Prostate Indeterminate Lesions on Magnetic Resonance Imaging—Biopsy Versus Surveillance: A Literature Review

Rivas, Juan Gómez; Giganti, Francesco; Maestro, M. Álvarez; Freire, Maria José; Kasivisvanathan, Veeru; Martínez‐Piñeiro, Luis; Emberton, Mark

doi:10.1016/j.euf.2018.02.012

Cited by 33 publications

(10 citation statements)

References 37 publications

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“…Furthermore, echo planar imaging (EPI)‐based diffusion scans often suffer from distortion, signal pile‐up, or stretching artifacts, leading to less accurate results and in some circumstances unusable images. Different studies have tried to solve some of these issues, particularly with regard to reducing the proportion of lesions classified as indeterminate, but none has conclusively solved them.…”

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confidence: 99%

Simplified Luminal Water Imaging for the Detection of Prostate Cancer From Multiecho T₂ MR Images

Devine

Giganti

Johnston

et al. 2018

Magnetic Resonance Imaging

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Background Luminal water imaging (LWI) suffers less from imaging artifacts than the diffusion‐weighted imaging used in multiparametric MRI of the prostate. LWI obtains multicompartment tissue information from a multiecho T2 dataset. Purpose To compare a simplified LWI technique with apparent diffusion coefficient (ADC) in classifying lesions based on groupings of PI‐RADS v2 scores. Secondary aims were to investigate whether LWI differentiates between histologically confirmed tumor and normal tissue as effectively as ADC, and whether LWI is correlated with the multicompartment parameters of the vascular, extracellular, and restricted diffusion for cytometry in tumors (VERDICT) diffusion model. Study Type A subset of a larger prospective study. Population In all, 65 male patients aged 49–79 were scanned. Field Strength/Sequence A 32‐echo T2 and a six b‐value diffusion sequence (0, 90, 500, 1500, 2000, 3000 s/mm2) at 3T. Assessment Regions of interest were placed by a board‐certified radiologist in areas of lesion and benign tissue and given PI‐RADS v2 scores. Statistical Tests Receiver operating characteristic and logistic regression analyses were performed. Results LWI classifies tissue as PI‐RADS 1,2 or PI‐RADS 3,4,5 with an area under curve (AUC) value of 0.779, compared with 0.764 for ADC. LWI differentiated histologically confirmed malignant from nonmalignant tissue with AUC, sensitivity, and specificity values of 0.81, 75%, and 87%, compared with 0.75, 83%, and 67% for ADC. The microstructural basis of the LWI technique is further suggested by the correspondence with the VERDICT diffusion‐based microstructural imaging technique, with α, A1, A2, and LWF showing significant correlations. Data Conclusion LWI alone can predict PI‐RADS v2 score groupings and detect histologically confirmed tumors with an ability similar to ADC alone without the limitations of diffusion‐weighted MRI. This is important, given that ADC has an advantage in these tests as it already informs PI‐RADS v2 scoring. LWI also provides multicompartment information that has an explicit biophysical interpretation, unlike ADC. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:910–917.

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confidence: 99%

Simplified Luminal Water Imaging for the Detection of Prostate Cancer From Multiecho T₂ MR Images

Devine

Giganti

Johnston

et al. 2018

Magnetic Resonance Imaging

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“…Moreover, Gomez Rivas et al [30] suggested in a systematic review about the value of intermediate or equivocal lesions that the combination of mpMRI, clinical parameters, biomarkers and nomograms may allow a more accurate decision for or against a biopsy in these patients. Also in our cohort, especially patients with maxPI-RADS ≤3 and a PSA density ≥0.2 ng/mL 2 showed a higher detection rate of csPCa highlighting the importance of PSA density in the prediction of csPCa in this subgroup.…”

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confidence: 99%

Evaluation of Transperineal Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy Compared to Transrectal Systematic Biopsy in the Prediction of Tumour Aggressiveness in Patients with Previously Negative Biopsy

Borkowetz¹,

Renner²,

Platzek³

et al. 2018

Urol Int

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Objectives: We compared the transperineal MRI/ultrasound-fusion biopsy (fusPbx) to transrectal systematic biopsy (sysPbx) in patients with previously negative biopsy and investigated the prediction of tumour aggressiveness with regard to radical prostatectomy (RP) specimen. Material and Methods: A total of 710 patients underwent multiparametric magnetic resonance imaging (mpMRI), which was evaluated in accordance with Prostate Imaging Reporting and Data System (PI-RADS). The maximum PI-RADS (maxPI-RADS) was defined as the highest PI-RADS of all lesions detected in mpMRI. In case of proven prostate cancer (PCa) and performed RP, tumour grading of the biopsy specimen was compared to that of the RP. Significant PCa (csPCa) was defined according to Epstein criteria. Results: Overall, scPCa was detected in 40% of patients. The detection rate of scPCa was 33% for fusPbx and 25% for sysPbx alone (p < 0.005). Patients with a maxPI-RADS ≥3 and a prostate specific antigen (PSA)-density ≥0.2 ng/mL² harboured more csPCa than those with a PSA-density < 0.2 ng/mL² (41% [33/81] vs. 20% [48/248]; p < 0.001). Compared to the RP specimen (n = 140), the concordance of tumour grading was 48% (γ = 0.57), 36% (γ = 0.31) and 54% (γ = 0.6) in fusPbx, sysPbx and comPbx, respectively. Conclusions: The combination of fusPbx and sysPbx outperforms both biopsy modalities in patients with re-biopsy. Additionally, the PSA-density may represent a predictor for csPCa in patients with maxPI-RADS ≥3.

