Interobserver Agreement and Accuracy in Interpreting mpMRI of the Prostate: a Systematic Review

Annamalai, Arvind; Fustok, Judy; Beltran-Perez, Jesus; MD, None Ahmed Rashad,; Krane, L. Spencer; Triche, Benjamin L

doi:10.1007/s11934-022-01084-y

Cited by 18 publications

(8 citation statements)

References 27 publications

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“…In other studies, the range of csPCa in men with PI-RADS 3 and PI-RADS 1 or 2 lesions ranged from 3% to 46% and 0% to 17%, respectively . The observed variation could be due to several factors, including heterogenous patient populations and suboptimal interobserver agreement of PI-RADS . Our results suggest that combining PI-RADS with PSAD would reduce the number of unnecessary biopsies and improve the diagnostic yield.…”

Section: Discussionmentioning

confidence: 50%

Magnetic Resonance Imaging, Clinical, and Biopsy Findings in Suspected Prostate Cancer

Haj-Mirzaian,

Burk,

Lacson

et al. 2024

JAMA Netw Open

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ImportanceMultiple strategies integrating magnetic resonance imaging (MRI) and clinical data have been proposed to determine the need for a prostate biopsy in men with suspected clinically significant prostate cancer (csPCa) (Gleason score ≥3 + 4). However, inconsistencies across different strategies create challenges for drawing a definitive conclusion.ObjectiveTo determine the optimal prostate biopsy decision-making strategy for avoiding unnecessary biopsies and minimizing the risk of missing csPCa by combining MRI Prostate Imaging Reporting &amp; Data System (PI-RADS) and clinical data.Data SourcesPubMed, Ovid MEDLINE, Embase, Web of Science, and Cochrane Library from inception to July 1, 2022.Study SelectionEnglish-language studies that evaluated men with suspected but not confirmed csPCa who underwent MRI PI-RADS followed by prostate biopsy were included. Each study had proposed a biopsy plan by combining PI-RADS and clinical data.Data Extraction and SynthesisStudies were independently assessed for eligibility for inclusion. Quality of studies was appraised using the Quality Assessment of Diagnostic Accuracy Studies 2 tool and the Newcastle-Ottawa Scale. Mixed-effects meta-analyses and meta-regression models with multimodel inference were performed. Reporting of this study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.Main Outcomes and MeasuresIndependent risk factors of csPCa were determined by performing meta-regression between the rate of csPCa and PI-RADS and clinical parameters. Yields of different biopsy strategies were assessed by performing diagnostic meta-analysis.ResultsThe analyses included 72 studies comprising 36 366 patients. Univariable meta-regression showed that PI-RADS 4 (β-coefficient [SE], 7.82 [3.85]; P = .045) and PI-RADS 5 (β-coefficient [SE], 23.18 [4.46]; P &lt; .001) lesions, but not PI-RADS 3 lesions (β-coefficient [SE], −4.08 [3.06]; P = .19), were significantly associated with a higher risk of csPCa. When considered jointly in a multivariable model, prostate-specific antigen density (PSAD) was the only clinical variable significantly associated with csPCa (β-coefficient [SE], 15.50 [5.14]; P &lt; .001) besides PI-RADS 5 (β-coefficient [SE], 9.19 [3.33]; P &lt; .001). Avoiding biopsy in patients with lesions with PI-RADS category of 3 or less and PSAD less than 0.10 (vs &lt;0.15) ng/mL2 resulted in reducing 30% (vs 48%) of unnecessary biopsies (compared with performing biopsy in all suspected patients), with an estimated sensitivity of 97% (vs 95%) and number needed to harm of 17 (vs 15).Conclusions and RelevanceThese findings suggest that in patients with suspected csPCa, patient-tailored prostate biopsy decisions based on PI-RADS and PSAD could prevent unnecessary procedures while maintaining high sensitivity.

