PI-RADS v2 Findings of MRI and Positive Biopsy Core Percentage would Predict Pathological Extraprostatic Extension in Patients who Underwent Robot Assisted Radical Prostatectomy: A Retrospective Study
Urology Journal,
Vol. 19 No. 06 (2022),
6 December 2022
,
Page 438-444
https://doi.org/10.22037/uj.v19i06.6923
Abstract
Purpose: This study aimed to examine whether preoperative Prostate Imaging Reporting and Data System v2 (PI-RADS v2) can predict pathological extracapsular extension (EPE) after radical prostatectomy. We also studied the preoperative factors which can predict EPE.
Materials and Methods: In our institute, 294 patients underwent robot assisted radical prostatectomy (RARP) between December 2012 and August 2016. In this era, we performed MRI after biopsy to determine clinical stage before surgery. PI-RADS v2 scores were retrospectively reviewed using biparametric MRI and EPE in pathological mapping of resected specimens for each lobe.
Results: In the excised specimen, EPE was observed in 73 lobes (12%). The percentage of EPE by PI-RADS v2 score was score ‘1’: 6% (17/297 lobes), ‘2’: 3% (1/33 lobes), ‘3’: 12% (8/67 lobes), ‘4’: 19% (27/139 lobes), and ‘5’: 38% (20/52 lobes). The higher the PI-RADS score, the higher the percentage of EPE (P <0.01). When classified as PI-RADS score ≥4 and <4, the positive predictive value (PPV) was 24.6% (47/191 lobes, 95%CI: 0.187 – 0.313) and negative predictive value (NPV) was 93.5% (371/397 lobes, 95%CI: 0.906 – 0.957). By multivariate analysis, positive biopsy core percentage ≥60%, and PI-RADS score ≥4 were independent factors for predicting EPE. The positive rate of EPE in lobes with zero, one and two factors (PI-RADS ≥4 and positive biopsy core percentage ≥60%) was 4%, 19%, and 38%, respectively.
Conclusion: PPV and NPV of PI-RADS ≥4 for predicting pathologic EPE were 24.6% and 93.5%, respectively. PI-RADS ≥4 and positive biopsy core percentage ≥60% were independent risk factors for predicting EPE. The positive rate of EPE in lobes with zero, one and two factors (PI-RADS ≥4 and positive biopsy core percentage ≥60%) was 4%, 19%, and 38%, respectively.
- Radical prostatectomy, Extraprostatic extension, PIRADS v2, biparametric
How to Cite
References
2. Oberlin DT, Casalino DD, Miller FH, Meeks JJ. Dramatic increase in the utilization of multiparametric magnetic resonance imaging for detection and management of prostate cancer. Abdom Radiol (NY). 2017 Apr;42(4):1255-8. PubMed PMID: 27858090. Epub 2016/11/20.
3. Weinreb JC, Barentsz JO, Choyke PL, et al. PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. Eur Urol. 2016 Jan;69(1):16-40. PubMed PMID: 26427566. Pubmed Central PMCID: PMC6467207. Epub 2015/10/03.
4. Barentsz JO, Richenberg J, Clements R, et al. ESUR prostate MR guidelines 2012. Eur Radiol. 2012 Apr;22(4):746-57. PubMed PMID: 22322308. Pubmed Central PMCID: PMC3297750. Epub 2012/02/11.
5. Lim CS, McInnes MDF, Lim RS, et al. Prognostic value of Prostate Imaging and Data Reporting System (PI-RADS) v. 2 assessment categories 4 and 5 compared to histopathological outcomes after radical prostatectomy. J Magn Reson Imaging. 2017 Jul;46(1):257-66. PubMed PMID: 27807914. Epub 2016/11/04.
6. Kim R, Kim CK, Park JJ, et al. Prognostic Significance for Long-Term Outcomes Following Radical Prostatectomy in Men with Prostate Cancer: Evaluation with Prostate Imaging Reporting and Data System Version 2. Korean J Radiol. 2019 Feb;20(2):256-64. PubMed PMID: 30672165. Pubmed Central PMCID: PMC6342765. Epub 2019/01/24.
