Assessing Extraprostatic Extension with Multiparametric MRI of the Prostate: Mehralivand Extraprostatic Extension Grade or Extraprostatic Extension Likert Scale?

Reisæter, Lars Anders Rokne; Halvorsen, Ole J.; Beisland, Christian; Honoré, Alfred; Gravdal, Karsten; Losnegård, Are; Monssen, Jan Ankar; Akslen, Lars A.; Biermann, Martin

doi:10.1148/rycan.2019190071

Cited by 23 publications

(21 citation statements)

References 43 publications

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“…In our study, by using EPE grade, even the junior radiologist could perform the EPE evaluation with a good diagnostic performance, which to some extent reflected the simplicity and comprehensibility of the EPE grade. Reisæter et al compared the EPE grade with a five-point Likert score for EPE and the prediction of biochemical recurrence-free survival, and the results showed that the EPE grade and the EPE Likert have an equivalent diagnostic performance with a similar degree of observer dependence ( 20 ). Park et al ( 15 ) compared the diagnostic performance of MRI-based criteria (including EPE grade, European Society of Urogenital Radiology score, Likert scale, and capsular contact length) for the assessment of EPE, and these criteria showed good overall diagnostic performance, with AUC ranges of 0.77–0.81, 0.79–0.81, 0.78–0.79, and 0.78–0.85, respectively, with substantial intra- and interreader agreement.…”

Section: Discussionmentioning

confidence: 99%

External Validation of the Extraprostatic Extension Grade on MRI and Its Incremental Value to Clinical Models for Assessing Extraprostatic Cancer

Zhang

et al. 2021

Front. Oncol.

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ObjectivesTo externally validate the extraprostatic extension (EPE) grade criteria on MRI and analyze the incremental value of EPE grade to clinical models of prostate cancer.MethodsA consecutive 130 patients who underwent preoperative prostate MRI followed by radical prostatectomy between January 2015 to January 2020 in our institution were retrospectively enrolled. The EPE grade, Cancer of the Prostate Risk Assessment (CAPRA), and Memorial Sloan Kettering Cancer Center nomogram (MSKCCn) score for each patient were assigned. Significant clinicopathological factors in univariate and multivariate analyses were combined with EPE grade to build the Clinical + EPE grade model, and the CAPRA and MSKCCn score were also combined with EPE grade to build the CAPRA + EPE grade and MSKCCn + EPE grade model, respectively. The area under the curve (AUC), sensitivity and specificity of these models were calculated to evaluate their diagnostic performance. Calibration and decision curve analyses were used to analyze their calibration performance and clinical utility.ResultsThe AUC for predicting EPE was 0.767–0.778 for EPE grade, 0.704 for CAPRA, and 0.723 for MSKCCn. After combination with EPE grade, the AUCs of these clinical models increased significantly than using clinical models along (P < 0.05), but was comparable with using EPE grade alone (P > 0.05). The calibration curves of EPE grade, clinical models and combined models showed that these models are well-calibrated for EPE. In the decision curve analysis, EPE grade showed slightly higher net benefit than MSKCCn and CAPRA.ConclusionThe EPE grade showed good performance for evaluating EPE in our cohort and possessed well clinical utility. Further combinations with the EPE grade could improve the diagnostic performance of clinical models.

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Section: Discussionmentioning

confidence: 99%

External Validation of the Extraprostatic Extension Grade on MRI and Its Incremental Value to Clinical Models for Assessing Extraprostatic Cancer

Zhang

et al. 2021

Front. Oncol.

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“…Regarding the cutoff, 1 study reported the outcomes of 3 thresholds (EPE grades ≥1, ≥2, and ≥3) ( 18 ), whereas the remaining studies only reported the outcome of a cutoff threshold ≥1. Aside from the EPE grading system, diagnostic accuracy of a quantitative assessment of the length of capsular contact (LCC) and in-house Likert scale were reported by 2 studies ( 18 , 25 , 26 ). In all studies, the MRI images were interpreted by 2 radiologists independently with experience of 2–15 years.…”

Section: Resultsmentioning

confidence: 99%

“…reported good inter-reader agreement while using the EPE grading system, and less experienced radiologists could benefit from this guideline and yield good diagnostic accuracy ( 26 , 27 ). Nonetheless, the EPE grading system is still burdened with a subjective bias between radiologists due to some qualitative analyses ( 25 ).…”

Section: Resultsmentioning

confidence: 99%

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Diagnostic Performance of Extraprostatic Extension Grading System for Detection of Extraprostatic Extension in Prostate Cancer: A Diagnostic Systematic Review and Meta-Analysis

Shang

et al. 2022

Front. Oncol.

