A Systematic Review of the Existing Prostate Imaging Reporting and Data System Version 2 (PI-RADSv2) Literature and Subset Meta-Analysis of PI-RADSv2 Categories Stratified by Gleason Scores

Barkovich, Emil Jernstedt; Shankar, Prasad R.; Westphalen, Antonio C.

doi:10.2214/ajr.18.20571

Cited by 78 publications

(55 citation statements)

References 28 publications

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“…Our findings demonstrated that in lesions assigned with a PIRADS 1 or 2 score, the probability of finding a clinically significant cancer is low (3/51, (6%)) and the risks of prostate core biopsy (sepsis, haemorrhage/haematuria and pain) may outweigh the probability of detecting a clinically significant lesion that is occult on MRI 8 (Table 1). In lesions categorized as PIRADS 4 and 5, our detection rate of csCaP (Gleason ≥3 + 4) was 41% (31/75) and 68% (28/41), respectively, which supports findings in a recent meta‐analysis 9 showing the probability of detecting Gleason ≥7 CaP in PIRADS 4 and 5 lesions was 50% and 70%, respectively. This suggests that in men suspected of CaP, a PIRADS 4 or 5 lesion should undergo further investigation with tissue sampling due to a step‐wise increase in prevalence of csCaP in these cohort.…”

Section: Discussionsupporting

confidence: 88%

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Review of the accuracy of multi‐parametric MRI prostate in detecting prostate cancer within a local reporting service

2020

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Introduction Multi‐parametric magnetic resonance imaging of the prostate is crucial in detecting prostate cancer (CaP) and staging local disease. The Prostate Imaging Reporting and Data System (PIRADS) scoring system is used to assess and classify lesions and enables communication between clinicians and radiologists. This study aimed to assess the accuracy of PIRADSv2 in detecting CaP using histopathology specimens within our local service. Methods This retrospective study included 192 patients between September 2016 and May 2019. All had mpMRI prostate examinations prior to biopsy or prostatectomy. Lesions on MRI were assigned a PIRADS score and comparison made with histopathology results. Gleason score ≥7 was considered as clinically significant prostate cancer (csCaP). We calculated accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting all CaP and csCaP. Results In the PIRADS 3 group, 32% were Gleason 6 and 32% were Gleason 7 lesions. In the PIRADS 4 group, 37% were Gleason 6 and 41% were Gleason ≥7. For PIRADS 5 lesions, 32% were Gleason 6 and 68% were Gleason ≥7. For all CaP, sensitivity was 84.7%, specificity 54.6%, PPV 82.3% and NPV 58.8%. For csCaP Gleason ≥7, PIRADS cut‐off ≥3 had sensitivity, specificity, PPV and NPV of 95.7%, 39.3%, 47.5% and 94.1%, respectively, and cut‐off ≥4 had sensitivity, specificity, PPV and NPV of 84.3%, 53.3%, 50.9% and 85.5%. Conclusions This study confirms PIRADS has high accuracy, sensitivity and NPV for detecting all CaP and csCaP. A high NPV may obviate need for biopsy in low‐risk patients.

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Section: Discussionsupporting

confidence: 88%

“…Barkovich et al 9 . reported the probability of detecting csCaP in PIRADS 3 should be approximately 12% or less; however, our PIRADS 3 lesions returned a higher number of Gleason ≥7 disease at 32% (8/25) and this discrepancy with the literature may be attributed to several reasons.…”

Section: Discussioncontrasting

confidence: 87%

Review of the accuracy of multi‐parametric MRI prostate in detecting prostate cancer within a local reporting service

2020

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“…Another study in 339 biopsy-naive men using transrectal US targeting and systematic transrectal US-guided biopsy of 737 targets found ISUP grade group 2 or higher cancers in 12%, 22%, and 72% of men for PI-RADS categories 3, 4, and 5, respectively (54). On average, the diagnostic yields of ISUP grade group 2 or higher for PI-RADS categories 3, 4, and 5 were 12%, 48%, and 72%, respectively, in a pooled analysis by Barkovich et al (55) and 21% (95% CI: 4%, 27%), 39% (95% CI: 31%, 52%), and 73% (95% CI: 61%, 86%), respectively, in the pooled analysis by Schoots (56).…”

