Who can safely evade a magnetic resonance imaging fusion-targeted biopsy (MRIFTB) for prostate imaging reporting and data system (PI-RADS) 3 lesion?

Kim, Myong; Ryu, Hoyoung; Lee, Hak Jong; Hwang, Sung Il; Choe, Gheeyoung; Hong, Sung Kyu

doi:10.1007/s00345-020-03352-3

Cited by 8 publications

(17 citation statements)

References 20 publications

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“…The PI-RADS scoring system, designed to detect PCA with an ISUP ≥ 2, also showed a positive correlation with the pathologic biopsy ISUP groups in our analysis which also served as a measure of consistency given that PI-RADS assessment category 5 lesions contain significantly more higher ISUP grade PCA compared to the other PI-RADS categories. However, in PI-RADS 4 and 5 also ISUP 1 PCA were detected [1,2]. Head-to-head comparison of the single MRI parameters for MRI-based grading of PCA using a linear mixed model demonstrated the best performance for a combination of parameters within MRI grading groups.…”

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

“…Although PI-RADS is designed for assessing the likelihood of clinically significant PCA (ISUP ≥ 2) being present, especially when using a low threshold for biopsy, e.g. patients in PI-RADS overall assessment category 3, and/or if patients receive additional systematic biopsies, the rate of low-grade, non-significant PCA (ISUP 1) increases as high as 90% of all diagnosed PCA [ 1 , 2 ]. Since there are many different therapy options for PCA, MRI can provide helpful assistance for treatment decisions, as established in the EAU guidelines.…”

Section: Introductionmentioning

confidence: 99%

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MRI grading for the prediction of prostate cancer aggressiveness

Boschheidgen

Schimmöller

Arsov³

et al. 2021

Eur Radiol

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Objectives T o evaluate the value of multiparametric MRI (mpMRI) for the prediction of prostate cancer (PCA) aggressiveness. Methods In this single center cohort study, consecutive patients with histologically confirmed PCA were retrospectively enrolled. Four different ISUP grade groups (1, 2, 3, 4–5) were defined and fifty patients per group were included. Several clinical (age, PSA, PSAD, percentage of PCA infiltration) and mpMRI parameters (ADC value, signal increase on high b-value images, diameter, extraprostatic extension [EPE], cross-zonal growth) were evaluated and correlated within the four groups. Based on combined descriptors, MRI grading groups (mG1–mG3) were defined to predict PCA aggressiveness. Results In total, 200 patients (mean age 68 years, median PSA value 8.1 ng/ml) were analyzed. Between the four groups, statistically significant differences could be shown for age, PSA, PSAD, and for MRI parameters cross-zonal growth, high b-value signal increase, EPE, and ADC (p < 0.01). All examined parameters revealed a significant correlation with the histopathologic biopsy ISUP grade groups (p < 0.01), except PCA diameter (p = 0.09). A mixed linear model demonstrated the strongest prediction of the respective ISUP grade group for the MRI grading system (p < 0.01) compared to single parameters. Conclusions MpMRI yields relevant pre-biopsy information about PCA aggressiveness. A combination of quantitative and qualitative parameters (MRI grading groups) provided the best prediction of the biopsy ISUP grade group and may improve clinical pathway and treatment planning, adding useful information beyond PI-RADS assessment category. Due to the high prevalence of higher grade PCA in patients within mG3, an early re-biopsy seems indicated in cases of negative or post-biopsy low-grade PCA. Key Points • MpMRI yields relevant pre-biopsy information about prostate cancer aggressiveness. • MRI grading in addition to PI-RADS classification seems to be helpful for a size independent early prediction of clinically significant PCA. • MRI grading groups may help urologists in clinical pathway and treatment planning, especially when to consider an early re-biopsy.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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MRI grading for the prediction of prostate cancer aggressiveness

Boschheidgen

Schimmöller

Arsov³

et al. 2021

Eur Radiol

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“…One of the most studied of these techniques is the PSA density (PSAD), which, when combined with PI-RADS 3 lesions showed an improvement in the selection of patients for prostate biopsy [11]. However, heterogeneous evidence about specific lesion location and clinical scenarios have been reported [12][13][14][15]. In line with these issues, there appears to be value in adding standard biopsies to targeted biopsies.…”

Section: Introductionmentioning

confidence: 99%

Does Adding Standard Systematic Biopsy to Targeted Prostate Biopsy in PI-RADS 3 to 5 Lesions Enhance the Detection of Clinically Significant Prostate Cancer? Should All Patients with PI-RADS 3 Undergo Targeted Biopsy?

