Local staging with multiparametric MRI in daily clinical practice: diagnostic accuracy and evaluation of a radiologic learning curve

Abstract

PurposeTo estimate the diagnostic accuracy of multiparametric MRI (mpMRI) for the detection of locally advanced prostate cancer (T-stage 3–4) prior to radical prostatectomy, in a multicenter cohort representing daily clinical practice. In addition, the radiologic learning curve for the detection of locally advanced disease is evaluated.MethodsPreoperative mpMRI findings of 430 patients (2012–2016) were compared to pathology results following radical prostatectomy. The diagnostic accuracy (sensitivity, specificity, PPV, and NPV) for the detection of locally advanced disease was calculated and compared for all years separately, to evaluate the presence of a radiological learning curve.ResultsOf all 137 patients with locally advanced disease, 62 patients were preoperatively detected with mpMRI [sensitivity 45.3% (95% CI 36.9–53.6%), specificity 75.8% (CI 70.9–80.7%), PPV 46.6% (CI 38.1–55.1%), and NPV 74.7% (CI 69.8–79.7%)]. The diagnostic accuracy did not improve significantly over time (sensitivity p = 0.12; specificity p = 0.57).ConclusionsIn daily clinical practice, the diagnostic accuracy of mpMRI for the detection of locally advanced prostate cancer remains limited. It, therefore, seems questionable whether mpMRI is adequate to guide preoperative decision-making. No significant radiologic learning curve for the detection of locally advance disease was observed.

Feasibility of multi-parametric magnetic resonance imaging in detection and local staging of prostatic carcinoma

“…Furthermore, there is a potential role for mpMRI in not only localizing tumor but also in identifying the areas of more aggressive cancer that could be selectively targeted by biopsy or for focal ablation therapy. Several studies have shown that both DWI and spectroscopic imaging are correlated with the Gleason grade [5,[18][19][20]. As confirmed by our pathologic-radiologic comparison, low ADC values are associated with an increasing Gleason score.…”

“…With higher sensitivity and specificity, mpMRI is increasingly used in guiding biopsies in biopsy-negative and previously negative cases. Also, it is used for proper staging, risk stratification and decision-making and is being incorporated in clinical nomograms [5,8,9,[13][14][15][16]. Moreover, MR tractography helps visualizing the prostatic nerve bundles guiding the nerve-sparing surgery to reserve the erectile function [17].…”

“…This traditional technique is based on anatomical sequences only, and its resolution is allowed for only assessment of T3 disease [4]. The recent advent of multiparametric MRI (mpMRI), based on the anatomic T1and T2-weighted imaging (WI) and functional imaging of alteration caused by neoplastic tissue, expanded the scope of MRI in diagnosis and local staging of PCa [5,6].…”

The Role of Magnetic Resonance Imaging and Positron Emission Tomography/Computed Tomography in the Primary Staging of Newly Diagnosed Prostate Cancer: A Systematic Review of the Literature

“…MRI techniques included only partly diffusion-weighted (DW) imaging, and no standardized reporting was used. Moreover, Jansen et al [38] observed comparable sensitivity for the prediction of EPE between 133 high-risk and 297 low-risk patients (49% vs 42%, p = 0.5).…”

“…Risk stratification. Several studies were found to assess the performance of MRI according to different risk groups [8,19,20,24,38,40,46,59,62,66,70,75]. While better performance for high-risk patients has been presumed in literature, the data actually remain inconclusive.…”