Histologic findings associated with false-positive multiparametric magnetic resonance imaging performed for prostate cancer detection

Gordetsky, Jennifer B.; Ullman, David; Schultz, Luciana; Porter, Kristin K.; Peña, Maria Del Carmen Rodriguez; Calderone, Carli E; Nix, Jeffrey; Ullman, Michael A.; Bae, Sejong; Rais‐Bahrami, Soroush

doi:10.1016/j.humpath.2018.08.021

Cited by 27 publications

(16 citation statements)

References 23 publications

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“…However, benign tissue could also be representative of the true state of the IT. This situation was recently shown to correlate with a higher density of connective tissue, basal cell hyperplasia, and inflammation than observed in concurrent systematic biopsies [25]. In the present series, it was observed in 18 patients, of whom 12 showed active or chronic inflammation.…”

Section: Discussionsupporting

confidence: 61%

Managing Discordant Findings Between Multiparametric Magnetic Resonance Imaging and Transrectal Magnetic Resonance Imaging–directed Prostate Biopsy—The Key Role of Magnetic Resonance Imaging–directed Transperineal Biopsy

Bajeot

Covin²,

Meyrignac

et al. 2022

European Urology Oncology

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Background: Discordant findings between multiparametric magnetic resonance imaging (mpMRI) and transrectal image-guided biopsies of the prostate (TRUS-P) may result in inadequate risk stratification of localized prostate cancer. Objective: To assess transperineal image-guided biopsies of the index target (TPER-IT) in terms of disease reclassification and treatment recommendations. Design, setting, and participants: Cases referred for suspicion or treatment of localized prostate cancer were reviewed in a multidisciplinary setting, and discordance was characterized into three scenarios: type I-negative biopsies or International Society of Urological Pathology (ISUP) grade 1 cancer in Prostate Imaging Reporting and Data System (PI-RADS) 4 index target (IT); type II-negative biopsies or ISUP grade 1 cancer in anterior IT; and type III-<3 mm stretch of cancer in PI-RADS 3 IT. Discordant findings were characterized in 132/558 (23.7%) patients after TRUS-P. Of these patients, 102 received reassessment TPER-IT. Outcome measurements and statistical analysis: The primary objective was to report changes in treatment recommendations after TPER-IT. Therefore, cores obtained by primary TRUS-P and TPER-IT were analyzed in terms of cancer detection, ISUP grade, and Cambridge Prognostic Group classification using descriptive statistics. Results and limitations: TPER-IT biopsies that consisted of fewer cores than the initial TRUS-P (seven vs 14, p < 0.0001) resulted in more cancer tissue materials for analysis (56 vs 42.5 mm, p = 0.0003). As a result, 40% of patients initially considered for follow-up (12/30) and 49% for active surveillance (30/61) were reassigned after TPER-IT to surgery or intensity-modulated radiotherapy.

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Section: Discussionsupporting

confidence: 61%

Managing Discordant Findings Between Multiparametric Magnetic Resonance Imaging and Transrectal Magnetic Resonance Imaging–directed Prostate Biopsy—The Key Role of Magnetic Resonance Imaging–directed Transperineal Biopsy

Bajeot

Covin²,

Meyrignac

et al. 2022

European Urology Oncology

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“…[6] However, mpMRI is not disease specific, and many benign conditions such as acute and chronic prostatitis, basal cell hyperplasia, benign prostatic hyperplasia, or postbiopsy changes can give false-positive results and thus may result in an unnecessary biopsy. [78] Besides these, the field of evaluation is usually limited to the pelvis, and separate imaging is usually required to image for distant metastasis.…”

