Prognostic value of Prostate Imaging and Data Reporting System (PI-RADS) v. 2 assessment categories 4 and 5 compared to histopathological outcomes after radical prostatectomy
Christopher S. Lim BMBS
Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
Search for more papers by this authorMatthew D.F. McInnes MD
Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
Search for more papers by this authorRobert S. Lim BMBS
Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
Search for more papers by this authorRodney H. Breau MD
Ottawa Hospital, University of Ottawa, Division of Urology, Department of Surgery, General Campus, Ottawa, Ontario, Canada
Search for more papers by this authorTrevor A. Flood MD
Ottawa Hospital, University of Ottawa, Department of Anatomical Pathology, General Campus, Ottawa, Ontario, Canada
Search for more papers by this authorSatheesh Krishna MD
Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
Search for more papers by this authorChristopher Morash MD
Ottawa Hospital, University of Ottawa, Division of Urology, Department of Surgery, General Campus, Ottawa, Ontario, Canada
Search for more papers by this authorWael M. Shabana MD, PhD
Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
Search for more papers by this authorCorresponding Author
Nicola Schieda MD
Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
Address reprint requests to: N.S., Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, 1053 Carling Avenue; Ottawa, Ontario, Canada, K1Y 4E9. E-mail: [email protected]Search for more papers by this authorChristopher S. Lim BMBS
Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
Search for more papers by this authorMatthew D.F. McInnes MD
Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
Search for more papers by this authorRobert S. Lim BMBS
Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
Search for more papers by this authorRodney H. Breau MD
Ottawa Hospital, University of Ottawa, Division of Urology, Department of Surgery, General Campus, Ottawa, Ontario, Canada
Search for more papers by this authorTrevor A. Flood MD
Ottawa Hospital, University of Ottawa, Department of Anatomical Pathology, General Campus, Ottawa, Ontario, Canada
Search for more papers by this authorSatheesh Krishna MD
Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
Search for more papers by this authorChristopher Morash MD
Ottawa Hospital, University of Ottawa, Division of Urology, Department of Surgery, General Campus, Ottawa, Ontario, Canada
Search for more papers by this authorWael M. Shabana MD, PhD
Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
Search for more papers by this authorCorresponding Author
Nicola Schieda MD
Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, Ottawa, Ontario, Canada
Address reprint requests to: N.S., Ottawa Hospital, University of Ottawa, Department of Radiology, Civic Campus C1, 1053 Carling Avenue; Ottawa, Ontario, Canada, K1Y 4E9. E-mail: [email protected]Search for more papers by this authorAbstract
Purpose
To assess Prostate Imaging and Data Reporting System (PI-RADS) v. 2 score 4/5 lesions compared to Gleason score (GS) and stage after radical prostatectomy (RP) and to validate the proposed 15-mm size threshold that differentiates category 4 versus 5 lesions.
Materials and Methods
With Institutional Review Board (IRB) approval, 140 men underwent 3T magnetic resonance imaging (MRI) and RP between 2012–2015. Two blinded radiologists: 1) assigned PI-RADS v. 2 scores, 2) measured tumor size on axial T2-weighted-MRI, and 3) assessed for extraprostatic extension (EPE). Interobserver agreement was calculated and consensus diagnoses achieved through reference standard (MRI-RP maps). PI-RADS v. 2 scores and tumor size were compared to GS and stage using chi-square, analysis of variance (ANOVA), and receiver operating characteristic (ROC) curve analysis.
Results
In all, 80.7% (113/140) of tumors were category 4 (n = 45) or 5 (n = 68) lesions (κ = 0.45). Overall tumor size was 18.2 ± 7.7 mm and category 5 lesions were larger (22.6 ± 6.8 versus 11.5 ± 1.9 mm, P < 0.001). High-risk (GS ≥8) tumors were larger than low- and intermediate-risk tumors (P = 0.016) and were more frequently, but not significantly so, category 5 lesions (78.9% [15/19] vs. 22.1% [4/10], P = 0.18). 67.3% (76/113) of patients had EPE. Category 5 lesions were strongly associated with EPE (P < 0.0001). Area under the ROC curve for diagnosis of EPE by size was 0.74 (confidence interval 0.64–0.83), with size ≥15 mm yielding a sensitivity/specificity of 72.4/64.9%. Size improved sensitivity for diagnosis of EPE compared to subjective assessment (sensitivity/specificity ranging from 46.1–48.7%/70.3–86.5%, κ = 0.29) (P = 0.028).
