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Value of prostate multiparametric magnetic resonance imaging for predicting biopsy results in first or repeat biopsy

2013; Elsevier BV; Volume: 69; Issue: 3 Linguagem: Inglês

10.1016/j.crad.2013.10.018

1365-229X

Hocine Habchi, Flavie Bratan, A. Paye, G. Pagnoux, Thomas Sanzalone, F. Mège-Lechevallier, Sébastien Crouzet, Marc Colombel, Muriel Rabilloud, Olivier Rouvière,

MRI in cancer diagnosis

Aim To assess multiparametric magnetic resonance imaging (mp-MRI) in predicting prostate biopsy results. Materials and methods Patients who underwent mp-MRI prior to prostate biopsy were prospectively included. The prostate was subdivided into 14 sectors and mp-MRI findings assessed using a five-level subjective suspicion score (SSS). Biopsy included targeted samples of abnormal sectors and systematic samples of normal peripheral zone sectors. Results Two hundred and eighty-eight patients were included [153 biopsy naïve, 135 with negative (n = 51) or positive (n = 84) prior biopsy]. Biopsy was positive in 168 patients. mp-MRI area under the receiver operating characteristic (ROC) curve (AUC) was 69.1% (95% CI: 67.1–70.9%), 72.5% (95% CI: 69.5–76%), and 73.8% (95% CI: 68.3–79.3%) at per sector, per lobe, and per patient analysis, respectively. At the per sector level, the AUC was significantly larger if detection was limited to cancers with a Gleason score of ≥7 (72.6%; 95% CI: 69.8–75.8%; p < 0.01) or ≥8 (87.1%; 95% CI: 78.3–95.7%; p < 0.01). mp-MRI performance was significantly influenced by prostate volume (p = 0.02), the presence of a concordant hypoechoic area (p < 0.001), but not by prostate-specific antigen (PSA) value, status of prior biopsy, or radiologists' experience. SSS was significantly associated with the Gleason score in true-positive lobes and patients (p < 0.0001). Using a SSS threshold of ≥3, cancer was missed in 13/102 lobes and 4/72 patients with cancers of Gleason score ≥7. Conclusion mp-MRI provides a good detection of cancers with a Gleason score of ≥7 in candidates suitable for prostate biopsy. To assess multiparametric magnetic resonance imaging (mp-MRI) in predicting prostate biopsy results. Patients who underwent mp-MRI prior to prostate biopsy were prospectively included. The prostate was subdivided into 14 sectors and mp-MRI findings assessed using a five-level subjective suspicion score (SSS). Biopsy included targeted samples of abnormal sectors and systematic samples of normal peripheral zone sectors. Two hundred and eighty-eight patients were included [153 biopsy naïve, 135 with negative (n = 51) or positive (n = 84) prior biopsy]. Biopsy was positive in 168 patients. mp-MRI area under the receiver operating characteristic (ROC) curve (AUC) was 69.1% (95% CI: 67.1–70.9%), 72.5% (95% CI: 69.5–76%), and 73.8% (95% CI: 68.3–79.3%) at per sector, per lobe, and per patient analysis, respectively. At the per sector level, the AUC was significantly larger if detection was limited to cancers with a Gleason score of ≥7 (72.6%; 95% CI: 69.8–75.8%; p < 0.01) or ≥8 (87.1%; 95% CI: 78.3–95.7%; p < 0.01). mp-MRI performance was significantly influenced by prostate volume (p = 0.02), the presence of a concordant hypoechoic area (p < 0.001), but not by prostate-specific antigen (PSA) value, status of prior biopsy, or radiologists' experience. SSS was significantly associated with the Gleason score in true-positive lobes and patients (p < 0.0001). Using a SSS threshold of ≥3, cancer was missed in 13/102 lobes and 4/72 patients with cancers of Gleason score ≥7. mp-MRI provides a good detection of cancers with a Gleason score of ≥7 in candidates suitable for prostate biopsy.