Section: Introductionmentioning

confidence: 99%

Comparison of percentage free PSA, MRI and GaPSMA PET scan for diagnosing cancer prostate in men with PSA between 4 and 20 ng/ml

et al. 2019

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Introduction: We compared the diagnostic accuracy of percentage free prostate-specific antigen (PSA), multiparametric magnetic resonance imaging (mpMRI), and gallium-68 prostate-specific membrane antigen positron emission tomography (Ga-PSMA PET) to detect cancer prostate in men with PSA between 4 and 20 ng/ml in prebiopsy settings. Materials and Methods: This prospective study evaluated men with PSA values between 4 and 20 ng/ml, and all patients underwent percentage free PSA estimation, mpMRI, and Ga-PSMA PET scan, followed by cognitive fusion/registration biopsy along with systematic 12-core biopsy to detect cancer prostate. The diagnostic accuracy of percentage free PSA, mpMRI, and Ga-PSMA PET scan was compared with results of cognitive fusion/registration biopsy. Results: A total of 15 patients were included, of which 11 had an identifiable lesion on imaging and 9 had malignancy on the final histopathology report. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and diagnostic accuracy of mpMRI were 62.5%, 71.4%, 71.4%, 62.5%, and 66.6%, respectively, and that of Ga-PSMA PET scan were 88.8%, 66.6%, 80%, 80%, and 80%, respectively. The sensitivity of detection of clinically significant cancers for Ga-PSMA was higher (100%) compared to MRI (33.3%). However, Ga-PSMA also detected a greater number of insignificant lesions as compared to MRI. Conclusion: Ga-PSMA PET scan has high NPV and accuracy in predicting presence of cancer and can also be used to direct specific biopsy cores during systematic biopsy.

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“…Our results show 61% suspicious ventral lesions in men with negative F-Bx but later PCa diagnosis. Moreover, as stated by the authors, those regions could be misinterpreted by radiologists [24]. The success of a F-Bx is directly correlated to the radiologist’s experience and skill for identifying suspicious lesions in mpMRI and minimizing false-positive results.…”

Section: Discussionmentioning

confidence: 99%

Probability of Prostate Cancer Diagnosis following Negative Systematic and Targeted MRI: Transrectal Ultrasound Fusion Biopsy: A Real-Life Observational Study

et al. 2021

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Introduction: The risk of occult prostate carcinoma (PCa) after negative multiparametric MRI (mpMRI)-transrectal fusion biopsy (F-Bx) is unknown. To determine the false-negative predictive value, we examined PCa detection after prior negative F-Bx. Methods: Between December 2012 and November 2016, 491 patients with suspected PCa and suspicious mpMRI findings underwent transrectal F-Bx. Patients with benign pathology (n = 191) were eligible for our follow-up (FU) survey. Patient characteristics and clinical parameters were correlated to subsequent findings of newly detected PCa. Results: Complete FU with a median of 31 (interquartile range: 17–39) months was available for 176/191 (92.2%) patients. Of those, 54 men had either surgical interventions on the prostate or re-Bxs. Newly detected PCa was evident in 14/176 (7.95%) patients stratified to ISUP ≤2 in 10 and ≥3 in 4 cases. The comparison of patients with newly detected PCa to those without cancerous findings in FU showed significant differences in prostate-specific antigen (PSA) density (0.16 vs. 0.13 ng/mL2) and prostate volume (45 vs. 67 mL, both p < 0.05). Both factors are significant predictors for newly detected cancer after initial negative F-Bx. Conclusion: Only PSA density (>0.13 ng/mL2) and small prostate volume are significant predictors for newly detected PCa after initial negative F-Bx. Despite negative mpMRI/TRUS F-Bx results, patients should be further monitored due to a risk of developing PCa over time. Notwithstanding the limitation of our study that not all patients underwent another Bx, we assume that the false-negative rate is low but existing. Our data represent a real-world scenario.

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Histologic findings associated with false-positive multiparametric magnetic resonance imaging performed for prostate cancer detection

Cited by 27 publications

References 23 publications

Managing Discordant Findings Between Multiparametric Magnetic Resonance Imaging and Transrectal Magnetic Resonance Imaging–directed Prostate Biopsy—The Key Role of Magnetic Resonance Imaging–directed Transperineal Biopsy

Managing Discordant Findings Between Multiparametric Magnetic Resonance Imaging and Transrectal Magnetic Resonance Imaging–directed Prostate Biopsy—The Key Role of Magnetic Resonance Imaging–directed Transperineal Biopsy

Comparison of percentage free PSA, MRI and GaPSMA PET scan for diagnosing cancer prostate in men with PSA between 4 and 20 ng/ml

Probability of Prostate Cancer Diagnosis following Negative Systematic and Targeted MRI: Transrectal Ultrasound Fusion Biopsy: A Real-Life Observational Study

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