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PurposeTo evaluate the diagnostic performance of the extraprostatic extension (EPE) grading system for detection of EPE in patients with prostate cancer (PCa).Materials and MethodsWe performed a literature search of Web of Science, MEDLINE (Ovid and PubMed), Cochrane Library, EMBASE, and Google Scholar to identify eligible articles published before August 31, 2021, with no language restrictions applied. We included studies using the EPE grading system for the prediction of EPE, with histopathological results as the reference standard. The pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR−), and diagnostic odds ratio (DOR) were calculated with the bivariate model. Quality assessment of included studies was performed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.ResultsA total of 4 studies with 1,294 patients were included in the current systematic review. The pooled sensitivity and specificity were 0.82 (95% CI 0.76–0.87) and 0.63 (95% CI 0.51–0.73), with the area under the hierarchical summary receiver operating characteristic (HSROC) curve of 0.82 (95% CI 0.79–0.85). The pooled LR+, LR−, and DOR were 2.20 (95% CI 1.70–2.86), 0.28 (95% CI 0.22–0.36), and 7.77 (95% CI 5.27–11.44), respectively. Quality assessment for included studies was high, and Deeks’s funnel plot indicated that the possibility of publication bias was low (p = 0.64).ConclusionThe EPE grading system demonstrated high sensitivity and moderate specificity, with a good inter-reader agreement. However, this scoring system needs more studies to be validated in clinical practice.

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“…There are several other methods of providing EPE predictions scales; EPE grade (20), ESUR (21), curvilinear contact length (CCL) (22), and tumour capsule length (TCL) (23). The EPE Grade system has been externally validated with promisingly similar results (24). Importantly, Park et al have shown that different methods can perform similarly (25) and there is good evidence to consistently suggest that incorporation of clinical details alongside MRI interpretation (such as in our study) may also improve diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 99%

Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer Before Robot-Assisted Radical Prostatectomy

Dinneen¹,

Allen²,

Strange³

et al. 2022

Preprint

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The accuracy of multi-parametric MRI (mpMRI) in pre-operative staging of prostate cancer (PCa) remains controversial. Objective: To evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (EPE) on a side-specific basis using a risk-stratified 5-point Likert scale. This study also aimed to assess the influence of mpMRI scan quality on diagnostic accuracy. Patients and Methods: We included 124 men who underwent robot-assisted RP (RARP) as part of the NeuroSAFE PROOF study at our centre. Three radiologists retrospectively reviewed mpMRI blinded to RP pathology and assigned a Likert score (1-5) for EPE on each side of the prostate. Each scan was also ascribed a Prostate Imaging Quality (PI-QUAL) score for assessing the quality of the mpMRI scan, where 1 represents poorest and 5 represents best diagnostic quality. Outcome measurements and statistical analyses: Diagnostic performance is presented for binary classification of EPE including 95% confidence intervals and area under the receiver operating characteristic curve (AUC). Results: A total of 231 lobes from 121 men (mean age 56.9 years) were evaluated. 39 men (32.2%), or 43 lobes (18.6%) had EPE. Likert score ≥3 had sensitivity (SE), specificity (SP), NPV, PPV of 90.4%, 52.3%, 96%, 29.9%, respectively, and AUC was 0.82 (95% CI: 0.77-0.86). AUC was 0.63 (95% CI: 0.37-0.9), 0.77 (0.71-0.84) and 0.92 (0.88-0.96) for biparametric scans, PI-QUAL 1-3 and PI-QUAL 4-5 scans, respectively. Conclusions: MRI can be used effectively by genitourinary radiologists to rule out EPE and help inform surgical planning for men undergoing RARP. EPE prediction was more reliable when the MRI scan was a) multi-parametric and b) of a higher image quality according to the PI-QUAL scoring system.

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Assessing Extraprostatic Extension with Multiparametric MRI of the Prostate: Mehralivand Extraprostatic Extension Grade or Extraprostatic Extension Likert Scale?

Cited by 23 publications

References 43 publications

External Validation of the Extraprostatic Extension Grade on MRI and Its Incremental Value to Clinical Models for Assessing Extraprostatic Cancer

External Validation of the Extraprostatic Extension Grade on MRI and Its Incremental Value to Clinical Models for Assessing Extraprostatic Cancer

Diagnostic Performance of Extraprostatic Extension Grading System for Detection of Extraprostatic Extension in Prostate Cancer: A Diagnostic Systematic Review and Meta-Analysis

Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer Before Robot-Assisted Radical Prostatectomy

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