. We found re-review of PI-RADS 5 discordance events to be a source of potential quality improvement as the review of these cases allows for the identification of those who may benefit from re-biopsy versus close surveillance. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e997 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rohith Arcot More articles by this author Srinath Kotamarti More articles by this author Madison Krischak More articles by this author Zoe Michael More articles by this author Isaac Alderete More articles by this author Thomas Polascik More articles by this author Rajan Gupta More articles by this author Expand All Advertisement PDF DownloadLoading ...