Diagnostic Utility of a Likert Scale Versus Qualitative Descriptors and Length of Capsular Contact for Determining Extraprostatic Tumor Extension at Multiparametric Prostate MRI

Costa, Daniel N.; Passoni, Niccolò; Leyendecker, John R.; Leon, Alberto Diaz de; Lotan, Yair; Roehrborn, Claus G.; Otero-Muinelo, Susana; Grewal, Harpreet; Xi, Yin; Francis, Franto; Rofsky, Neil M.; Pedrosa, Iván

doi:10.2214/ajr.17.18849

Cited by 48 publications

(31 citation statements)

References 25 publications

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“…Recently, studies have aimed to apply a Likert scale of 1-5 to EPE that showed moderate interreader agreement. However, Likert scales typically lack objective criteria and therefore are difficult to reproduce (13). Additionally, few studies have used specific Prostate Imaging Reporting and Data System (PI-RADS) terms as criteria in the assessment of pathologic EPE (14-16).…”

Section: Implications For Patient Carementioning

confidence: 99%

A Grading System for the Assessment of Risk of Extraprostatic Extension of Prostate Cancer at Multiparametric MRI

et al. 2019

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To evaluate MRI features associated with pathologically defined extraprostatic extension (EPE) of prostate cancer and to propose an MRI grading system for pathologic EPE. Materials and Methods: In this prospective study, consecutive male study participants underwent preoperative 3.0-T MRI from June 2007 to March 2017 followed by robotic-assisted laparoscopic radical prostatectomy. An MRI-based EPE grading system was defined as follows: curvilinear contact length of 1.5 cm or capsular bulge and irregularity were grade 1, both features were grade 2, and frank capsular breach were grade 3. Multivariable logistic regression and decision curve analyses were performed to compare the MRI grade model and clinical parameters (prostate-specific antigen, Gleason score) for pathologic EPE prediction by using the area under the receiver operating characteristic curve (AUC) value. Results: Among 553 study participants, the mean age was 60 years 6 8 (standard deviation); the median prostate-specific antigen value was 6.3 ng/mL. A total of 125 of 553 (22%) participants had pathologic EPE at radical prostatectomy. Detection of pathologic EPE, defined as number of pathologic EPEs divided by number of participants with individual MRI features, was as follows: curvilinear contact length, 88 of 208 (42%); capsular bulge and irregularity, 78 of 175 (45%); and EPE visible at MRI, 37 of 56 (66%). For MRI, grades 1, 2, and 3 for detection of pathologic EPE were 18 of 74 (24%), 39 of 102 (38%), and 37 of 56 (66%), respectively. Clinical features plus the MRI-based EPE grading system (prostate-specific antigen, International Society of Urological Pathology stage, MRI grade) predicted pathologic EPE better than did MRI grade alone (AUC, 0.81 vs 0.77, respectively; P , .001). Conclusion: Higher MRI-based extraprostatic extension (EPE) grading categories were associated with a greater risk of pathologic EPE. Clinical features plus MRI grading had the highest diagnostic performance for prediction of pathologic EPE.

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Section: Implications For Patient Carementioning

confidence: 99%

A Grading System for the Assessment of Risk of Extraprostatic Extension of Prostate Cancer at Multiparametric MRI

et al. 2019

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“…MRIstaging can provide both, either as a stand-alone test or in combination with PSA and/or other clinical variables [52]. A Likert-scale approach, based on grouping of PPVs from low to high, might also be useful to convey the preoperative MRI staging results in a standardized way [53,54].…”

Section: D)mentioning

confidence: 99%

T-staging of prostate cancer: Identification of useful signs to standardize detection of posterolateral extraprostatic extension on prostate MRI

et al. 2020

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“…For the 13 studies combined, the summary sensitivity was cancer patients were analyzed (13)(14)(15)(16)(25)(26)(27)(28)(29)(30)(31)(32)(33). Figure 1 summarizes the detailed study selection process.…”

Section: Diagnostic Performance Of Lcc On Mri For Detection Of Epementioning

confidence: 99%

The Diagnostic Performance of the Length of Tumor Capsular Contact on MRI for Detecting Prostate Cancer Extraprostatic Extension: A Systematic Review and Meta-Analysis

et al. 2020

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Objective: The purpose was to review the diagnostic performance of the length of tumor capsular contact (LCC) on magnetic resonance imaging (MRI) for detecting prostate cancer extraprostatic extension (EPE). Materials and Methods: PubMed and EMBASE databases were searched up to March 24, 2019. We included diagnostic accuracy studies that evaluated LCC on MRI for EPE detection using radical prostatectomy specimen histopathology as the reference standard. Quality of studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Sensitivity and specificity were pooled and graphically presented using hierarchical summary receiver operating characteristic (HSROC) plots. Meta-regression and subgroup analyses were conducted to explore heterogeneity. Results: Thirteen articles with 2136 patients were included. Study quality was generally good. Summary sensitivity and specificity were 0.79 (95% confidence interval [CI] 0.73-0.83) and 0.67 (95% CI 0.60-0.74), respectively. Area under the HSROC was 0.81 (95% CI 0.77-0.84). Substantial heterogeneity was present among the included studies according to Cochran's Q-test (p < 0.01) and Higgins I 2 (62% and 86% for sensitivity and specificity, respectively). In terms of heterogeneity, measurement method (curvilinear vs. linear), prevalence of Gleason score ≥ 7, MRI readers' experience, and endorectal coils were significant factors (p ≤ 0.01), whereas method to determine the LCC threshold, cutoff value, magnet strength, and publication year were not (p = 0.14-0.93). Diagnostic test accuracy estimates were comparable across all assessed MRI sequences. Conclusion: Greater LCC on MRI is associated with a higher probability of prostate cancer EPE. Due to heterogeneity among the studies, further investigation is needed to establish the optimal cutoff value for each clinical setting.

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Diagnostic Utility of a Likert Scale Versus Qualitative Descriptors and Length of Capsular Contact for Determining Extraprostatic Tumor Extension at Multiparametric Prostate MRI

Abstract: A Likert score conveying the degree of suspicion at multiparametric MRI is a stronger predictor of EPE than is either ESUR score or TCL and may facilitate informed decision making, patient counseling, and treatment planning.

Cited by 48 publications

References 25 publications

A Grading System for the Assessment of Risk of Extraprostatic Extension of Prostate Cancer at Multiparametric MRI

A Grading System for the Assessment of Risk of Extraprostatic Extension of Prostate Cancer at Multiparametric MRI

T-staging of prostate cancer: Identification of useful signs to standardize detection of posterolateral extraprostatic extension on prostate MRI

The Diagnostic Performance of the Length of Tumor Capsular Contact on MRI for Detecting Prostate Cancer Extraprostatic Extension: A Systematic Review and Meta-Analysis

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