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Section: Discussionmentioning

confidence: 50%

Magnetic Resonance Imaging, Clinical, and Biopsy Findings in Suspected Prostate Cancer

Haj-Mirzaian,

Burk,

Lacson

et al. 2024

JAMA Netw Open

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“…The detection phase, that is also a source of interpretation variability, was outside the scope of this study. However, many other studies have already assessed the overall performance of the PI-RADS score [23][24][25]. Instead, we wanted to specifically evaluate whether the PI-RADS descriptors were specific enough to induce reproducible characterization of the same lesion across multiple readers.…”

Section: Discussionmentioning

confidence: 99%

“…Although PI-RADSv2.1 has been extensively evaluated [11][12][13][14][15][16][17][18][19][20][21][22], meta-analyses yielded discordant results on the relative diagnostic performance of PI-RADSv2 and PI-RADSv2.1 [23][24][25]. Particularly, whether PI-RADSv2.1 improves inter-reader agreement remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Characterization of high-grade prostate cancer at multiparametric MRI: assessment of PI-RADS version 2.1 and version 2 descriptors across 21 readers with varying experience (MULTI study)

et al. 2023

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Objective To assess PI-RADSv2.1 and PI-RADSv2 descriptors across readers with varying experience. Methods Twenty-one radiologists (7 experienced (≥ 5 years) seniors, 7 less experienced seniors and 7 juniors) assessed 240 ‘predefined’ lesions from 159 pre-biopsy multiparametric prostate MRIs. They specified their location (peripheral, transition or central zone) and size, and scored them using PI-RADSv2.1 and PI-RADSv2 descriptors. They also described and scored ‘additional’ lesions if needed. Per-lesion analysis assessed the ‘predefined’ lesions, using targeted biopsy as reference; per-lobe analysis included ‘predefined’ and ‘additional’ lesions, using combined systematic and targeted biopsy as reference. Areas under the curve (AUCs) quantified the performance in diagnosing clinically significant cancer (csPCa; ISUP ≥ 2 cancer). Kappa coefficients (κ) or concordance correlation coefficients (CCC) assessed inter-reader agreement. Results At per-lesion analysis, inter-reader agreement on location and size was moderate-to-good (κ = 0.60–0.73) and excellent (CCC ≥ 0.80), respectively. Agreement on PI-RADSv2.1 scoring was moderate (κ = 0.43–0.47) for seniors and fair (κ = 0.39) for juniors. Using PI-RADSv2.1, juniors obtained a significantly lower AUC (0.74; 95% confidence interval [95%CI]: 0.70–0.79) than experienced seniors (0.80; 95%CI 0.76–0.84; p = 0.008) but not than less experienced seniors (0.74; 95%CI 0.70–0.78; p = 0.75). As compared to PI-RADSv2, PI-RADSv2.1 downgraded 17 lesions/reader (interquartile range [IQR]: 6–29), of which 2 (IQR: 1–3) were csPCa; it upgraded 4 lesions/reader (IQR: 2–7), of which 1 (IQR: 0–2) was csPCa. Per-lobe analysis, which included 60 (IQR: 25–73) ‘additional’ lesions/reader, yielded similar results. Conclusions Experience significantly impacted lesion characterization using PI-RADSv2.1 descriptors. As compared to PI-RADSv2, PI-RADSv2.1 tended to downgrade non-csPCa lesions, but this effect was small and variable across readers.

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“…MpMRI was also recommended in biopsy‐naïve men with a strong family history or elevated known genetic risk [ 2 ] . Current evidence mostly originates from retrospective data; multicenter prospective clinical trials may provide more evidence for future strategies [ 11 ] .…”

Section: Selection Of Imaging Examination Of the Prostatementioning

confidence: 99%

“…The interobserver agreement varied among lesions with different locations (peripheral zone or transition zone) and different scores. Generally for score ≥3 lesions, the interobserver agreement is good ( κ : 0.62–0.78) [ 11 ] . To largely reduce subjectivity and improve reproducibility, a dedicated training protocol should be performed in less‐experienced readers.…”

Section: Selection Of Imaging Examination Of the Prostatementioning

confidence: 99%

Indications, strategies, and development on prostate targeted biopsy: Report of the Panjiayuan Consensus Conference 2022

Gang

Hou

et al. 2023

UroPrecision

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Interobserver Agreement and Accuracy in Interpreting mpMRI of the Prostate: a Systematic Review

Cited by 18 publications

References 27 publications

Magnetic Resonance Imaging, Clinical, and Biopsy Findings in Suspected Prostate Cancer

Magnetic Resonance Imaging, Clinical, and Biopsy Findings in Suspected Prostate Cancer

Characterization of high-grade prostate cancer at multiparametric MRI: assessment of PI-RADS version 2.1 and version 2 descriptors across 21 readers with varying experience (MULTI study)

Indications, strategies, and development on prostate targeted biopsy: Report of the Panjiayuan Consensus Conference 2022

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