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

Pesapane, Filippo; Standaert, Chloë; Visschere, Pieter De; Villeirs, Geert

doi:10.1016/j.clinimag.2019.08.007

Cited by 20 publications

(29 citation statements)

References 54 publications

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“…High accuracy of unenhanced prostate MRI, combined with PSA evaluation, was shown for the detection of clinically significant PCa [ 8 , 12 , 21 , 22 ], and a meta-analysis showed that bpMRI, with a high b-value, is a sensitive tool for diagnosing PCa [ 23 ]. We considered previous studies, both those in favor of the added value of DCE [ 24 , 25 ] and those against it [ 21 , 26 ], arguing that different results may have been caused by heterogeneity in technical issues, study populations, and interpretation criteria.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Sensitivity and Specificity of Biparametric versus Multiparametric Prostate MRI in the Detection of Prostate Cancer in 431 Men with Elevated Prostate-Specific Antigen Levels

et al. 2021

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(1) Background: the study of dynamic contrast enhancement (DCE) has a limited role in the detection of prostate cancer (PCa), and there is a growing interest in performing unenhanced biparametric prostate-MRI (bpMRI) instead of the conventional multiparametric-MRI (mpMRI). In this study, we aimed to retrospectively compare the performance of the mpMRI, which includes DCE study, and the unenhanced bpMRI, composed of only T2-weighted imaging and diffusion-weighted imaging (DWI), in PCa detection in men with elevated prostate-specific-antigen (PSA) levels. (2) Methods: a 1.5 T MRI, with an endorectal-coil, was performed on 431 men (aged 61.5 ± 8.3 years) with a PSA ≥4.0 ng/mL. The bpMRI and mpMRI tests were independently assessed in separate sessions by two readers with 5 (R1) and 3 (R2) years of experience. The histopathology or ≥2 years follow-up served as a reference standard. The sensitivity and specificity were calculated with their 95% CI, and McNemar’s and Cohen’s κ statistics were used. (3) Results: in 195/431 (45%) of histopathologically proven PCa cases, 62/195 (32%) were high-grade PCa (GS ≥ 7b) and 133/195 (68%) were low-grade PCa (GS ≤ 7a). The PCa could be excluded by histopathology in 58/431 (14%) and by follow-up in 178/431 (41%) of patients. For bpMRI, the sensitivity was 164/195 (84%, 95% CI: 79–89%) for R1 and 156/195 (80%, 95% CI: 74–86%) for R2; while specificity was 182/236 (77%, 95% CI: 72–82%) for R1 and 175/236 (74%, 95% CI: 68–80%) for R2. For mpMRI, sensitivity was 168/195 (86%, 95% CI: 81–91%) for R1 and 160/195 (82%, 95% CI: 77–87%) for R2; while specificity was 184/236 (78%, 95% CI: 73–83%) for R1 and 177/236 (75%, 95% CI: 69–81%) for R2. Interobserver agreement was substantial for both bpMRI (κ = 0.802) and mpMRI (κ = 0.787). (4) Conclusions: the diagnostic performance of bpMRI and mpMRI were similar, and no high-grade PCa was missed with bpMRI.

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Section: Discussionmentioning

confidence: 99%

Comparison of Sensitivity and Specificity of Biparametric versus Multiparametric Prostate MRI in the Detection of Prostate Cancer in 431 Men with Elevated Prostate-Specific Antigen Levels

et al. 2021

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“…The ''early" signs were: capsular disruption, unsharp prostatic margin and bulging of the prostatic contour, and the ''late" signs were: irregular contour, periprostatic fat infiltration, RPA obliteration and periprostatic mass. They found that ''late" signs had lower prevalence but higher positive predictive values for EPE after radical prostatectomy [7]. Abbreviations: cT = clinical t; mrT = multiparametric magnetic resonance imaging determined-T stage.…”

Section: Discussionmentioning

confidence: 99%

“…However, T3a stage may be a very heterogeneous entity. Although some authors have reported higher positive predictive values (PPV) for EPE in patients with periprostatic fat invasion, recto-prostatic angle obliteration and neurovascular bundle asymmetry [5] , [6] , [7] , there are no published studies evaluating the risk of failure associated with these radiologic characteristics.…”

Section: Introductionmentioning

confidence: 99%

MRI detected extaprostatic extension (EPE) in prostate cancer: Do all T3a patients have the same outcomes?

