Diagnostic Accuracy and Interobserver Agreement of PI-RADS Version 2 and Version 2.1 for the Detection of Transition Zone Prostate Cancers

Wei, Chaogang; Zhang, Yue-Yue; Pan, Peng; Chen, Tong; Yu, Hai Zhou; Dai, Guangcheng; Tu, Jian; Yang, Shuo; Zhao, Wei; Shen, Jing

doi:10.2214/ajr.20.23883

Cited by 41 publications

(31 citation statements)

References 22 publications

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“…Full-text reviews were conducted for 29 articles, and 19 articles were further excluded. Finally, 10 original articles were included in this meta-analysis, [10][11][12][13]15,[22][23][24][25][26] five of which described head-to-head comparisons between PI-RADS v2 and v2.1. [10][11][12]15,26…”

Section: Literature Searchmentioning

confidence: 99%

“…The size of the study populations is ranged from 50 to 355 patients, with mean ages of 50.5-73 years and mean PSA levels of 5.8-13.7 ng/mL. Nine studies were retrospective, [10][11][12]15,[22][23][24][25][26] and one study was prospective. 13 Five studies made evaluations on a per-lesion basis, 10,11,13,22,25 and five studies made them on a per-patient basis.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Four studies evaluated the transitional zone only, 11,12,15,26 whereas six studies evaluated the whole gland including the transitional and peripheral zones. 10,13,[22][23][24][25] With regard to zonal location, the pooled sensitivity and specificity were 90% (95% CI, 84-96%) and 76% (95% CI, 62-90%) for the transition zone only, which were higher than the values for the whole gland (sensitivity of 85% [79-91%] and specificity of 71% [57-85%]; P = 0.04; Table 2).…”

Section: Subgroup Analysismentioning

confidence: 99%

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Performance of Prostate Imaging Reporting and Data System Version 2.1 for Diagnosis of Prostate Cancer: A Systematic Review and Meta‐Analysis

Park

Choi

Kim

et al. 2021

Magnetic Resonance Imaging

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Background: The Prostate Imaging Reporting and Data System (PI-RADS) was introduced in 2012 and updated to version 2.1 (v2.1) in early 2019 to improve diagnostic performance and interreader reliability. Purpose: To evaluate the diagnostic performance of PI-RADS v2.1 in comparison with v2. Methods: A systematic review and meta-analysis of the literature was performed using MEDLINE, EMBASE, and Cochrane databases to identify studies evaluating the diagnostic performance of PI-RADS v2.1 for diagnosing clinically significant prostate cancer (csPCa). Study Type: Systematic review and meta-analysis. Subject: One thousand two hundred forty-eight patients with 1406 lesions from 10 eligible articles. Field Strength/sequence: Conventional MR sequences at 1.5 T and 3 T. Assessment: Two reviewers independently identified and reviewed the original articles reporting diagnostic performance of PI-RADS v2.1. Statistical Tests: Meta-analytic summary sensitivity and specificity were calculated using a bivariate random effects model. Meta-analytic sensitivity and specificity between PI-RADS v2 and v2.1 were compared. Results: The pooled sensitivity and specificity of PI-RADS v2.1 were 87% (95% confidence intervals, 82-91%) and 74% (63-82%), respectively. In five studies available for a head-to-head comparison between PI-RADS v2.1 and v2, there were no significant differences in either sensitivity (90% [86-94%] vs. 88% [83-93%], respectively) or specificity (76% [59-93%] vs. 61% [39-83%], respectively; P = 0.37). The sensitivity and specificity were 81% (73-87%) and 82% (68-91%), respectively, for a PI-RADS score cutoff of ≥4, and 94% (88-97%) and 56% (35-97%) for ≥3. Regarding the zonal location, the sensitivity and specificity for the transitional zone only were 90% (84-96%) and 76% (62-90%) respectively, whereas for the whole gland they were 85% (79-91%) and 71% (57-85%). Data Conclusion: PI-RADS v2.1 demonstrated good overall performance for the diagnosis of csPCa. PI-RADS v2.1 tended to show higher specificity than v2, but the difference lacked statistical significance. Level of Evidence: 3 Technical Efficacy Stage: 3

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Section: Literature Searchmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Subgroup Analysismentioning

confidence: 99%

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Performance of Prostate Imaging Reporting and Data System Version 2.1 for Diagnosis of Prostate Cancer: A Systematic Review and Meta‐Analysis

Park

Choi

Kim

et al. 2021

Magnetic Resonance Imaging

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“…However, lesions fulfilling these criteria seem to be rare in clinical routine and we did not see any in our study cohort: Both readers scored lesions nearly identical when using PI-RADS version 2.0 and 2.1 and the small increase in AUC seen in both readers is probably not clinically relevant. Research data on the comparison between PIRADS 2.0 and 2.1 is still sparse, with a few report indicating a slight improvement in the detection of cancer in the transitional zone [15,16], however, a recent study of Moreira et al aligns with our results and did not see "significant changes in the number of positive and negative MRI results" and "expected low influence in clinical management" [17]. We did see an effect of reader experience, with the experienced reader reaching higher levels of sensitivity/ specificity than the unexperienced reader, even when using the same PI-RADS criteria for the https://doi.org/10.1371/journal.pone.0239975.g001…”

