Is possible to rule out clinically significant prostate cancer using PI-RADS v2 for the assessment of prostate MRI?

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0382


Publio Cesar Cavalcanti Viana 1, Natally Horvat 1, Valter Ribeiro dos Santos Júnior 1, Thais Carneiro Lima 1, Davi dos Santos Romão 1, Luciana Mendes de Oliveira Cerri 1, Marilia Germanos de Castro 2, Herbert Alberto Vargas 3, Júlia Azevedo Miranda 1, Claudia da Costa Leite 1, Giovanni Guido Cerri 1
1 Departamento de Radiologia do Hospital Sírio-Libanês, São Paulo, SP, Brasil; 2 Departamento de Patologia do Hospital Sírio-Libanês, São Paulo, SP, Brasil; 3 Departamento de Radiologia, Memorial Sloan Kettering Cancer Center, Nova York, NY, EUA


Objectives: To evaluate the diagnostic performance and interobserver agreement of PI-RADS v2.

Materials and Methods: In this Institutional Review Board approved single-center retrospective study, 98 patients with clinically suspected PCa who underwent 3-T multiparametric MRI followed by MRI/TRUS fusion-guided prostate biopsy were included from June 2013 to February 2015. Two radiologists (R1 and R2) with 8 and 1 years of experience in abdominal radiology reviewed the MRI scans and assigned PI-RADS v2 scores in all prostate zones. PI-RADS v2 were compared to MRI/TRUS fusion-guided biopsy results, which were classifi ed as negative, PCa, and significant PCa (sPCa).

Results: Sensitivity, specifi city, NPV, PPV and accuracy for PCa was 85.7% (same for all metrics) for R1 and 81.6%, 79.6%, 81.2%, 80.0% and 80.6% for R2. For detecting sPCa, the corresponding values were 95.3%, 85.4%, 95.9%, 83.7% and 89.8% for R1 and 93.0%, 81.8%, 93.7%, 86.7% and 86.7% for R2. There was substantial interobserver agreement in assigning PI-RADS v2 score as negative (1, 2, 3) or positive (4, 5) (Kappa=0.78). On multivariate analysis, PI-RADS v2 (p <0.001) was the only independent predictor of sPCa compared with age, abnormal DRE, prostate volume, PSA and PSA density.

Conclusions: Our study population demonstrated that PI-RADS v2 had high diagnostic accuracy, substantial interobserver agreement, and it was the only independent predictor of sPCa.

Keywords: Prostate; Magnetic Resonance Imaging; Neoplasms; Prostatic Neoplasms

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