Gómez-Iturriaga

Büchser

Miguel

et al. 2020

Clinical and Translational Radiation Oncology

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“…Among them, a score based on qualitative parameters (i.e., Likert scale) showed good performance [8,9] and low inter-observer variability [8]; however, Likert scales lack objective criteria and are often difficult to reproduce. Three more "quantitative" scores [10][11][12] attempted to create a progressive risk score by combining in different ways some of the imaging features present in Prostate Imaging Reporting and Data System (PI-RADS) v2.1 [1], i.e., "asymmetry or invasion of the neurovascular bundles, bulging prostatic contour, irregular or spiculated margin, obliteration of the recto-prostatic angle, tumor-capsule interface greater than 1.0 cm, breach of the capsule with evidence of direct tumor extension or bladder wall invasion. "…”

Section: Introductionmentioning

confidence: 99%

mEPE-score: a comprehensive grading system for predicting pathologic extraprostatic extension of prostate cancer at multiparametric magnetic resonance imaging

et al. 2022

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Objective To investigate the diagnostic accuracy of the PI-RADS v2.1 multiparametric magnetic resonance imaging (mpMRI) features in predicting extraprostatic extension (mEPE) of prostate cancer (PCa), as well as to develop and validate a comprehensive mpMRI-derived score (mEPE-score). Methods We retrospectively reviewed all consecutive patients admitted to two institutions for radical prostatectomy for PCa with available records of mpMRI performed between January 2015 and December 2020. Data from one institution was used for investigating diagnostic performance of each mEPE feature using radical prostatectomy specimens as benchmark. The results were implemented in a mEPE-score as follows: no mEPE features: 1; capsular abutment: 2; irregular or spiculated margin: 3; bulging prostatic contour, or asymmetry of the neurovascular bundles, or tumor-capsule interface > 1.0 cm: 4; ≥ 2 of the previous three parameters or measurable extraprostatic disease: 5. The performance of mEPE features was evaluated using the five diagnostic parameters and ROC curve analysis. Results Two-hundred patients were enrolled at site 1 and 76 at site 2. mEPE features had poor sensitivities ranging from 0.08 (0.00–0.15) to 0.71 (0.59–0.83), whereas specificity ranged from 0.68 (0.58–0.79) to 1.00. mEPE-score showed excellent discriminating ability (AUC > 0.8) and sensitivity = 0.82 and specificity = 0.77 with a threshold of 3. mEPE-score had AUC comparable to ESUR-score (p = 0.59 internal validation; p = 0.82 external validation), higher than or comparable to mEPE-grade (p = 0.04 internal validation; p = 0.58 external validation), and higher than early-and-late-EPE (p < 0.0001 internal and external validation). There were no significant differences between readers having different expertise with EPE-score (p = 0.32) or mEPE-grade (p = 0.45), but there were significant differences for ESUR-score (p = 0.02) and early-versus-late-EPE (p = 0.03). Conclusions The individual mEPE features have low sensitivity and high specificity. The use of mEPE-score allows for consistent and reliable assessment for pathologic EPE. Key Points • Individual PI-RADS v2.1 mpMRI features had poor sensitivities ranging from 0.08 (0.00–0.15) to 0.71 (0.59–0.83), whereas Sp ranged from 0.68 (0.58–0.79) to 1.00. • mEPE-score is an all-inclusive score for the assessment of pEPE with excellent discriminating ability (i.e., AUC > 0.8) and Se = 0.82, Sp = 0.77, PPV = 0.74, and NPV = 0.84 with a threshold of 3. • The diagnostic performance of the expert reader and beginner reader with pEPE-score was comparable (p = 0.32).

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

Cited by 20 publications

References 54 publications

Comparison of Sensitivity and Specificity of Biparametric versus Multiparametric Prostate MRI in the Detection of Prostate Cancer in 431 Men with Elevated Prostate-Specific Antigen Levels

Comparison of Sensitivity and Specificity of Biparametric versus Multiparametric Prostate MRI in the Detection of Prostate Cancer in 431 Men with Elevated Prostate-Specific Antigen Levels

MRI detected extaprostatic extension (EPE) in prostate cancer: Do all T3a patients have the same outcomes?

mEPE-score: a comprehensive grading system for predicting pathologic extraprostatic extension of prostate cancer at multiparametric magnetic resonance imaging

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