et al. 2021

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Introduction. Our aim was to assess the value of adding standard biopsy to targeted biopsy in cases of suspicious multiparametric magnetic resonance imaging (mp-MRI) and also to evaluate when a biopsy of a PI-RADS 3 lesion could be avoided. Methods: A retrospective study of patients who underwent targeted biopsy plus standard systematic biopsy between 2016–2019 was performed. All the 1.5 T magnetic resonance images were evaluated according to PI-RADSv.2. An analysis focusing on the clinical scenario, lesion location, and PI-RADS score was performed. Results. A total of 483 biopsies were evaluated. The mean age was 65 years, with a PSA density of 0.12 ng/mL/cc. One-hundred and two mp-MRIs were categorized as PI-RADS-3. Standard biopsy was most helpful in detecting clinically significant prostate cancer (csPCa) in patients in the active surveillance (AS) cohort (increasing the detection rate 12.2%), and in peripheral lesions (6.5%). Adding standard biopsy showed no increase in the detection rate for csPCa in patients with PI-RADS-5 lesions. Considering targeted biopsy in patients with PI-RADS 3 lesions, a higher detection rate was shown in biopsy-naïve patients versus AS and in patients with a previous negative biopsy (p = 0.002). Furthermore, in these patients, the highest rate of csPCa detection was in anterior lesions [42.9% (p = 0.067)]. Conclusions. Our results suggest that standard biopsy could be safely omitted in patients with anterior lesions and in those with PI-RADS-5 lesions. Targeted biopsy for PI-RADS-3 lesions would be less effective in peripheral lesions with a previous negative biopsy.

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“…Several studies have shown that csPCa in PI-RADS 3 have higher PSA density, lower prostate volume, and apparent diffusion coefficient (ADC) value compared with benign lesions in PI-RADS 3 (11)(12)(13)(14). Using conventional scanning sequences makes it difficult to distinguish TZ cancers from fibromuscular (stromal) benign prostatic hyperplasia (BPH) as both of these conditions can manifest low T2 signal intensity on MR images.…”

Section: Introductionmentioning

confidence: 99%

Sub-differentiation of PI-RADS 3 lesions in TZ by advanced diffusion-weighted imaging to aid the biopsy decision process

Zhou

Huang²,

Bu³

et al. 2023

Front. Oncol.

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BackgroundPerforming biopsy for intermediate lesions with PI-RADS 3 has always been controversial. Moreover, it is difficult to differentiate prostate cancer (PCa) and benign prostatic hyperplasia (BPH) nodules in PI-RADS 3 lesions by conventional scans, especially for transition zone (TZ) lesions. The purpose of this study is sub-differentiation of transition zone (TZ) PI-RADS 3 lesions using intravoxel incoherent motion (IVIM), stretched exponential model, and diffusion kurtosis imaging (DKI) to aid the biopsy decision process.MethodsA total of 198 TZ PI-RADS 3 lesions were included. 149 lesions were BPH, while 49 lesions were PCa, including 37 non-clinical significant PCa (non-csPCa) lesions and 12 clinical significant PCa (csPCa) lesions. Binary logistic regression analysis was used to examine which parameters could predict PCa in TZ PI-RADS 3 lesions. The ROC curve was used to test diagnostic efficiency in distinguishing PCa from TZ PI-RADS 3 lesions, while one-way ANOVA analysis was used to examine which parameters were statistically significant among BPH, non-csPCa and csPCa.ResultsThe logistic model was statistically significant (χ2 = 181.410, p<0.001) and could correctly classify 89.39% of the subjects. Parameters of fractional anisotropy (FA) (p=0.004), mean diffusion (MD) (p=0.005), mean kurtosis (MK) (p=0.015), diffusion coefficient (D) (p=0.001), and distribute diffusion coefficient (DDC) (p=0.038) were statistically significant in the model. ROC analysis showed that AUC was 0.9197 (CI 95%: 0.8736-0.9659). Sensitivity, specificity, positive predictive value and negative predictive value were 92.1%, 80.4%, 93.9% and 75.5%, respectively. FA and MK of csPCa were higher than those of non-csPCa (all p<0.05), while MD, ADC, D, and DDC of csPCa were lower than those of non-csPCa (all p<0.05).ConclusionFA, MD, MK, D, and DDC can predict PCa in TZ PI-RADS 3 lesions and inform the decision-making process of whether or not to perform a biopsy. Moreover, FA, MD, MK, D, DDC, and ADC may have ability to identify csPCa and non-csPCa in TZ PI-RADS 3 lesions.

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Who can safely evade a magnetic resonance imaging fusion-targeted biopsy (MRIFTB) for prostate imaging reporting and data system (PI-RADS) 3 lesion?

Cited by 8 publications

References 20 publications

MRI grading for the prediction of prostate cancer aggressiveness

MRI grading for the prediction of prostate cancer aggressiveness

Does Adding Standard Systematic Biopsy to Targeted Prostate Biopsy in PI-RADS 3 to 5 Lesions Enhance the Detection of Clinically Significant Prostate Cancer? Should All Patients with PI-RADS 3 Undergo Targeted Biopsy?

Sub-differentiation of PI-RADS 3 lesions in TZ by advanced diffusion-weighted imaging to aid the biopsy decision process

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