Conclusion
PI-RADS v. 2 category 5 lesions are associated with higher Gleason scores and EPE. A 15-mm size threshold is reasonably accurate for diagnosis of EPE with increased sensitivity compared to subjective assessment.
Level of Evidence: 3
Technical Efficacy: Stage 2
J. MAGN. RESON. IMAGING 2017;46:257–266
References
- 1 National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology: prostate cancer. Volume 2013. Fort Washington, PA; 2012.
- 2 Heidenreich A, Bellmunt J, Bolla M, et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 2011; 59: 61–71.
- 3 Barentsz JO, Richenberg J, Clements R, et al. ESUR prostate MR guidelines 2012. Eur Radiol 2012; 22: 746–757.
- 4 Hoeks CM BJ, Hambrock T, et al. Prostate cancer: multiparametric MR imaging for detection, localization, and staging. Radiology 2011; 261: 46–66.
- 5 Flood TA, Schieda N, Keefe DT, et al. Utility of Gleason pattern 4 morphologies detected on transrectal ultrasound (TRUS)-guided biopsies for prediction of upgrading or upstaging in Gleason score 3 + 4 = 7 prostate cancer. Virchows Arch 2016; 469: 313–319.
- 6 Gondo T, Hricak H, Sala E, et al. Multiparametric 3T MRI for the prediction of pathological downgrading after radical prostatectomy in patients with biopsy-proven Gleason score 3 + 4 prostate cancer. Eur Radiol 2014; 24: 3161–3170.
- 7 Epstein JI, Feng Z, Trock BJ, Pierorazio PM. Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades. Eur Urol 2012; 61: 1019–1024.
- 8 Siddiqui MM, Rais-Bahrami S, Truong H, et al. Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy. Eur Urol 2013; 64: 713–719.
- 9 Turkbey B, Mani H, Aras O, et al. Prostate cancer: can multiparametric MR imaging help identify patients who are candidates for active surveillance? Radiology 2013; 268: 144–152.
- 10 Eifler JB, Feng Z, Lin BM, et al. An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int 2013; 111: 22–29.
- 11 Boyce S, Fan Y, Watson RW, Murphy TB. Evaluation of prediction models for the staging of prostate cancer. BMC Med Inform Decis Mak 2013; 13: 126.
- 12 Rosenkrantz AB, Ginocchio LA, Cornfeld D, et al. Interobserver reproducibility of the PI-RADS V. 2 lexicon: a multicenter study of six experienced prostate radiologists. Radiology 2016: 152542.
- 13 Wibmer A, Vargas HA, Donahue TF, et al. Diagnosis of extracapsular extension of prostate cancer on prostate MRI: impact of second-opinion readings by subspecialized genitourinary oncologic radiologists. AJR Am J Roentgenol 2015; 205: W73–78.
- 14 Mullerad M, Hricak H, Wang L, Chen HN, Kattan MW, Scardino PT. Prostate cancer: detection of extracapsular extension by genitourinary and general body radiologists at MR imaging. Radiology 2004; 232: 140–146.
- 15 Rozenberg R, Thornhill RE, Flood TA, Hakim SW, Lim C, Schieda N. Whole-tumor quantitative apparent diffusion coefficient histogram and texture analysis to predict Gleason score upgrading in intermediate-risk 3 + 4 = 7 prostate cancer. AJR Am J Roentgenol 2016; 206: 775–782.
- 16 Rosenkrantz AB, Triolo MJ, Melamed J, Rusinek H, Taneja SS, Deng FM. Whole-lesion apparent diffusion coefficient metrics as a marker of percentage Gleason 4 component within Gleason 7 prostate cancer at radical prostatectomy. J Magn Reson Imaging 2015; 41: 708–714.
- 17 Weinreb JC, Barentsz JO, Choyke PL, et al. PI-RADS prostate imaging — reporting and data system: 2015, version 2. Eur Urol 2016; 69: 16–40.
