Second-opinion reads in prostate MRI: added value of subspecialty interpretation and review at multidisciplinary rounds

Abstract

Purpose This study evaluates the impact of second-opinion review of multiparametric prostate MRI for cancer detection by a multidisciplinary review board at a tertiary care center when compared with the initial community radiologist interpretation. Methods Cases were collected retrospectively from multidisciplinary prostate MRI rounds from 2017 to 2020 at a single tertiary care center. Patients with suspected prostate cancer or on active surveillance were referred for consideration of TRUS/MRI-fusion biopsy based on community-read prostate MRIs. All MRIs were re-read by subspecialized abdominal radiologists and a PI-RADS score assigned. Targeted fusion and 8–12 core systematic biopsy was performed in patients with PIRADS ≥ 3 lesions. Cohen kappa values were used to quantify interobserver agreement. Positive predictive value (PPV) was used to determine accuracy of PI-RADS score for detection of clinically significant prostate cancer (csPCa) (ISUP Grade Group ≥ 2). Results Three hundred and thirty-two lesions in 303 patients were reviewed and 252 lesions in 198 patients biopsied. The PI-RADS score was concordant in 60.5% of lesions, downgraded in 17.8%, and upgraded in 7.8%. Agreement between community and tertiary center interpretation was fair ( κ = 0.354), with greater agreement for PI-RADS ≥ 4 ( κ = 0.523) than PI-RADS ≥ 3 ( κ = 0.456), and peripheral zone ( κ = 0.419) than transition zone lesions ( κ = 0.251). Prevalence of csPCa in biopsied lesions was 40.9%. Conclusion There is variability in community and tertiary care center interpretation of prostate MRI in cancer detection, with higher concordance rates for higher grade and peripheral zone lesions. These differences demonstrate the added value of multidisciplinary round review and highlight the need for ongoing education and feedback. Graphical abstract

The Feasibility and Value of a Focal Therapy Multidisciplinary Tumor Board, Including Radiographic and Pathological Overreads in Refining the Selection for High Intensity Focused Ultrasound in Prostate Cancer Patients

“…In our prospective study, MRI overreads were 60% concordant with original reports, a proportion similar to previously published data. 8 Of interest, MRI overread identified new lesions in 10/67 (14.9%) and upgraded low-risk lesions (PI-RADS 1-3) to concerning lesions warranting further workup (PI-RADS 4-5) 11/67 (16.4%) of the time. MRI overreads also determined that 12/67 lesions (17.9%) crossed anterior to the urethra, and as such, HIFU would not be a suitable treatment choice unless one would be willing to risk higher rates of strictures.…”

“…All these factors are known to impact the quality of the interpretation. [7][8][9][10] Furthermore, despite the clear benefits of standardized prostate MRI reporting in general, 12,15 there remains a lack of standardization when it comes to reporting of MRIs for FT. This ultimately leads to the omission of meaningful nomenclature for treatment planning (ie, if a lesion crosses the midline, if a lesion is anterior to the urethra, the lesion distance to urethra/rectum/sphincter, presence of calcification, etc).…”

“…7 In fact, when compared to the original MRI read, second-opinion interpretation of mpMRI by dedicated GU radiologists, coined MRI overread, was shown to be discordant in 40% of cases, with significant changes in treatment plans in a subset of those cases. 8 The MRI overread improves the detection of extracapsular extension, 9 the positive predictive value for csPCa, as well as the negative predictive value in the setting of MRI-negative cases (Prostate Imaging Reporting & Data System [PI-RADS] 1-2). 10 In similar fashion, pathology overreads have demonstrated National Comprehensive Cancer Network (NCCN) reclassification in approximately 20% of cases reviewed by a dedicated GU pathologist.…”

Quality Assurance of a Cross-Border and Sub-Specialized Teleradiology Service

“…The risk of turning into an isolated specialized expert should be met with frequent teamwork and participation at MDTMs. Current literature widely supports the superiority of sub-specialized radiology reports [ 43 , 44 ] and the incorporation of sub-specialized radiology can be regarded as a measure to meet sub-specialized clinical experts and contribute to improved clinical outcomes in patients [ 45 ]. Integration of platforms for inside and outside expert dialogues into the next generation of commercially available RIS/PACS environments will thus prove to be a major accelerator for sub-specialized teleradiology [ 26 ].…”

A semi-automated software program to assess the impact of second reads in prostate MRI for equivocal lesions: results from a UK tertiary referral centre

“…Currently, research on this subject has focused on readers with different levels of experience, with inter-reader agreement ranging from 39 to 61% [10][11][12][13] and higher positive predictive values for detecting csPCa for more experienced readers [12,13]. However, second reading is a time-consuming task during daily clinical practice given the increasing burden in prostate MRI reporting that radiologists face.…”