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“…Higher PSAD has been shown to be a predictor of CSPCa cancer and is a widely evaluated biomarker [4, 7-10, 16, 17]. PI-RADS 3 lesions are indeterminate and currently there is no consensus on the optimal management [5,6]. It has been proposed that patients with lower PSAD values (≤0.10 -0.15 ng/mL/cc) and PI-RADS category 3 lesions could be safely managed with close surveillance [4,9,10].…”

Section: Cuaj -Original Researchmentioning

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“…Studies evaluating the likelihood of CSPCa cancer at targeted biopsy of PI-RADSv2 category 3 lesions have reported variable rates of PCa diagnosis, ranging from 5% to 30%, with the majority of studies showing a relatively low likelihood of eventual CSPCa diagnosis [2][3][4]. Management of PI-RADSv2 category 3 lesion is variable, ranging from immediate biopsy to surveillance [5,6].…”

Section: Introductionmentioning

confidence: 99%

When to biopsy Prostate Imaging and Data Reporting System version 2 (PI-RADSv2) assessment category 3 lesions? Use of clinical and imaging variables to predict cancer diagnosis at targeted biopsy

Lim

Abreu‐Gomez

Leblond

et al. 2020

CUAJ

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Introduction: We aimed to determine if clinical and imaging features can stratify men at higher risk for clinically significant (CS, International Society of Urological Pathology [ISUP] grade group ≥2) prostate cancer (PCa) in equivocal Prostate Imaging and Data Reporting System (PI-RADS) category 3 lesions on magnetic resonance imaging (MRI). Methods: Approved by the institutional review board-approved, this retrospective study involved 184 men with 198 lesions who underwent 3T-MRI and MRI-directed transrectal ultrasound biopsy for PI-RADS 3 lesions. Men were evaluated including clinical stage, prostate-specific antigen density (PSAD), indication, and MRI lesion size. Diagnoses for all men and by indication (no cancer, any PCa, CSPCa) were compared using multivariate logistic regression, including stage, PSAD, and lesion size. Results: We found an overall PCa rate of 31.8% (63/198) and 10.1% (20/198) CSPCa (13 grade group 2, five group 3, and two group 4). Higher stage (p=0.001), PSAD (p=0.007), and lesion size (p=0.015) were associated with CSPCa, with no association between CSPCa and age, PSA, or prostate volume (p>0.05). PSAD modestly predicted CSPCa area under the curve (AUC) 0.66 (95% confidence interval [CI] 0.518–0.794) in all men and 0.64 (0.487–0.799) for those on active surveillance (AS). Model combining clinical stage, PSAD, and lesion size improved accuracy for all men and AS (AUC 0.82 [0.736–0.910], p<0.001 and 0.785 [0.666-0.904], p<0.001). In men with prior negative biopsy and persistent suspicion, PSAD (0.90 [0.767–1.000]) was not different from the model (p>0.05), with optimal cutpoint of ≥0.215 ng/mL/cc achieving sensitivity/specificity of 85.7/84.4%. Conclusions: PI-RADSv2 category 3 lesions are often not CSPCa. PSAD predicted CSPCa in men with a prior negative biopsy; however, PSAD alone had limited value, and accuracy improved when using a model incorporating PSAD with clinical stage and MR lesion size.

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Prostate Indeterminate Lesions on Magnetic Resonance Imaging—Biopsy Versus Surveillance: A Literature Review

Cited by 33 publications

References 37 publications

Simplified Luminal Water Imaging for the Detection of Prostate Cancer From Multiecho T₂ MR Images

Simplified Luminal Water Imaging for the Detection of Prostate Cancer From Multiecho T₂ MR Images

Evaluation of Transperineal Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy Compared to Transrectal Systematic Biopsy in the Prediction of Tumour Aggressiveness in Patients with Previously Negative Biopsy

When to biopsy Prostate Imaging and Data Reporting System version 2 (PI-RADSv2) assessment category 3 lesions? Use of clinical and imaging variables to predict cancer diagnosis at targeted biopsy

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Prostate Indeterminate Lesions on Magnetic Resonance Imaging—Biopsy Versus Surveillance: A Literature Review

Cited by 33 publications

References 37 publications

Simplified Luminal Water Imaging for the Detection of Prostate Cancer From Multiecho T2 MR Images

Simplified Luminal Water Imaging for the Detection of Prostate Cancer From Multiecho T2 MR Images

Evaluation of Transperineal Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy Compared to Transrectal Systematic Biopsy in the Prediction of Tumour Aggressiveness in Patients with Previously Negative Biopsy

When to biopsy Prostate Imaging and Data Reporting System version 2 (PI-RADSv2) assessment category 3 lesions? Use of clinical and imaging variables to predict cancer diagnosis at targeted biopsy

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Product

Resources

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Simplified Luminal Water Imaging for the Detection of Prostate Cancer From Multiecho T₂ MR Images

Simplified Luminal Water Imaging for the Detection of Prostate Cancer From Multiecho T₂ MR Images