MRI-Ultrasound Fusion Targeted Biopsy of Prostate Imaging Reporting and Data System Version 2 Category 5 Lesions Found False-Positive at Multiparametric Prostate MRI

Sheridan, Alison; Nath, Sameer K.; Aneja, Sanjay; Syed, Jamil; Pahade, Jay; Mathur, Mahan; Sprenkle, Preston; Weinreb, Jeffrey C.; Spektor, Michael

doi:10.2214/ajr.17.18680

Cited by 26 publications

(22 citation statements)

References 23 publications

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“…Other studies describe rates for malignancy in PI-RADS 5 lesions between 83 and 97% for low and intermediate-risk PCa and 62–81% for clinically significant PCa (Gleason 7a or greater) [3, 8, 9, 15]. Although the detection rate of PCa is high in PI-RADS 5 lesions, cases of benign findings have been described [10, 16].…”

Section: Discussionmentioning

confidence: 99%

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Multiparametric MRI Lesion Classified as Prostate Imaging-Reporting and Data System 5 but Histopathologically Described as Benign: A Case Report and Review of Literature

et al. 2021

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Introduction: Prostate cancer (PCa) is the most common malignancy in men. The multiparametric MRI (mpMRI) significantly improved the diagnostic approach of PCa. Although PCa is highly likely to be present in prostate imaging-reporting and data system (PI-RADS) 5 lesions, there are up to 18% of PI-RADS 5 lesions with benign histopathology after targeted biopsy. Case Description: We present the case of a 66-year-old man who was referred to our hospital for MRI/ultrasound fusion-based targeted biopsy due to an elevated PSA and a PI-RADS 5 lesion described in the mpMRI. After 2 consecutive biopsies, the mpMRI target showed no malignancy. The lesion was described as PI-RADS 2 two years later. Conclusion: This case demonstrates the risk of false-positive classified PI-RADS 5 lesions in the mpMRI and the challenge in some cases to distinguish between BPH nodules and cancer. Until today, a limited amount of studies exists concerning this issue. However, further studies are required to evaluate further characteristics associated with a higher possibility of histopathologically benign findings in PI-RADS 5 lesions.

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Section: Discussionmentioning

confidence: 99%

“…It is generally known that inflammation within the prostate can mimic PCa in the mpMRI [7, 10, 16, 17]. As prostatitis can lead to early contrast enhancement, low ADC values appear as hypointense lesions in the mpMRI similar to cancer [16, 17].…”

Section: Discussionmentioning

confidence: 99%

Multiparametric MRI Lesion Classified as Prostate Imaging-Reporting and Data System 5 but Histopathologically Described as Benign: A Case Report and Review of Literature

et al. 2021

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“…In our study, we found that only in 9% of the FP cases for the inexperienced radiologists and in 50% of the FP cases for the experienced radiologist technical issues could have been the reason for a FP lesion. A study by Sheriden et al [23] reported that 28% of the FP PIRADS 5 lesions could have been missed at biopsy. The difference with our study is that they only investigated PIRADS 5 lesions that are usually large and therefore technique-wise less likely to be missed at biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…Second, we were not able to analyze false negatives and their relation to reader experience, which could have been done if the reference standard would have been prostatectomy specimens or if longterm follow-up data would have been available. Third, this study did not investigate other factors potentially associated with a FP reading, such as clinical variables and apex-base location [23]. Fourth, this study consisted of patients who had received prior biopsy (either negative or with cancer but on active surveillance) possibly reducing the future generalizability of the results.…”

