Abstract
ObjectiveTo determine whether evaluating the mean apparent diffusion coefficient (ADC) together with capsular contact (CC) adds value in the prediction of microscopic extracapsular extension (ECE) of prostate cancer.Materials and MethodsBetween January 2012 and December 2016, 383 patients underwent multiparametric magnetic resonance imaging (mpMRI) of the prostate. A total of 67 patients were selected for inclusion. Two radiologists (observers 1 and 2), working independently, performed qualitative and quantitative analyses of ECE, macroscopic ECE, and microscopic ECE. A third radiologist assessed the correlation with the clinical data, and two experienced pathologists reviewed all histopathological findings.ResultsAmong the 67 patients, mpMRI showed lesions that were confined to the capsule in 44 (66.7%), had microscopic ECE in 12 (17.9%), and had macroscopic ECE in 11 (16.4%). There were no significant differences, in terms of the diagnostic accuracy, as measured by determining the area under the curve (AUC), of CC on T2-weighted images (CCT2), CC on diffusion-weighted imaging (CCDWI), and the mean ADC for the prediction of microscopic ECE, between observer 1 (AUC of 0.728, 0.691, and 0.675, respectively) and observer 2 (AUC of 0.782, 0.821, and 0.799, respectively). Combining the mean ADC with the CCT2 or CCDWI did not improve the diagnostic accuracy for either observer. There was substantial interobserver agreement for the qualitative evaluation of ECE, as demonstrated by the kappa statistic, which was 0.77 (0.66-0.87). The diagnostic accuracy (AUC) of the qualitative assessment for predicting microscopic ECE was 0.745 for observer 1 and 0.804 for observer 2, and the difference was less than significant. In a multivariate analysis, none of clinical or imaging parameters were found to be associated with ECE.ConclusionFor the detection of microscopic ECE on mpMRI, CC appears to have good diagnostic accuracy, especially if the observer has considerable experience. Adding the mean ADC to the CCT2 or CCDWI does not seem to provide any significant improvement in that diagnostic accuracy.
Highlights
Prostate adenocarcinoma is the second leading type of malignant neoplasm in men, surpassed only by nonmelanoma skin cancer in terms of incidence and by lung cancer in terms of mortality[1]
The extracapsular extension (ECE) of prostate neoplasms is an important prognostic factor because it is associated with an increased risk of postoperative biochemical recurrence; it has important therapeutic implications because, when it is present, a more radical surgical resection is indicated to reduce the chance of positive surgical margins[4]
When logistic regression was used in order to determine which variables were independent predictors of microscopic ECE, we found that serum prostate specific antigen (PSA) level, lesion size, Gleason score/International Society of Urological Pathology (ISUP) grade, percentage of tumorpositive fragments on biopsy, CC on T2-weighted images (CCT2), CC on diffusion-weighted imaging (CCDWI), and mean apparent diffusion coefficient (ADC) were predictors only in the univariate analysis
Summary
Prostate adenocarcinoma is the second leading type of malignant neoplasm in men, surpassed only by nonmelanoma skin cancer in terms of incidence and by lung cancer in terms of mortality[1]. The procedure is performed for curative purposes, it is aimed at preserving the neurovascular bundle, preventing erectile dysfunction and urinary incontinence (the so-called trifecta outcomes of urinary continence, sexual potency, and cancer control), because these possible postoperative complications have a negative impact on patient quality of life[3]. The extracapsular extension (ECE) of prostate neoplasms is an important prognostic factor because it is associated with an increased risk of postoperative biochemical recurrence; it has important therapeutic implications because, when it is present, a more radical surgical resection is indicated to reduce the chance of positive surgical margins[4]. For better therapeutic planning and a more well-informed decision-making process aimed at cancer control with preservation of erectile function and urinary continence, it is extremely important to carry out a preoperative assessment of the risk of ECE
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