Likert score 3 prostate lesions: Association between whole‐lesion ADC metrics and pathologic findings at MRI/ultrasound fusion targeted biopsy

Abstract

For score 3 lesions in patients without prior negative biopsy, whole-lesion ADC metrics help detect GS > 6 cancer while avoiding negative biopsies. However, deferral of fusion biopsy may be considered for score 3 lesions in patients with prior negative biopsy (without applying whole-lesion ADC metrics) given exceedingly low (∼ 2%) frequency of GS > 6 tumor in this group.

Magnetic resonance imaging/transrectal ultrasound fusion‐targeted prostate biopsy using three‐dimensional ultrasound‐based organ‐tracking technology: Initial experience in Japan

“…Of these 16 lesions, 12% (2/16) were Gleason 4 + 3, and 6% (1/16) were GS: the remainder were GS 3 + 4. That study indicated that the prostate lesions evaluated on 3T multiparametric MRI as Likert score 3 were associated with a low likelihood of the presence of CSCa . In the current study, the positive rate of CSCa per patient was 83.0% (177/213) in Likert scores 4 and 5 versus 14.2% (7/49) in Likert score 3 ( P < 0.0001).…”

“…That study indicated that the prostate lesions evaluated on 3T multiparametric MRI as Likert score 3 were associated with a low likelihood of the presence of CSCa. 26 In the current study, the positive rate of CSCa per patient was 83.0% (177/213) in Likert scores 4 and 5 versus 14.2% (7/49) in Likert score 3 (P < 0.0001). We showed that Likert score 3 lesions were associated with a low percentage of CSCa using the technique of MRUS fusion TB.…”

Sub-differentiating equivocal PI-RADS-3 lesions in multiparametric magnetic resonance imaging of the prostate to improve cancer detection

“…This needs to be considered in the context of a "miss rate" of around 10% for a PIRADS score of 1-2. Importantly, detection rates have been shown to be higher in the peripheral zone [14] and as high as 40% in the context of a second-biopsy population [15], suggesting some PI-RADS 3 lesions deserve biopsy, whereas others could be safely deferred. Informing management of such lesions is particularly relevant given the reported prevalence of indeterminate of 20.5-26.3% using earlier Likert-based systems [10,[16][17][18] is predicted to increase with a switch to using the PI-RADS-version 2 reporting system [19].…”

Prostate cancer heterogeneity: texture analysis score based on multiple magnetic resonance imaging sequences for detection, stratification and selection of lesions at time of biopsy

“…Their maximal AUC of 0.71 was lower than our present results and based on a single sequence analysis. Rosenkrantz et al applied different features of first order to discriminate lesions with Gleason >6 to others amongst VS lesions. Harbouring similar range of values to our present results, entropy of ADC alone failed to discriminate those even in their larger cohort.…”