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Minerva Urologica e Nefrologica 2020 Oct 05

DOI: 10.23736/S0393-2249.20.03952-1


lingua: Inglese

Comparison of multiple abbreviated multiparametric MRI-derived protocols for the detection of clinically significant prostate cancer

Lorenzo CERESER 1, Gianluca GIANNARINI 2 , Filippo BONATO 3, Stefano PIZZOLITTO 4, Giuseppe COMO 1, Claudio VALOTTO 2, Vincenzo FICARRA 5, Fabrizio DAL MORO 6, 7, Chiara ZUIANI 1, 3, Rossano GIROMETTI 1, 3

1 Institute of Radiology, Academic Medical Centre “Santa Maria della Misericordia”, Udine, Italy; 2 Urology Unit, Academic Medical Centre “Santa Maria della Misericordia”, Udine, Italy; 3 Department of Medicine, University of Udine, Academic Medical Centre “Santa Maria della Misericordia”, Udine, Italy; 4 Pathology Unit, Academic Medical Centre “Santa Maria della Misericordia”, Udine, Italy; 5 Urologic Section, Department of Human and Pediatric Pathology “Gaetano Barresi”, University of Messina, Messina, Italy; 6 Urologic Clinic, University of Udine, Udine, Italy; 7 Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy


BACKGROUND: To compare the accuracy of multiple abbreviated multiparametric magnetic resonance imaging (mpMRI)-derived protocols in detecting clinically significant prostate cancer (csPCa).
METHODS: 108 men undergoing staging 3.0T mpMRI with a Prostate Imaging - Reporting and Data System version 2 (PI-RADSv2)-compliant protocol before radical prostatectomy (RP) were retrospectively evaluated. Two readers (R1, R2) independently analyzed mpMRI, assigning a PI-RADSv2 category to each observation as appearing on each examination sequence. A study coordinator assessed final PI-RADSv2 category by combining readers’ assignments according to four protocols: short MRI (sMRI) (diffusion-weighted imaging + axial T2-weighted imaging), contrast-enhanced short MRI (cesMRI) (sMRI + dynamic contrast-enhanced [DCE] imaging), biparametric MRI (diffusion-weighted imaging + multiplanar T2-weigthed imaging), and mpMRI. Using RP pathology as the reference standard for csPCa, we calculated the per-lesion cancer detection rate (CDR) and false discovery rate (FDR) for each MRI protocol (cutoff PI-RADSv2 category ≥3), and the per-PI-RADSv2 category prevalence of csPCa and false positives.
RESULTS: Pathology after RP found 142 csPCas with median International Society of Urogenital Pathology grade group 2, and stage ≤pT2c in 68.6% of cases. CDR was comparable across the four MRI protocols (74.6% to 75.3% for R1, and 68.3% for R2). FDR was comparable as well (14.4%-14.5% for R1 and 11.1% for R2). sMRI was the minimum protocol equaling mpMRI in terms of CDR, although cesMRI, similarly to mpMRI, was associated with fewer PI-RADSv2 category 3 assignments and higher prevalence of csPCa within PI-RADSv2 category 3 observations (66.7% versus 76.9% for R1, and 100% versus 91.7% for R2, respectively).
CONCLUSIONS: Among multiple abbreviated mpMRI-derived protocols, cesMRI was the one equaling mpMRI in terms of csPCa detection and minimizing PI-RADSv2 category 3 assignments.

KEY WORDS: Prostate cancer; Radical prostatectomy, magnetic resonance imaging; Diagnosis; Contrast medium

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