PurposeThere is substantial variability in multiparametric MRI (mpMRI) protocols and inter-readers' agreement. We tested the effect of a central mpMRI review on the detection of clinically significant PCa (csPCa) in a tertiary referral center.MethodsWe retrospectively analyzed a cohort of 364 consecutive men with a positive externally performed mpMRI (PI-RADS >= 3) who underwent a targeted biopsy (TBx) plus a systematic biopsy at a single tertiary referral center (2018-2020). Of those mpMRIs, 32% (n = 116) were centrally reviewed. We compared the detection of csPCa between the non-central-reviewed vs reviewed group. Multivariable logistic regression models (MVA) tested the relationship between mpMRI central review and the detection of csPCa at TBx.ResultsThe detection of csPCa at TBx in non-central-reviewed vs central-reviewed group was 41 vs 63%, respectively (p = 0.001). The distribution of PI-RADS 2, 3, 4, and 5 at initial assessment vs after mpMRI central review was 0, 37, 47, and 16% vs 39, 9, 35, and 16%, respectively (p < 0.004). Of 43 patients with initial PI-RADS 3 score, respectively 67, 21, and 12, and 0% had a revised PI-RADS score of <= 2, 3, 4, and 5. At MVA, mpMRI central review (OR: 1.65, CI 0.85-0.98) was significantly associated with higher csPCa detection at TBx.ConclusionsWe demonstrated that a central review of external mpMRIs may decrease the overcall of equivocal lesions, namely PI-RADS 3, and should be considered to maximize the clinical benefit of TBx in terms of increasing the detection of csPCa and eventually decreasing the rate of unnecessary biopsies.
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 Ottone; Gandaglia, Giorgio; De Cobelli, Francesco; Montorsi, Francesco; Briganti, Alberto. - In: WORLD JOURNAL OF UROLOGY. - ISSN 0724-4983. - (2023). [Epub ahead of print] [10.1007/s00345-023-04365-4]
Impact of prostate MRI central review over the diagnostic performance of MRI-targeted biopsy: should we routinely ask for an expert second opinion?
Stabile, ArmandoCo-primo
;Sorce, GabrieleCo-primo
;Barletta, FrancescoSecondo
;Brembilla, Giorgio;Mazzone, Elio;Pellegrino, Francesco;Cannoletta, Donato;Cirulli, Giuseppe Ottone;Gandaglia, Giorgio
;De Cobelli, Francesco;Montorsi, FrancescoPenultimo
;Briganti, AlbertoUltimo
2023-01-01
Abstract
PurposeThere is substantial variability in multiparametric MRI (mpMRI) protocols and inter-readers' agreement. We tested the effect of a central mpMRI review on the detection of clinically significant PCa (csPCa) in a tertiary referral center.MethodsWe retrospectively analyzed a cohort of 364 consecutive men with a positive externally performed mpMRI (PI-RADS >= 3) who underwent a targeted biopsy (TBx) plus a systematic biopsy at a single tertiary referral center (2018-2020). Of those mpMRIs, 32% (n = 116) were centrally reviewed. We compared the detection of csPCa between the non-central-reviewed vs reviewed group. Multivariable logistic regression models (MVA) tested the relationship between mpMRI central review and the detection of csPCa at TBx.ResultsThe detection of csPCa at TBx in non-central-reviewed vs central-reviewed group was 41 vs 63%, respectively (p = 0.001). The distribution of PI-RADS 2, 3, 4, and 5 at initial assessment vs after mpMRI central review was 0, 37, 47, and 16% vs 39, 9, 35, and 16%, respectively (p < 0.004). Of 43 patients with initial PI-RADS 3 score, respectively 67, 21, and 12, and 0% had a revised PI-RADS score of <= 2, 3, 4, and 5. At MVA, mpMRI central review (OR: 1.65, CI 0.85-0.98) was significantly associated with higher csPCa detection at TBx.ConclusionsWe demonstrated that a central review of external mpMRIs may decrease the overcall of equivocal lesions, namely PI-RADS 3, and should be considered to maximize the clinical benefit of TBx in terms of increasing the detection of csPCa and eventually decreasing the rate of unnecessary biopsies.File | Dimensione | Formato | |
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