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The absolute tumor-capsule contact length in the diagnosis of extraprostatic extension of prostate cancer

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Abstract

Background

Extraprostatic extension (EPE) of prostate cancer is associated with a poor prognosis. The broad-based capsule-tumor interface has been recognized as one of the worrisome imaging features in multiparametric prostate MRI (mpMRI). However, there was significant heterogeneity among the measurement method used in prior studies.

Objectives

This study’s objectives were to investigate and compare the accuracy between the curvilinear and linear measurement, find the optimal cut-off contact surface threshold for the diagnosis of EPE, and assess the benefit of the additional contact surface measurement versus visual assessment alone.

Methods

The status of EPE in mpMRI and the overall PI-RADS were assessed. The tumor’s dimensions, the actual tumor-capsule contact length (ACTCL), and the absolute tumor-capsule contact length (ABTCL) were measured. The parameters were analyzed and correlated with the EPE status from prostatectomy specimens.

Results

Ninety-five patients who underwent mpMRI followed by prostatectomy were included in the study. High Gleason score (score 8–9), radiologist’s impression of EPE, and PI-RADS 5 were significantly correlated with EPE in surgical specimens (p = 0.014, p < 0.001, and p < 0.001, respectively). Both ACTCL and ABTCL of patients with EPE were significantly higher than those without EPE in all imaging sequences (p < 0.001 to p = 0.003). The ABTCL has higher accuracy than the ACTCL. Dynamic contrast enhancement (DCE) was the most accurate sequence to measure the contact interface. The recommended cut-off value of ABTCL was 15.0 mm, which had a sensitivity and specificity of 75.86% and 72.09%. Multivariable analysis revealed that the ABTCL > 15 mm and the radiologist’s impression on visual assessment were the only two independent predictors for the prediction of EPE (p = 0.048 and p = 0.016, respectively). Improvement of diagnostic performance was achieved when the two factors were combined.

Conclusion

The ABTCL has better accuracy than the curvilinear measurement in the prediction of EPE. The optimum sequence for the measurement of the contact surface is the DCE. We recommended using 15.0 mm as a cut-off point.

Clinical impact

The addition of the ABTCL measurement showed an increase in diagnostic performance. We encourage radiologists to use the capsular contact measurement in addition to their visual assessment to detect EPE in pre-operative MRI.

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Authors and Affiliations

  1. Abdominal Imaging Division, Radiology Department, Massachusetts General Hospital, Boston, USA

    Kulyada Eurboonyanun, Nisanard Pisuchpen, Aileen O’Shea, Rita Maria Lahoud, Isha D. Atre & Mukesh Harisinghani

  2. Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Kulyada Eurboonyanun

  3. Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Nisanard Pisuchpen

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  1. Kulyada Eurboonyanun
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Eurboonyanun, K., Pisuchpen, N., O’Shea, A. et al. The absolute tumor-capsule contact length in the diagnosis of extraprostatic extension of prostate cancer. Abdom Radiol 46, 4014–4024 (2021). https://doi.org/10.1007/s00261-021-03063-2

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