- 18 Barentsz JO, Weinreb JC, Verma S, et al. Synopsis of the PI-RADS v2 guidelines for multiparametric prostate magnetic resonance imaging and recommendations for use. Eur Urol 2016; 69: 41–49.
- 19 Rosenkrantz AB, Oto A, Turkbey B, Westphalen AC. Prostate Imaging Reporting and Data System (PI-RADS), Version 2: a critical look. AJR Am J Roentgenol 2016: 1–5.
- 20 Schieda N, Quon JS, Lim C, et al. Evaluation of the European Society of Urogenital Radiology (ESUR) PI-RADS scoring system for assessment of extra-prostatic extension in prostatic carcinoma. Eur J Radiol 2015 [Epub ahead of print].
- 21 Stamatakis L, Siddiqui MM, Nix JW, et al. Accuracy of multiparametric magnetic resonance imaging in confirming eligibility for active surveillance for men with prostate cancer. Cancer 2013; 119: 3359–3366.
- 22 Montironi R, Hammond EH, Lin DW, et al. Consensus statement with recommendations on active surveillance inclusion criteria and definition of progression in men with localized prostate cancer: the critical role of the pathologist. Virchows Arch 2014; 465: 623–628.
- 23 Turkbey B, Mani H, Aras O, et al. Correlation of magnetic resonance imaging tumor volume with histopathology. J Urol 2012; 188: 1157–1163.
- 24 Amin MB, Lin DW, Gore JL, et al. The critical role of the pathologist in determining eligibility for active surveillance as a management option in patients with prostate cancer: consensus statement with recommendations supported by the College of American Pathologists, International Society of Urological Pathology, Association of Directors of Anatomic and Surgical Pathology, the New Zealand Society of Pathologists, and the Prostate Cancer Foundation. Arch Pathol Lab Med 2014; 138: 1387–1405.
- 25 Johnson LM, Choyke PL, Figg WD, Turkbey B. The role of MRI in prostate cancer active surveillance. Biomed Res Int 2014; 2014: 203906.
- 26 Epstein JI, Allsbrook WC Jr, Amin MB, Egevad LL. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol 2005; 29: 1228–1242.
- 27 Epstein JI, Zelefsky MJ, Sjoberg DD, et al. A contemporary prostate cancer grading system: a validated alternative to the Gleason score. Eur Urol 2015 [Epub ahead of print].
- 28
Xiao-Hua Zhou NAO,
Donna K. McClish. Statistical methods in diagnostic medicine, 2nd ed. Hoboken, NJ: John Wiley and Sons; 2011.
10.1002/9780470906514 Google Scholar
- 29 Lim C, Flood TA, Hakim SW, et al. Evaluation of apparent diffusion coefficient and MR volumetry as independent associative factors for extra-prostatic extension (EPE) in prostatic carcinoma. J Magn Reson Imaging 2016; 43: 726–736.
- 30 Yadav R, Tu JJ, Jhaveri J, Leung RA, Rao S, Tewari AK. Prostate volume and the incidence of extraprostatic extension: is there a relation? J Endourol 2009; 23: 383–386.
- 31 Knoedler JJ, Karnes RJ, Thompson RH, Rangel LJ, Bergstralh EJ, Boorjian SA. The association of tumor volume with mortality following radical prostatectomy. Prostate Cancer Prostatic Dis 2014; 17: 144–148.
- 32 Kim KH, Lim SK, Shin TY, et al. Tumor volume adds prognostic value in patients with organ-confined prostate cancer. Ann Surg Oncol 2013; 20: 3133–3139.
- 33 Rosenkrantz AB, Oei M, Babb JS, Niver BE, Taouli B. Diffusion-weighted imaging of the abdomen at 3.0 Tesla: image quality and apparent diffusion coefficient reproducibility compared with 1.5 Tesla. J Magn Reson Imaging 2011; 33: 128–135.
- 34 Graves MJ, Mitchell DG. Body MRI artifacts in clinical practice: a physicist's and radiologist's perspective. J Magn Reson Imaging 2013; 38: 269–287.
- 35 Fedorov A, Penzkofer T, Hirsch MS, et al. The role of pathology correlation approach in prostate cancer index lesion detection and quantitative analysis with multiparametric MRI. Acad Radiol 2015; 22: 548–555.
