The detailed an alysis of European Society of Urogenital Radiology (ESUR) and American College of Radiology (ACR) guide-linesforprostatecancer MRI system PI-RADS v.2.1 (2019) was presented. The several scattered theses of this system were structured in suchsectionsas: MRI data acquisition, interpretation, definition of lesion category for prostate cancer probability. This kind of systematization would be helpful for radiologists to master this newest guide-lines version. Finally, the differences between PI-RADS v.2.1 and the previousone were highlighted.
This paper contains historical review of prostate gland zonal anatomy approaches from morphological and radiological points of view. Nowadays, someconfusion remains in “central zone” term usage. Thus, authors propose to avoid using this termin conclusions of MR and TRUS exams. It’s also recommended to use 39 sectors prostate scheme for tumor localization only in cases, where MR exams were technically corresponded to PIRADSv2 system requirements.
Suspicious lesions were reported on both TRUS (hypoechoic lesion (HEL)) and MRI (!PI-RADS v2 score 3) in 69% of patients. More lesions per patient were found on MRI compared to TRUS (1.49 vs. 1.03, p<0.01). PI-RADS 3, 4, and 5 MRI lesions were seen as HEL on TRUS in 51%, 69%, and 85% of patients, respectively. PCa and clinically significant PCa were detected in 84% and 5% of PI-RADS 3 lesions, 80% and 49% of PI-RADS 4 lesions, and 93% and 79% of PI-RADS 5 lesions, respectively. SBx detected the highest overall Gleason score or was equivalent to MBx/TBx in 135 patients (67%). The highest overall Gleason score was detected in 17 patients (8%) by TBx, and in 13 patients (6%) by MBx. In 36 patients (18%) no PCa was found by any biopsy method.CONCLUSIONS: In the setting of high expertise and experience with TRUS and TBx, MRI and MBx do identify some additional high-grade cases, but this is not common, and the incremental value of MBx over SBx and TBx is relatively modest. SBx should not be omitted routinely from biopsy protocols, and urologists should not abandon TRUS as an important diagnostic imaging modality.
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