You have accessJournal of UrologyProstate Cancer: Detection & Screening IV1 Apr 2014MP67-02 PROSTATE CANCER MISSED BY MULTI-PARAMETRIC MRI: CORRELATION WITH WHOLE-MOUNT PATHOLOGY Nelly Tan, Jesse Le, Daniel Margolis, David Lu, Kevin King, Reiter Robert, and Steven Raman Nelly TanNelly Tan More articles by this author , Jesse LeJesse Le More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , David LuDavid Lu More articles by this author , Kevin KingKevin King More articles by this author , Reiter RobertReiter Robert More articles by this author , and Steven RamanSteven Raman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2069AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The value of multi-parametric magnetic resonance imaging (mp-MRI) of the prostate has been demonstrated in improved diagnostic accuracy provided by targeted prostate biopsy, but systematic biopsy continues to reveal prostate cancer (CaP) in areas not deemed suspicious by MRI. Our objective was to characterize CaP tumor foci identified by whole-mount pathology that evaded detection by mp-MRI. METHODS A HIPAA-compliant, IRB-approved retrospective study of 122 patients with mp- MRI prior to radical prostatectomy between 10/2010-2/2013 was performed. Clinical (age, PSA, biopsy), MRI (T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging), and pathologic (Gleason score, GS; size of tumor; pathologic stage; extra-capsular extension) features were obtained. A genitourinary radiologist and pathologist collectively reviewed each case and matched each MRI lesion to its whole-mount pathology counterpart. A Likert-like scale (1-5) was used to classify level of suspicion by mp-MRI. Chi-square analysis was performed for categorical and t-test for continuous variables. RESULTS 135/283 histologically confirmed CaP tumors were identified by mp-MRI (48% sensitivity). Of 148/283 (52%) tumors in 74/122 (61%) men that missed MR detection, 110 (74%) were GS 6, 23 (16%) GS 3+4, 9 (6%) GS 4+3, 6 (4%) GS ≥8. Missed CaP foci were smaller in size (0.8 vs 1.8 cm, p<0.01) and lower grade (74% vs 29% GS 6), compared to those detected (p<0.01). Missed CaP had a higher proportion of tumors localized to one level of the prostate [apex (30% vs 10%), mid (37% vs 18%), base (9% vs 5%)] and lower proportion of foci involving multiple levels [apex to base (3% vs 20%), apex to mid (11% vs 26%), mid to base (10% vs 22%)] compared to detected CaP lesions (p<0.01). There was no difference in use of endorectal coil (87% vs 86%, p=0.86), PSA (7.7 vs 7.1 ng/ml, p=0.44) or prostate volume (41 vs 45 cc, p=0.12) between detected and missed CaP. CONCLUSIONS Prostate tumors that evaded MRI detection tended to be smaller, involved fewer prostate levels, and were of lower Gleason score compared to those detected by mp-MRI. Performance in CaP detection by mp-MRI was unaffected by PSA, prostate gland volume, or endorectal coil use. Hemorrhage, geometric distortion, or motion significantly may limit diagnostic confidence, and future studies are required to address the effect of these technical limitations on diagnostic performance. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e748-e749 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Nelly Tan More articles by this author Jesse Le More articles by this author Daniel Margolis More articles by this author David Lu More articles by this author Kevin King More articles by this author Reiter Robert More articles by this author Steven Raman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...