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Necessity of differentiating small (< 10 mm) and large (≥ 10 mm) PI-RADS 4

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Abstract

Purpose

Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) provides reasonable performance in detecting significant cancers. Still, it is unclear about whether all PI-RADS 4 lesions show the same cancer detection rate (CDR) regardless of tumor size. The aim was to compare the CDRs of small (< 10 mm) and large (≥ 10 mm) PI-RADS 4.

Methods

After magnetic resonance imaging (MRI) was performed in 684 men, a radiologist interpreted the MR images and detected 281 index lesions categorized as PI-RADS 4 in 281 men. PI-RADS 4 lesions were divided into small and large groups on size of 10 mm. Overall and significant CDRs were compared between the groups. A significant cancer was defined as one with Gleason score (GS) ≥ 7 or tumor volume ≥ 0.5 ml. Tumor volumes were roughly calculated as πr34/3 (π = 3.14 and r = a half of tumor size) and were compared between the groups. Standard reference was a biopsy examination. Fisher’s exact and Mann–Whitney tests were used for statistical analysis.

Results

The overall CDRs of small and large groups were 39.0% (53/136) and 59.3% (86/145), respectively, (p = 0.0008). The median tumor volumes of cancer-proven small and large groups were 0.18 ml (0.01–0.38 ml) and 0.70 ml (0.52–1.44 ml), respectively (p < 0.0001). Using GS or tumor volume, the significant CDRs of these groups were 26.5% (36/136) and 59.3% (86/145), respectively (p < 0.0001), and using GS alone, 26.5% (36/136) and 39.3% (57/145), respectively (p = 0.0232).

Conclusions

PI-RADS 4 lesions should be sub-divided on size of 10 mm because of different significant CDRs.

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Authors and Affiliations

  1. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-dong, Gangnam-ku, Seoul, 06351, Republic of Korea

    Sung Yoon Park & Byung Kwan Park

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  1. Sung Yoon Park
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  2. Byung Kwan Park
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Contributions

SYP: data collection, data analysis, and manuscript writing/editing. BKP: project development, and manuscript writing/editing.

Corresponding author

Correspondence to Byung Kwan Park.

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None of the authors have conflict of interest to report.

Research involving human participants and/or animals

This study was retrospectively performed on human participants but not animals.

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This retrospective study was approved by our IRB and the approval number is 2018-12-069-001. Informed consent was waived.

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Park, S.Y., Park, B.K. Necessity of differentiating small (< 10 mm) and large (≥ 10 mm) PI-RADS 4. World J Urol 38, 1473–1479 (2020). https://doi.org/10.1007/s00345-019-02924-2

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  • DOI: https://doi.org/10.1007/s00345-019-02924-2

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