Extraprostatic Tumor Extension: Comparison of Preoperative Multiparametric MRI Criteria and Histopathologic Correlation after Radical Prostatectomy

Abstract

Background: There are no standardized and well-validated criteria for assessing the risk of extraprostatic extension (EPE) of prostate cancer at preoperative multiparametric MRI.Purpose: To compare diagnostic performance, intra-and interreader agreement, and correlations of MRI-based criteria for assessment of EPE after radical prostatectomy, including EPE grade, European Society of Urogenital Radiology (ESUR) score, Likert scale, and capsular contact length (CCL). Materials and Methods:This retrospective study included consecutive men who underwent MRI and radical prostatectomy between July 2016 and March 2017. Two genitourinary radiologists independently estimated the probability of EPE by using four MRIbased scoring methods. The diagnostic accuracies and intra-and interobserver agreement were evaluated with area under the receiver operating characteristic curve (AUC) and k statistics, respectively. Correlations between MRI-based score and histologic extent of EPE were analyzed by using the Spearman correlation coefficient (r).Results: A total of 301 men (mean age 6 standard deviation, 65 years 6 7) were evaluated. A total of 129 (42.9%) men had EPE. The AUC ranges of EPE grade, ESUR score, Likert scale, and CCL for assessment of EPE were 0.77-0.81, 0.79-0.81, 0.78-0.79, and 0.78-0.85, respectively, for the two readers. The Likert scale showed lower sensitivity (68.2% [88 of 129] for reader 1, 72.1% [93 of 129] for reader 2) than did EPE grade (77.5% [100 of 129] for reader 1, 79.8% [103 of 129] for reader 2; P  .04). Intraand interreader agreement were substantial (k range, 0.61-0.74) for the four methods, with ESUR score showing the lowest values (k = 0.61 and k = 0.63, respectively). EPE grade showed highest correlation with histologic extent of EPE (r = 0.53 and r = 0.55 for circumferential length; r = 0.42 and r = 0.55 for radial length for readers 1 and 2, respectively; P , .001). Conclusion:Extraprostatic extension (EPE) grade, European Society of Urogenital Radiology score, Likert scale, and capsular contact length showed good overall diagnostic performance; however, the EPE grade resulted in more reliable performance and had the highest correlation with histologic EPE extent.

Artificial intelligence is a promising prospect for the detection of prostate cancer extracapsular extension with mpMRI: a two-center comparative study

“…While, the use of MRI instead of DRE leads to a signi cant upstaging of clinical T-stage and risk grouping [12][13][14][15]. In addition, despite considerable efforts such as alternative high-resolution imaging and new grading approaches, the diagnostic accuracy of MRI for T3a-staging revealed a poor and heterogeneous sensitivity of 30%-70% [16][17][18][19]. The heterogeneity of MRI in PCa T3a-staging may be caused by the fact that there are no standard criteria for evaluation [20].…”

Prostate-specific membrane antigen positron emission tomography (PSMA-PET) for local staging of prostate cancer: a systematic review and meta-analysis

“…Nomograms combining clinicopathological information including prostate-specific antigen (PSA) levels, clinical stage based on digital rectal examination, and biopsyrelated information (Gleason score, number, and percentage of positive cores) are often used to predict the extent of prostate cancer (Ohori et al 2004). However, there is an increasing number of studies showing that incorporating preoperative magnetic resonance imaging (MRI) results provide incremental value in predicting SVI and EPE (Ohori et al 2004;Nyarangi-Dix et al 2018;Mehralivand et al 2019;Park et al 2020). Nevertheless, these results are still imperfect with area under the curves (AUC) ranging from 0.74-0.87 (Jansen et al 2019;Wang et al 2007;Weaver et al 2018).…”

Multiparametric MRI in the management of prostate cancer: an update—a narrative review

“…The lack of properly validated systems in EPE imaging interpretation is one of the main issue as regard to the performance of multiparametric MRI, as it is the main cause of the inter-reader variability. According with Park et al, among the grading systems for EPE, despite its simplicity, EPE grade is the system with the higher performance and correlates well with the histologic extent of EPE (63).…”