Section: Discussionmentioning

confidence: 99%

False positives in PIRADS (V2) 3, 4, and 5 lesions: relationship with reader experience and zonal location

et al. 2019

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Purpose To investigate the effect of reader experience and zonal location on the occurrence of false positives (FPs) in PIRADS (V2) 3, 4, and 5 lesions on multiparametric (MP)-MRI of the prostate. Materials and methods This retrospective study included 139 patients who had consecutively undergone an MP-MRI of the prostate in combination with a transrectal ultrasound MRI fusion-guided biopsy between 2014 and 2017. MRI exams were prospectively read by a group of inexperienced radiologists (cohort 1; 54 patients) and an experienced radiologist (cohort 2; 85 patients). Multivariable logistic regression analysis was performed to determine the association of experience of the radiologist and zonal location with a FP reading. FP rates were compared between readings by inexperienced and experienced radiologists according to zonal location, using Chi-square (χ 2) tests. Results A total of 168 lesions in 139 patients were detected. Median patient age was 68 years (Interquartile range (IQR) 62.5-73), and median PSA was 10.9 ng/mL (IQR 7.6-15.9) for the entire patient cohort. According to multivariable logistic regression, inexperience of the radiologist was significantly (P = 0.044, odds ratio 1.927, 95% confidence interval [CI] 1.017-3.651) and independently associated with a FP reading, while zonal location was not (P = 0.202, odds ratio 1.444, 95% CI 0.820-2.539). In the transition zone (TZ), the FP rate of the inexperienced radiologists 59% (17/29) was significantly higher (χ 2 P = 0.033) than that of the experienced radiologist 33% (13/40). Conclusion Inexperience of the radiologist is significantly and independently associated with a FP reading, while zonal location is not. Inexperienced radiologists have a significantly higher FP rate in the TZ.

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“…5). False positive results may be due to misinterpretations of nodules of stromal benign prostatic hyperplasia within the central gland, due to large ISUP = 1 cancers or due to inflammation [22,23]. Non-cancer causes of positive MRI decrease with higher PI-RADS scores.…”

Section: When Mri Is Positivementioning

confidence: 99%

Delivering Clinical impacts of the MRI diagnostic pathway in prostate cancer diagnosis

Schoots

Padhani

2020

Abdom Radiol

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Pre-biopsy multiparametric MRI is now recommended by multiple guidelines, not only for men with persistent suspicion of prostate cancer after prior negative systematic biopsy, but also at initial screening before the first biopsy. The major benefit of pre-biopsy MRI in the diagnostic work-up is to promote individualized risk-adapted approaches for biopsy-decision management. Multiple MRI-directed diagnostic pathways can be conceived, with each approach having net-benefit tradeoffs between benefits and harms, based on improved diagnostic yields of significant cancers and reduced biopsy testing and reduced detection of indolent prostate cancer. In this paper, we illustrate how clinical benefits can be maximized in men with MRI-negative and MRI-positive results, using the PI-RADS Multiparametric MRI and MRI-directed biopsy pathway. From a practice perspective, we emphasize five golden rules: (1) that multiparametric MRI approach including targeted biopsies be reserved for men likely to benefit from early detection and treatment of prostate cancer; (2) that there is a need to carefully assess risk of significant disease using PSA and clinical parameters before and after MRI; (3) do not offer immediate biopsy if the MRI is negative, unless other high-risk factors are present; (4) accept that not all significant cancers are found immediately and have robust 'safety nets' for men with negative MRI scans who avoid immediate biopsy and for positive MRI patients with negative or non-explanatory histology; and (5) use MRI-directed biopsy methods that minimize overdiagnosis and improve risk stratification.

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MRI-Ultrasound Fusion Targeted Biopsy of Prostate Imaging Reporting and Data System Version 2 Category 5 Lesions Found False-Positive at Multiparametric Prostate MRI

Cited by 26 publications

References 23 publications

Multiparametric MRI Lesion Classified as Prostate Imaging-Reporting and Data System 5 but Histopathologically Described as Benign: A Case Report and Review of Literature

Multiparametric MRI Lesion Classified as Prostate Imaging-Reporting and Data System 5 but Histopathologically Described as Benign: A Case Report and Review of Literature

False positives in PIRADS (V2) 3, 4, and 5 lesions: relationship with reader experience and zonal location

Delivering Clinical impacts of the MRI diagnostic pathway in prostate cancer diagnosis

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