Section: Patient Implications After Intermediate-or High-likelihood Mmentioning

confidence: 89%

PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway

Padhani¹,

Barentsz²,

Villeirs³

et al. 2019

Radiology

176

118

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he current version of the Prostate Imaging Reporting and Data System (PI-RADS) was formulated on experience gained from PI-RADS version 1, accumulated scientific evidence, and expert consensus (1). The release of PI-RADS version 2.1 is expected to further improve observer variability (2). A recent publication evaluated multiple clinical studies, systematic analyses, and professional guidelines on their use of multiparametric MRI in prostate cancer detection (3). It showed that the test performance of multiparametric MRI-directed biopsy in the detection of prostate cancer is superior to that of systematic transrectal US-guided biopsy. High-level evidence has now established multiple benefits of MRI-directed biopsy over systematic transrectal US-guided biopsy of the prostate (4). These benefits include (a) a reduction in the number of men who need to undergo biopsy (5-9); (b) a reduction in the number of diagnoses of clinically insignificant cancers that are unlikely to cause harm (4,10), with the potential to reduce overtreatment, treatment-related complications, and active surveillance rates (6); (c) improved detection of clinically significant prostate cancers, particularly in patients with prior negative transrectal US-guided biopsy findings (4,10); and (d) improved risk stratification of diagnosed cancers owing to greater precision in tumor grade and volume determinations, which helps direct disease management. All these advantages can be achieved with fewer targeted biopsy cores per patient, potentially reducing biopsy-related morbidity (6,8,11). The purpose of this article is to focus on how multiparametric MRI results can positively impact the health of men suspected of having clinically significant prostate cancer. Who Should Undergo MRI before Biopsy? Patients chosen for MRI before biopsy include biopsynaive men with elevated serum prostate-specific antigen (PSA) levels, abnormal digital rectal examination findings, or both, and men who are deemed to have persistent elevated risk of harboring clinically significant cancers despite prior negative or nonexplanatory systematic transrectal US biopsy findings. Indications for MRI should be based on the recommendations for screening and early diagnosis of the National Comprehensive Cancer Network and the European Association of Urology (12,13). Accordingly, biopsy-naive men with lower than average risk of prostate cancer should not undergo prostate biopsy or MRI. However, limiting the options to prespecified PSA thresholds is not recommended, as there are many factors (eg, symptoms, age, race, family history, PSA kinetics, digital rectal examination findings) that in

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“…For detecting clinically significant prostate cancer, this binary MRI decision model has been shown to have high sensitivity (0.91; 95% CI: 0.83, 0.95) and low specificity (0.37; 95% CI: 0.29, 0.46), when referenced to template-guided mapping verification biopsies [6]. False positives have been shown to occur predominantly within PI-RADS category 3 and 4 lesions, and less so in category 5 lesions [37,38].…”

Section: From Five-point Likert Scale To Binary Mri Decision Modelmentioning

confidence: 96%

“…Detection rates for clinically significant prostate cancer according to PI-RADS assessment categories vary significantly within and between patient cohorts (biopsy-naïve, prior negative biopsy, and prior positive biopsy in active surveillance) [37] and between studies [38]. The yield of clinically significant cancers per likelihood category depends on multiple factors, including histologic definitions employed (with higher yields for definitions that incorporate both tumor volume and tumor grade), and with the use of combined systematic biopsy cores with MRI-directed biopsy cores.…”

Section: From Binary Mri Decision Model To Four-point Mri-based Risk mentioning

confidence: 99%

Personalizing prostate cancer diagnosis with multivariate risk prediction tools: how should prostate MRI be incorporated?

Schoots

Padhani

2019

World J Urol

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Risk-based patient selection for systematic biopsy in prostate cancer diagnosis has been adopted in daily clinical practice, either by clinical judgment and PSA testing, or using multivariate risk prediction tools. The use of multivariable risk prediction tools can significantly reduce unnecessary systematic biopsies, without compromising the detection of clinically significant disease. Increasingly multi-parametric magnetic resonance imaging (MRI) is performed, not only in men with a persistent suspicion of prostate cancer after prior negative systematic biopsy, but also at initial screening before the first biopsy. The combination of MRI and multivariate risk prediction tools could potentially enhance prostate cancer diagnosis using multivariate MRI incorporated risk-based models to decide on the need for prostate MRI, but also using MRI results to adjusted risk-based models, and to guide MRI-directed biopsies. In this review, we discuss the diagnostic work-up for clinically significant prostate cancer, where the combination of MRI and multivariate risk prediction tools is integrated, and how together they can contribute to personalized diagnosis.Keywords Prostate cancer · Biopsy · Magnetic resonance imaging (MRI) · Risk stratification · Multivariate risk prediction · Risk calculator · NomogramThe following relevant activities related to the submitted work: Ivo G. Schoots is a full panel member of the EAU-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer, and a full panel member of the PI-RADS Steering committee. Anwar R. Padhani is Co-Chair of the PI-RADS Steering committee.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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A Systematic Review of the Existing Prostate Imaging Reporting and Data System Version 2 (PI-RADSv2) Literature and Subset Meta-Analysis of PI-RADSv2 Categories Stratified by Gleason Scores

Cited by 78 publications

References 28 publications

Review of the accuracy of multi‐parametric MRI prostate in detecting prostate cancer within a local reporting service

Review of the accuracy of multi‐parametric MRI prostate in detecting prostate cancer within a local reporting service

PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway

Personalizing prostate cancer diagnosis with multivariate risk prediction tools: how should prostate MRI be incorporated?

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