Abstract
Background
We evaluated pathological findings in targeted biopsies of PI-RADS4 and PI-RADS5 lesions, and clinical data that could predict those patients with benign findings.
Materials and Methods
A retrospective study was conducted to summarize the experience from a single nonacademic center using cognitive fusion and a 1.5 or 3.0 Tesla scanner.
Results
We found a false positive rate of 29 and 3.7% for any cancer in PI-RADS 4 and 5 lesions, respectively. Diverse histologic patterns were observed among target biopsies. At multivariate analysis, size ≤ 6 mm and previous negative biopsy were independent predictors of false positive PI-RADS4 lesions. The small number of false PI-RADS5 lesions precluded further analyses.
Conclusion
Benign findings are common in PI-RADS4 lesions and most of them do not show obvious glandular or stromal hypercellularity as expected in hyperplastic nodules. Size ≤ 6 mm and previous negative biopsy predict a higher probability of false positive results in patients with PI-RADS 4 lesions.
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Data availability
Raw data were generated at IMAGEPAT Laboratory. Derived data supporting the findings of this study are available from the corresponding author [DAA] on request.
References
Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R et al (2017) PROMIS study group. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389:815–822. https://doi.org/10.1016/S0140-6736(16)32401-1
Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH (2018) PRECISION study group collaborators. mri-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 378:1767–1777. https://doi.org/10.1056/NEJMoa1801993
Ahdoot M, Wilbur AR, Reese SE, Lebastchi AH, Mehralivand S, Gomella PT et al (2020) MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis. N Engl J Med 382:917–928. https://doi.org/10.1056/NEJMoa1910038
Stolk TT, de Jong IJ, Kwee TC, Luiting HB, Mahesh SVK, Doornweerd BHJ et al (2019) False positives in PIRADS (V2) 3, 4, and 5 lesions: relationship with reader experience and zonal location. Abdom Radiol (NY) 44:1044–1051. https://doi.org/10.1007/s00261-019-01919-2
Rouvière O, Puech P, Renard-Penna R, Claudon M, Roy C, Mège-Lechevallier F,: MRI-FIRST Investigators, et al (2019) Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol 20:100–109. https://doi.org/10.1016/S1470-2045(18)30569-2
van der Leest M, Cornel E, Israël B, Hendriks R, Padhani AR, Hoogenboom M et al (2019) Head-to-head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naïve men with elevated prostate-specific antigen: a large prospective multicenter clinical study. Eur Urol 75:570–578. https://doi.org/10.1016/j.eururo.2018.11.023
Barentsz JO, Richenberg J, Clements R, Choyke P, Verma S, Villeirs G, Rouviere O et al (2012) European society of urogenital radiology. ESUR prostate MR guidelines 2012. Eur Radiol 22:746–757. https://doi.org/10.1007/s00330-011-2377-y
American College of Radiology: PI-RADS v2 (2015) available at. https://www.acr.org/Quality-Safety/Resources/PIRADS2015
Robinson BD, Epstein JI (2010) Intraductal carcinoma of the prostate without invasive carcinoma on needle biopsy: emphasis on radical prostatectomy findings. J Urol 184:1328–1333. https://doi.org/10.1016/j.juro.2010.06.017
Gordetsky JB, Ullman D, Schultz L, Porter KK, DelPenaRodriguez M, Calderone CE et al (2019) Histologic findings associated with false-positive multiparametric magnetic resonance imaging performed for prostate cancer detection. Hum Pathol 83:159–165
Hupe MC, Offermann A, Tharun L, Fürschke A, Frydrychowicz A, Garstka N et al (2020) Histomorphological analysis of false positive PI-RADS 4 and 5 lesions. Urol Oncol 38:636.e7-636.e12. https://doi.org/10.1016/j.urolonc.2020.01.017
Sheridan AD, Nath SK, Aneja S, Syed JS, Pahade J, Mathur M et al (2018) MRI-ultrasound fusion targeted biopsy of prostate imaging reporting and data system version 2 category 5 lesions found false-positive at multiparametric prostate MRI. AJR Am J Roentgenol 210:W218-225. https://doi.org/10.2214/AJR.17.18680
Yamanaka R, Sekino Y, Babasaki T, Kobatake K, Kitano H, Ikeda K et al (2022) Histopathological analysis of false-positive lesions in mpMRI/TRUS fusion prostate biopsy. In Vivo 36:496–500. https://doi.org/10.21873/invivo.12730
van Luijtelaar A, Bomers J, Futterer J (2019) A comparison of magnetic resonance imaging techniques used to secure biopsies in prostate cancer patients. Expert Rev Anticancer Ther 19:705–716. https://doi.org/10.1080/14737140.2019.1641086
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de Souza, B.C.A., Novaes, M.A.S., de Souza, M.F. et al. Analysis of false positive PI-RADS 4 lesions: experience from a single nonacademic center using cognitive fusion. Int Urol Nephrol 55, 1081–1085 (2023). https://doi.org/10.1007/s11255-023-03508-1
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DOI: https://doi.org/10.1007/s11255-023-03508-1