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Characteristics of missed prostate cancer lesions on 3T multiparametric-MRI in 518 patients: based on PI-RADSv2 and using whole-mount histopathology reference

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Abstract

Purpose

To determine the characteristics of missed prostate cancer (PCa) lesions on 3T multiparametric-MRI (mpMRI) based on PI-RADSv2 with whole-mount histopathology (WMHP) correlation.

Materials and methods

This IRB-approved, HIPAA-compliant study, included 614 consecutive men with 3T mpMRI prior to prostatectomy at a single tertiary center between 12/2009 and 4/2017. Clinical, mpMRI, and pathologic features were obtained. PI-RADSv2-based MRI detected lesions were matched with previously finalized WMHP by a genitourinary (GU) radiologist and a GU pathologist. Patients with no mpMRI detected PCa lesion, but with at least one lesion ≥ 1 cm on WMHP, were reviewed retrospectively and assigned a PI-RADSv2 score. Tumor characteristics were compared between missed and detected lesions.

Result

The final cohort included 518 patients with 1085 WMHP lesions. 51.9% (563/1085) of lesions were missed on 3T mpMRI. 71.4% (402/563), 21.7% (122/563), 4.4% (25/563), and 2.5% (14/563) of the missed lesions were Gleason scores (GS) 3 + 3, 3 + 4, 4 + 3, and 8 − 10, respectively. Missed PCa lesions had significantly lower proportion of GS ≥ 7 (p < 0.001) and smaller size for overall (p < 0.001) and index subcohorts (p < 0.001), as compared to detected lesions. 34.5% (194) of overall and 71.2% (79) index missed lesions were larger than 1 cm. In 13.7% (71/518) of patients without MR detected PCa, 149 lesions were detected on WMHP, with 70 (47%) lesions ≥ 1 cm. In retrospective review of these lesions, 42.9% (30), 18.6% (13), 21.5% (15), 10% (7), and 7% (5) were PI-RADSv2 1, 2, 3, 4, and 5, respectively.

Conclusion

3T mpMRI has an excellent per patients diagnostic performance for PCa and majority of missed lesions are clinically nonsignificant.

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Funding

The study was supported in part by the department of Radiology and Pathology Integrated Diagnostics (IDx) program and specialized program of research excellence (SPORE) of PCa.

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Authors and Affiliations

  1. Department of Radiology, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA

    Amirhossein Mohammadian Bajgiran, Sohrab Afshari Mirak, Sepideh Shakeri, Ely R. Felker, Danielle Ponzini, Preeti Ahuja, David S. Lu & Steven S. Raman

  2. Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Anthony E. Sisk

Authors
  1. Amirhossein Mohammadian Bajgiran
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  2. Sohrab Afshari Mirak
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  3. Sepideh Shakeri
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  4. Ely R. Felker
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  5. Danielle Ponzini
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  6. Preeti Ahuja
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  7. Anthony E. Sisk
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  8. David S. Lu
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  9. Steven S. Raman
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Corresponding author

Correspondence to Amirhossein Mohammadian Bajgiran.

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Ethical approval

This study was performed in accordance with the 1996 Health Information Portability and Accountability Act (HIPAA) and under waiver of informed consent by the institutional review board (IRB).

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Mohammadian Bajgiran, A., Afshari Mirak, S., Shakeri, S. et al. Characteristics of missed prostate cancer lesions on 3T multiparametric-MRI in 518 patients: based on PI-RADSv2 and using whole-mount histopathology reference. Abdom Radiol 44, 1052–1061 (2019). https://doi.org/10.1007/s00261-018-1823-6

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  • DOI: https://doi.org/10.1007/s00261-018-1823-6

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