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The performance of PI-RADSv2 and quantitative apparent diffusion coefficient for predicting confirmatory prostate biopsy findings in patients considered for active surveillance of prostate cancer

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Abstract

Purpose

To assess the performance of the updated Prostate Imaging Reporting and Data System (PI-RADSv2) and the apparent diffusion coefficient (ADC) for predicting confirmatory biopsy results in patients considered for active surveillance of prostate cancer (PCA).

Methods

IRB-approved, retrospective study of 371 consecutive men with clinically low-risk PCA (initial biopsy Gleason score ≤6, prostate-specific antigen <10 ng/ml, clinical stage ≤T2a) who underwent 3T-prostate MRI before confirmatory biopsy. Two independent radiologists recorded the PI-RADSv2 scores and measured the corresponding ADC values in each patient. A composite score was generated to assess the performance of combining PI-RADSv2 + ADC.

Results

PCA was upgraded on confirmatory biopsy in 107/371 (29%) patients. Inter-reader agreement was substantial (PI-RADSv2: k = 0.73; 95% CI [0.66–0.80]; ADC: r = 0.74; 95% CI [0.69–0.79]). Accuracies, sensitivities, specificities, positive predicted value and negative predicted value of PI-RADSv2 were 85, 89, 83, 68, 95 and 78, 82, 76, 58, 91% for ADC. PI-RADSv2 accuracy was significantly higher than that of ADC for predicting biopsy upgrade (p = 0.014). The combined PI-RADSv2 + ADC composite score did not perform better than PI-RADSv2 alone. Obviating biopsy in patients with PI-RADSv2 score ≤3 would have missed Gleason Score upgrade in 12/232 (5%) of patients.

Conclusion

PI-RADSv2 was superior to ADC measurements for predicting PCA upgrading on confirmatory biopsy.

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Abbreviations

ADC:

Apparent diffusion coefficient

PCA:

Prostate cancer

T2WI:

T2-weighted images

MRI:

Magnetic resonance imaging

DW:

Diffusion-weighted

DCE:

Dynamic contrast-enhanced

PI-RADS:

Prostate imaging reporting and data system

SD:

Standard deviation

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Author information

Authors and Affiliations

  1. INSERM, U1194, Institut de Recherche en Cancérologie de Montpellier (IRCM), Montpellier, France

    Stephanie Nougaret

  2. Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier, France

    Stephanie Nougaret

  3. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Room C278, New York, NY, 10065, USA

    Nicola Robertson, Jennifer Golia Pernicka, Andreas M. Hötker, Evis Sala, Hedvig Hricak & Hebert Alberto Vargas

  4. Department of Statistics, UMR 5149 IMAG, CHU Montpellier, Montpellier, France

    Nicolas Molinari

  5. Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Behfar Ehdaie

Authors
  1. Stephanie Nougaret
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  2. Nicola Robertson
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  3. Jennifer Golia Pernicka
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  4. Nicolas Molinari
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  7. Evis Sala
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  9. Hebert Alberto Vargas
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Corresponding author

Correspondence to Stephanie Nougaret.

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Funding

This study was partially funded by NIH grant P30 (CA008748) (Evis Sala, Hedvik Hricak, Alberto Vargas).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

The institutional review board approved this retrospective study and waived the informed consent requirement.

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Nougaret, S., Robertson, N., Golia Pernicka, J. et al. The performance of PI-RADSv2 and quantitative apparent diffusion coefficient for predicting confirmatory prostate biopsy findings in patients considered for active surveillance of prostate cancer. Abdom Radiol 42, 1968–1974 (2017). https://doi.org/10.1007/s00261-017-1086-7

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  • DOI: https://doi.org/10.1007/s00261-017-1086-7

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