Skip to main content
SpringerLink
Log in

Characteristics of PI-RADS 4 lesions within the prostatic peripheral zone: a retrospective diagnostic accuracy study evaluating 170 lesions

  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine whether peripheral zone PI-RADS 4 observations can be further risk-stratified.

Methods

This was an IRB-approved HIPAA-compliant retrospective diagnostic accuracy study. Peripheral zone PI-RADS 4 observations prospectively identified at the study institution from 8/1/2015 to 12/31/2016 (n = 170 in 149 mpMRIs) were reviewed independently by two blinded genitourinary radiologists on the basis of (a) PI-RADS v2 shape, (b) pattern of peripheral zone sparing, and (c) rationale for PI-RADS 4 designation. Reference standard was targeted MR–ultrasound fusion biopsy and detection of Gleason 7+ prostate cancer. Positive predictive values (PPVs) were calculated. Predictors were assessed with binary logistic regression.

Results

PI-RADS 4 lesions with a DWI score of 4 were more likely to represent Gleason 7+ prostate cancer (p = 0.008–0.01; Reader 1 PPV: 53%; Reader 2 PPV: 48%). Pattern of peripheral zone sparing and most lesion shapes were not predictive (p > 0.05); however, oval lesions were predictive for Reader 1 (PPV = 59%, p = 0.03) and lentiform lesions were predictive for Reader 2 (PPV = 74%, p = 0.01). Lesions scored as “not meeting PI-RADS 4 criteria” had significantly lower PPV (p = 0.016–0.003; Reader 1 PPV: 14%, Reader 2 PPV: 16%).

Discussion

Peripheral zone PI-RADS 4 lesions with a DWI score of 4 are more likely Gleason 7+ cancer than those with a DWI score of 3. Lesions overcalled as PI-RADS 4 have PPV similar to published PI-RADS 3 data. Lesion shape and peripheral zone sparing in general do not predict Gleason 7+ cancer within PI-RADS 4 observations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Weinreb JC, Barentsz JO, Choyke PL, et al. (2016) PI-RADS prostate imaging—reporting and data system: 2015, version 2. Eur Urol 69(1):16–40. https://doi.org/10.1016/j.eururo.2015.08.052

    Article  PubMed  Google Scholar 

  2. Rosenkrantz AB, Ginocchio LA, Cornfeld D, et al. (2016) Interobserver reproducibility of the PI-RADS version 2 Lexicon: a multicenter study of six experienced prostate radiologists. Radiology 280(3):793–804. https://doi.org/10.1148/radiol.2016152542

    Article  PubMed  PubMed Central  Google Scholar 

  3. Rosenkrantz AB, Babb JS, Taneja SS, Ream JM (2017) Proposed adjustments to PI-RADS version 2 decision rules: impact on prostate cancer detection. Radiology 283(1):119–129. https://doi.org/10.1148/radiol.2016161124

    Article  PubMed  Google Scholar 

  4. Mertan FV, Greer MD, Shih JH, et al. (2016) Prospective evaluation of the prostate imaging reporting and data system version 2 for prostate cancer detection. J Urol 196(3):690–696. https://doi.org/10.1016/j.juro.2016.04.057

    Article  PubMed  Google Scholar 

  5. Ahmed HU, El-Shater Bosaily A, Brown LC, et al. (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389(10071):815–822. https://doi.org/10.1016/S0140-6736(16)32401-1

    Article  PubMed  Google Scholar 

  6. Rosenkrantz AB, Oto A, Turkbey B, Westphalen AC (2016) Prostate imaging reporting and data system (PI-RADS), version 2: a critical look. Am J Roentgenol 206(6):1179–1183. https://doi.org/10.2214/AJR.15.15765

    Article  Google Scholar 

  7. Westphalen AC, Rosenkrantz AB (2014) Prostate imaging reporting and data system (PI-RADS): reflections on early experience with a standardized interpretation scheme for multiparametric prostate MRI. AJR Am J Roentgenol 202(1):121–123. https://doi.org/10.2214/ajr.13.10889

    Article  PubMed  Google Scholar 

  8. Purysko AS, Rosenkrantz AB, Barentsz JO, Weinreb JC, Macura KJ (2016) PI-RADS version 2: a pictorial update. RadioGraphics 36(5):1354–1372. https://doi.org/10.1148/rg.2016150234

    Article  PubMed  Google Scholar 

  9. Hassanzadeh E, Glazer DI, Dunne RM, et al. (2017) Prostate imaging reporting and data system version 2 (PI-RADS v2): a pictorial review. Abdom Radiol (New York) 42(1):278–289. https://doi.org/10.1007/s00261-016-0871-z

    Article  Google Scholar 

  10. McNeal JE, Redwine EA, Freiha FS, Stamey TA (1988) Zonal distribution of prostatic adenocarcinoma. Correlation with histologic pattern and direction of spread. Am J Surg Pathol 12(12):897–906

    Article  PubMed  CAS  Google Scholar 

  11. Augustin H, Erbersdobler A, Graefen M, et al. (2003) Biochemical recurrence following radical prostatectomy: a comparison between prostate cancers located in different anatomical zones. Prostate 55(1):48–54. https://doi.org/10.1002/pros.10216

    Article  PubMed  Google Scholar 

  12. Syed JS, Nguyen KA, Nawaf CB, et al. (2017) Prostate zonal anatomy correlates with the detection of prostate cancer on multiparametric magnetic resonance imaging/ultrasound fusion-targeted biopsy in patients with a solitary PI-RADS v2-scored lesion. Urol Oncol . https://doi.org/10.1016/j.urolonc.2017.04.011

    Article  PubMed  Google Scholar 

  13. Davenport MS, Khalatbari S, Liu PS, et al. (2014) Repeatability of diagnostic features and scoring systems for hepatocellular carcinoma by using MR imaging. Radiology 272(1):132–142. https://doi.org/10.1148/radiol.14131963

    Article  PubMed  PubMed Central  Google Scholar 

  14. NiMhurchu E, O’Kelly F, Murphy IG, et al. (2016) Predictive value of PI-RADS classification in MRI-directed transrectal ultrasound guided prostate biopsy. Clin Radiol 71(4):375–380. https://doi.org/10.1016/j.crad.2016.01.001

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Michigan Medicine, 1500 E. Medical Center Drive B1-D530H, Ann Arbor, MI, 48109, USA

    Prasad R. Shankar, Nicole E. Curci & Matthew S. Davenport

  2. Department of Urology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA

    Matthew S. Davenport

Authors
  1. Prasad R. Shankar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicole E. Curci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew S. Davenport
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Prasad R. Shankar.

Ethics declarations

Funding

No funding was received for this study.

Conflict of interest

Matthew S. Davenport reports royalties from Wolters Kluwer. Prasad R. Shankar and Nicole E. Curci declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The requirement for informed consent was waived, and institutional review board approval was obtained, for this Health Insurance Portability and Accountability Act-compliant retrospective diagnostic accuracy study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shankar, P.R., Curci, N.E. & Davenport, M.S. Characteristics of PI-RADS 4 lesions within the prostatic peripheral zone: a retrospective diagnostic accuracy study evaluating 170 lesions. Abdom Radiol 43, 2176–2182 (2018). https://doi.org/10.1007/s00261-017-1415-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-017-1415-x

Keywords

Search

Navigation