7. Idee JM, Fretellier N, Robic C, Corot C. The role of gadolinium chelates in the mechanism of nephrogenic systemic fibrosis: A critical update. Crit Rev Toxicol. 2014 Nov;44(10):895-913. PubMed PMID: 25257840. Epub 2014/09/27.
8. Choi MH, Kim CK, Lee YJ, Jung SE. Prebiopsy Biparametric MRI for Clinically Significant Prostate Cancer Detection With PI-RADS Version 2: A Multicenter Study. AJR Am J Roentgenol. 2019 Apr;212(4):839-46. PubMed PMID: 30779662. Epub 2019/02/20.
9. Jambor I, Bostrom PJ, Taimen P, et al. Novel biparametric MRI and targeted biopsy improves risk stratification in men with a clinical suspicion of prostate cancer (IMPROD Trial). J Magn Reson Imaging. 2017 Oct;46(4):1089-95. PubMed PMID: 28165653. Epub 2017/02/07.
10. Druskin SC, Ward R, Purysko AS, et al. Dynamic Contrast Enhanced Magnetic Resonance Imaging Improves Classification of Prostate Lesions: A Study of Pathological Outcomes on Targeted Prostate Biopsy. J Urol. 2017 Dec;198(6):1301-8. PubMed PMID: 28709889. Epub 2017/07/16.
11. Greer MD, Shih JH, Lay N, et al. Validation of the Dominant Sequence Paradigm and Role of Dynamic Contrast-enhanced Imaging in PI-RADS Version 2. Radiology. 2017 Dec;285(3):859-69. PubMed PMID: 28727501. Pubmed Central PMCID: PMC5708285. Epub 2017/07/21.
12. Koike H, Kohjimoto Y, Iba A, et al. Health-related quality of life after robot-assisted radical prostatectomy compared with laparoscopic radical prostatectomy. J Robot Surg. 2017 Jan 27. PubMed PMID: 28130703. Epub 2017/01/29.
13. Kasivisvanathan V, Stabile A, Neves JB, et al. Magnetic Resonance Imaging-targeted Biopsy Versus Systematic Biopsy in the Detection of Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol. 2019 Sep;76(3):284-303. PubMed PMID: 31130434. Epub 2019/05/28.
14. Turkbey B, Rosenkrantz AB, Haider MA, et al. Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2. Eur Urol. 2019 Sep;76(3):340-51. PubMed PMID: 30898406. Epub 2019/03/23.
15. Schieda N, Quon JS, Lim C, et al. Evaluation of the European Society of Urogenital Radiology (ESUR) PI-RADS scoring system for assessment of extra-prostatic extension in prostatic carcinoma. Eur J Radiol. 2015 Oct;84(10):1843-8. PubMed PMID: 26137904. Epub 2015/07/04.
16. Lim C, Flood TA, Hakim SW, et al. Evaluation of apparent diffusion coefficient and MR volumetry as independent associative factors for extra-prostatic extension (EPE) in prostatic carcinoma. J Magn Reson Imaging. 2016 Mar;43(3):726-36. PubMed PMID: 26303719. Epub 2015/08/26.
17. Matsuoka Y, Ishioka J, Tanaka H, et al. Impact of the Prostate Imaging Reporting and Data System, Version 2, on MRI Diagnosis for Extracapsular Extension of Prostate Cancer. AJR Am J Roentgenol. 2017 Aug;209(2):W76-W84. PubMed PMID: 28570124. Epub 2017/06/02.
18. Abreu-Gomez J, Walker D, Alotaibi T, McInnes MDF, Flood TA, Schieda N. Effect of observation size and apparent diffusion coefficient (ADC) value in PI-RADS v2.1 assessment category 4 and 5 observations compared to adverse pathological outcomes. Eur Radiol. 2020 Aug;30(8):4251-61. PubMed PMID: 32211965. Epub 2020/03/27.
- Abstract Viewed: 45 times
- 6923/pdf Downloaded: 56 times