Investigating the ability of multiparametric MRI to exclude significant prostate cancer prior to transperineal biopsy

Abstract

Introduction: We characterized false negative prostate magnetic resonance imaging (MRI) reporting by using histology derived from MRI-transrectal ultrasound (TRUS)-guided transperineal (MTTP) fusion biopsies.Methods: In total, 148 consecutive patients were retrospectively reviewed. Men underwent multiparametric MRI (mpMRI), reported by a consultant/attending radiologist in line with European Society of Urogenital Radiology (ESUR) standards. MTTP biopsy of the lesions was performed according to the Ginsburg recommendations. Cases with an MRI-histology mismatch were identified and underwent a second read by an experienced radiologist. A third review was performed with direct histology comparison to determine a true miss from an MRI-occult cancer. Statistical analysis was performed with McNemar's test. Results: False negative lesions were identified in 29 MRI examinations (19.6%), with a total of 46 lesions. Most false negative lesions (21/46) were located in the anterior sectors of the prostate. The second read led to a significant decrease of false-negative lesions with 7/29 further studies identified as positive on a patientby-patient basis (24.1% of studies, p = 0.016) and 11/46 lesions (23.9%; p = 0.001). Of these, 30 lesions following the first read and 23 lesions after the second read were considered significant cancer according to the University College London criteria. However, on direct comparison with histology, most lesions were MRI occult. Conclusion: We demonstrate that MRI can fail to detect clinically relevant lesions. Improved results were achieved with a second read but despite this, a number of lesions remain MRI-occult. Further advances in imaging are required to reduce false negative results. IntroductionCurrent methods for risk stratification of prostate cancer, including serum prostate-specific antigen (PSA) and transrectal ultrasound (TRUS)-guided biopsies, are limited by sampling error and low sensitivity and specificity.1-3 TRUSbiopsy can lead to inaccurate grading of 32% to 42% of cancers, 4-6 and may fail to detect 30% to 50% of cancers, particularly tumours in the anterior portion of the prostate. 7-12The improvement in multiparametric magnetic resonance imaging (mpMRI) in detecting prostate cancer has led to its recommendation in high-risk patients following a negative TRUS biopsy.13 MRI can then be used to guide subsequent biopsy either cognitively, in-bore (direct MRI-targeting), or by using MRI-TRUS fusion techniques.14-17 The latter combines anatomical MRI localization with the real-time guidance of ultrasound. Repeat biopsy is often undertaken by the transperineal (TP) route as this offers potential advantages over a transrectal route, including better sampling of the anterior and apical regions of the prostate, reduced false negative results, and a sterile approach. 18 mpMRI has the potential to accurately exclude prostate cancer and reduce biopsy burden. 19,20 To achieve this, it must have a high negative predictive value (NPV) on a patient-by-patient basis and maintain ...

The influence of prostate‐specific antigen density on positive and negative predictive values of multiparametric magnetic resonance imaging to detect Gleason score 7–10 prostate cancer in a repeat biopsy setting

“…Urologists need to be aware of the experience of the reporting radiologist when making clinical decisions based on mpMRI results. Inexperienced radiologists might overcall equivocal lesions and miss suspicious lesions, whereas experienced radiologists may help limit the number of equivocal and suspicious lesions to target with biopsies and reduce the risk of missing lesions with significant cancer .…”

Comparison of initial and tertiary centre second opinion reads of multiparametric magnetic resonance imaging of the prostate prior to repeat biopsy

“…These patients have usually undergone previous mpMRI at their referring hospital, which is then second-read by local subspecialist uroradiologists at the tertiary centre prior to biopsy. It has previously been shown that second-opinion interpretations of mpMRI significantly improve sensitivity for extracapsular extension of prostate cancer, even after adjustment for differences in imaging techniques [ 13 ], with limited retrospective data also suggesting this may be the case for improving detection of clinically relevant lesions in false-negative mpMRIs [ 19 ]. Thus, the aim of this study was to investigate whether prospective second opinion evaluation of prostate mpMRI by subspecialist uroradiologists at a tertiary centre affects the predictive values of the report prior to transperineal fusion biopsy.…”

Utilization of Multiparametric MRI of Prostate in Patients under Consideration for or Already in Active Surveillance: Correlation with Imaging Guided Target Biopsy

“…Ideally, a confirmatory repeat biopsy for any CSR on mp-MRI should be carried out by MRI or MRI/TRUS fusion image-guided target biopsy [ 27 ]. The combination of imaging-guided target biopsy and systematic TRUS biopsy may offer additional benefit particularly for those patients who did not have a prior TRUS biopsy because it can detect clinically significant tumors that are occult on mp-MRI even on retrospective evaluation due to a sparse growth pattern and a low malignant epithelium–stroma ratio [ 31 , 32 ].…”