Impact of prostate MRI central review over the diagnostic performance of MRI-targeted biopsy: should we routinely ask for an expert second opinion?

Stabile, Armando; Sorce, Gabriele; Barletta, Francesco; Brembilla, Giorgio; Mazzone, Elio; Pellegrino, Francesco; Cannoletta, Donato; Cirulli, Giuseppe; Gandaglia, Giorgio; Cobelli, Francesco De; Montorsi, Francesco; Briganti, Alberto

doi:10.1007/s00345-023-04365-4

Cited by 6 publications

(1 citation statement)

References 20 publications

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“…Despite MRI's good soft tissue contrast, higher sensitivity, and negative predictive value for PCa detection, a large number of prostate cancers still go undetected [3,[7][8][9]. It has been noted that up to 30% of clinically significant cancers can be missed even by expert radiologists on multiparametric MRI (mpMRI) using the PIRADS guidelines [9][10][11][12], with a large variation seen between radiologists and imaging centers [13,14].…”

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confidence: 99%

Prostate Cancers Invisible on Multiparametric MRI: Pathologic Features in Correlation with Whole-Mount Prostatectomy

Chatterjee,

Gallan,

Fan

et al. 2023

Cancers

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We investigated why some prostate cancers (PCas) are not identified on multiparametric MRI (mpMRI) by using ground truth reference from whole-mount prostatectomy specimens. A total of 61 patients with biopsy-confirmed PCa underwent 3T mpMRI followed by prostatectomy. Lesions visible on MRI prospectively or retrospectively identified after correlating with histology were considered “identified cancers” (ICs). Lesions that could not be identified on mpMRI were considered “unidentified cancers” (UCs). Pathologists marked the Gleason score, stage, size, and density of the cancer glands and performed quantitative histology to calculate the tissue composition. Out of 115 cancers, 19 were unidentified on MRI. The UCs were significantly smaller and had lower Gleason scores and clinical stage lesions compared with the ICs. The UCs had significantly (p < 0.05) higher ADC (1.34 ± 0.38 vs. 1.02 ± 0.30 μm2/ms) and T2 (117.0 ± 31.1 vs. 97.1 ± 25.1 ms) compared with the ICs. The density of the cancer glands was significantly (p = 0.04) lower in the UCs. The percentage of the Gleason 4 component in Gleason 3 + 4 lesions was nominally (p = 0.15) higher in the ICs (20 ± 12%) compared with the UCs (15 ± 8%). The UCs had a significantly lower epithelium (32.9 ± 21.5 vs. 47.6 ± 13.1%, p = 0.034) and higher lumen volume (20.4 ± 10.0 vs. 13.3 ± 4.1%, p = 0.021) compared with the ICs. Independent from size and Gleason score, the tissue composition differences, specifically, the higher lumen and lower epithelium in UCs, can explain why some of the prostate cancers cannot be identified on mpMRI.

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