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Prostate cancer staging with extracapsular extension risk scoring using multiparametric MRI: a correlation with histopathology

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Abstract

Objectives

To evaluate the diagnostic performance of preoperative multiparametric MRI with extracapsular extension (ECE) risk-scoring in the assessment of prostate cancer tumour stage (T-stage) and prediction of ECE at final pathology.

Materials and Methods

Eighty-seven patients with clinically localised prostate cancer scheduled for radical prostatectomy were prospectively enrolled. Multiparametric MRI was performed prior to prostatectomy, and evaluated according to the ESUR MR prostate guidelines by two different readers. An MRI clinical T-stage (cTMRI), an ECE risk score, and suspicion of ECE based on tumour characteristics and personal opinion were assigned. Histopathological prostatectomy results were standard reference.

Results

Histopathology and cTMRI showed a spearman rho correlation of 0.658 (p < 0.001) and a weighted kappa = 0.585 [CI 0.44;0.73](reader A). ECE was present in 31/87 (36 %) patients. ECE risk-scoring showed an AUC of 0.65–0.86 on ROC-curve for both readers, with sensitivity and specificity of 81 % and 78 % at best cutoff level (reader A), respectively. When tumour characteristics were influenced by personal opinion, the sensitivity and specificity for prediction of ECE changed to 61 %–74 % and 77 %-88 % for the readers, respectively.

Conclusions

Multiparametric MRI with ECE risk-scoring is an accurate diagnostic technique in determining prostate cancer clinical tumour stage and ECE at final pathology.

Key Points

• Multiparametric MRI is an accurate diagnostic technique for preoperative prostate cancer staging

• ECE risk scoring predicts extracapsular tumour extension at final pathology

• ECE risk scoring shows an AUC of 0.86 on the ROC-curve

• ECE risk scoring shows a moderate inter-reader agreement (K = 0.45)

• Multiparametric MRI provides essential knowledge for optimal clinical management

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Abbreviations

DRE:

Digital rectal examination

TRUS:

Transrectal ultrasound

PCa:

Prostate cancer

EPE:

Extraprostatic tumour extension

RP:

Radical prostatectomy

cT:

Clinical tumour stage

NVB:

Neurovascular bundle

MRI:

Magnetic resonance imaging

Mp-MRI:

Multiparametric MRI

PIRADS:

Prostate imaging reporting and data system

T2W:

T2-weighted

DWI:

Diffusion-weighted imaging

ADC:

Apparent diffusion coefficient

DCE:

Dynamic contrast-enhanced

ECE:

Extracapsular extension

SVI:

Seminal vesicle invasion

GS:

Gleason score

ERC:

Endorectal coil

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Acknowledgments

The scientific guarantor of this publication is Henrik S. Thomsen. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Approval from the institutional animal care committee was not required because the study was not on animals. Methodology: prospective, diagnostic, or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Urology, Herlev University Hospital, Herlev Ringvej 75, Herlev, 2730, Denmark

    Lars Boesen & Kari Mikines

  2. Department of Radiology, Herlev University Hospital, Herlev Ringvej 75, Herlev, 2730, Denmark

    Elizaveta Chabanova, Vibeke Løgager & Henrik S. Thomsen

  3. Department of Pathology, Herlev University Hospital, Herlev Ringvej 75, Herlev, 2730, Denmark

    Ingegerd Balslev

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  1. Lars Boesen
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Correspondence to Lars Boesen.

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Boesen, L., Chabanova, E., Løgager, V. et al. Prostate cancer staging with extracapsular extension risk scoring using multiparametric MRI: a correlation with histopathology. Eur Radiol 25, 1776–1785 (2015). https://doi.org/10.1007/s00330-014-3543-9

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  • DOI: https://doi.org/10.1007/s00330-014-3543-9

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