Section: Discussionmentioning

confidence: 99%

Comparison of the PI-RADS 2.1 scoring system to PI-RADS 2.0: Impact on diagnostic accuracy and inter-reader agreement

et al. 2020

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To assess the value of the PI-RADS 2.1 scoring system in the detection of prostate cancer on multiparametric MRI in comparison to the standard PI-RADS 2.0 system and to assess its inter-reader variability. Materials and methods This IRB-approved study included 229 patients undergoing multiparametric prostate MRI prior to MRI-guided TRUS-based biopsy, which were retrospectively recruited from our prospectively maintained institutional database. Two readers with high (reader 1, 6 years) and low (reader 2, 2 years) level of expertise identified the lesion with the highest PI-RADS score for both version 2.0 and 2.1 for each patient. Inter-reader agreement was estimated, and diagnostic accuracy analysis was performed. Results Inter-reader agreement on PI-RADS scores was fair for both version 2.0 (kappa: 0.57) and 2.1 (kappa: 0.51). Detection rates for prostate cancer (PCa) and clinically significant prostate cancer (csPCa) were almost identical for both PI-RADS versions and higher for the more experienced reader (AUC, Reader 1: PCa, 0.881-0.887, csPCa, 0.874-0.879; Reader 2: PCa, 0.765, csPCa, 0.746-0.747; both p > 0.05), both when using a PI-RADS score of � 4 and �3 as indicators for positivity for cancer. Conclusions The new PI-RADS 2.1 scoring system showed comparable diagnostic performance and inter-reader variability compared to version 2.0. The introduced changes in the version 2.1 seem only to take effect in a very small number of patients.

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“…Interestingly, even studies among experts describe only moderate agreement (kappa = 0.55) [ 9 ], which might be due to the subjective image impressions used for the PI-RADS classifications. PI-RADS v2.1 was developed, among other objectives, with the anticipation of an increased interreader agreement, which has recently been shown for lesions of the transition zone [ 17 , 19 ]. Nevertheless, PI-RADS v2.1-based evaluation is still subject to perceived image impressions, which makes it possibly susceptible to interobserver variability.…”

Section: Discussionmentioning

confidence: 99%

Computer-Aided Diagnosis in Multiparametric MRI of the Prostate: An Open-Access Online Tool for Lesion Classification with High Accuracy

Ellmann

Schlicht

Dietzel

et al. 2020

Cancers

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Computer-aided diagnosis (CADx) approaches could help to objectify reporting on prostate mpMRI, but their use in many cases is hampered due to common-built algorithms that are not publicly available. The aim of this study was to develop an open-access CADx algorithm with high accuracy for classification of suspicious lesions in mpMRI of the prostate. This retrospective study was approved by the local ethics commission, with waiver of informed consent. A total of 124 patients with 195 reported lesions were included. All patients received mpMRI of the prostate between 2014 and 2017, and transrectal ultrasound (TRUS)-guided and targeted biopsy within a time period of 30 days. Histopathology of the biopsy cores served as a standard of reference. Acquired imaging parameters included the size of the lesion, signal intensity (T2w images), diffusion restriction, prostate volume, and several dynamic parameters along with the clinical parameters patient age and serum PSA level. Inter-reader agreement of the imaging parameters was assessed by calculating intraclass correlation coefficients. The dataset was stratified into a train set and test set (156 and 39 lesions in 100 and 24 patients, respectively). Using the above parameters, a CADx based on an Extreme Gradient Boosting algorithm was developed on the train set, and tested on the test set. Performance optimization was focused on maximizing the area under the Receiver Operating Characteristic curve (ROCAUC). The algorithm was made publicly available on the internet. The CADx reached an ROCAUC of 0.908 during training, and 0.913 during testing (p = 0.93). Additionally, established rule-in and rule-out criteria allowed classifying 35.8% of the malignant and 49.4% of the benign lesions with error rates of <2%. All imaging parameters featured excellent inter-reader agreement. This study presents an open-access CADx for classification of suspicious lesions in mpMRI of the prostate with high accuracy. Applying the provided rule-in and rule-out criteria might facilitate to further stratify the management of patients at risk.

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Diagnostic Accuracy and Interobserver Agreement of PI-RADS Version 2 and Version 2.1 for the Detection of Transition Zone Prostate Cancers

Cited by 41 publications

References 22 publications

Performance of Prostate Imaging Reporting and Data System Version 2.1 for Diagnosis of Prostate Cancer: A Systematic Review and Meta‐Analysis

Performance of Prostate Imaging Reporting and Data System Version 2.1 for Diagnosis of Prostate Cancer: A Systematic Review and Meta‐Analysis

Comparison of the PI-RADS 2.1 scoring system to PI-RADS 2.0: Impact on diagnostic accuracy and inter-reader agreement

Computer-Aided Diagnosis in Multiparametric MRI of the Prostate: An Open-Access Online Tool for Lesion Classification with High Accuracy

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