- 36 Kayat Bittencourt L, Litjens G, Hulsbergen-van de Kaa CA, Turkbey B, Gasparetto EL, Barentsz JO. Prostate cancer: the European Society of Urogenital Radiology Prostate Imaging Reporting and Data System Criteria for Predicting Extraprostatic Extension by Using 3-T Multiparametric MR Imaging. Radiology 2015: 141412.
- 37 Engelbrecht MR, Jager GJ, Laheij RJ, Verbeek AL, van Lier HJ, Barentsz JO. Local staging of prostate cancer using magnetic resonance imaging: a meta-analysis. Eur Radiol 2002; 12: 2294–2302.
- 38 de Rooij M, Hamoen EH, Witjes JA, Barentsz JO, Rovers MM. Accuracy of magnetic resonance imaging for local staging of prostate cancer: a diagnostic meta-analysis. Eur Urol 2015 [Epub ahead of print].
- 39 Lim C, Flood TA, Hakim SW, et al. Evaluation of apparent diffusion coefficient and MR volumetry as independent associative factors for extra-prostatic extension (EPE) in prostatic carcinoma. J Magn Reson Imaging 2015.
- 40 Bloch BN, Genega EM, Costa DN, et al. Prediction of prostate cancer extracapsular extension with high spatial resolution dynamic contrast-enhanced 3-T MRI. Eur Radiol 2012; 22: 2201–2210.
- 41 Muller BG, Shih JH, Sankineni S, et al. Prostate cancer: interobserver agreement and accuracy with the revised prostate imaging reporting and data system at multiparametric MR imaging. Radiology 2015; 277: 741–750.
- 42 Kozminski MA, Palapattu GS, Mehra R, et al. Understanding the relationship between tumor size, gland size, and disease aggressiveness in men with prostate cancer. Urology 2014; 84: 373–378.
- 43 Junker D, Schafer G, Edlinger M, et al. Evaluation of the PI-RADS scoring system for classifying mpMRI findings in men with suspicion of prostate cancer. Biomed Res Int 2013; 2013: 252939.
- 44 Katz CL, Kosinski KE. Winthrop University Hospital, Garden City, NY; Winthrop University Hospital, Mineola, NY. Histopathologic correlation of PI-RADS V.2 lesions on 3T multiparametric prostate MRI. J Clin Oncol 2016; 34:(suppl 2S; abstr 10).
- 45 Thompson J, Lawrentschuk N, Frydenberg M, Thompson L, Stricker P. The role of magnetic resonance imaging in the diagnosis and management of prostate cancer. BJU Int 2013; 112(Suppl 2): 6–20.
- 46 Heidenreich A. Consensus criteria for the use of magnetic resonance imaging in the diagnosis and staging of prostate cancer: not ready for routine use. Eur Urol 2011; 59: 495–497.
- 47 Park SY, Jung DC, Oh YT, et al. Prostate cancer: PI-RADS V. 2 helps preoperatively predict clinically significant cancers. Radiology 2016: 151133.
- 48 Woo S, Kim SY, Lee J, Kim SH, Cho JY. PI-RADS v. 2 for prediction of pathological downgrading after radical prostatectomy: a preliminary study in patients with biopsy-proven Gleason score 7 (3 + 4) prostate cancer. Eur Radiol 2016; 26: 3580–3587.
- 49 Park SY, Oh YT, Jung DC, et al. Prediction of biochemical recurrence after radical prostatectomy with PI-RADS v. 2 in prostate cancers: initial results. Eur Radiol 2016; 26: 2502–2509.
- 50 Liddell H, Jyoti R, Haxhimolla HZ. mp-MRI prostate characterised PIRADS 3 lesions are associated with a low risk of clinically significant prostate cancer — a retrospective review of 92 biopsied PIRADS 3 lesions. Curr Urol 2015; 8: 96–100.
- 51 Rosenkrantz AB, Meng X, Ream JM, et al. Likert score 3 prostate lesions: Association between whole-lesion ADC metrics and pathologic findings at MRI/ultrasound fusion targeted biopsy. J Magn Reson Imaging 2016; 43: 325–332.
