Prostate multiparametric magnetic resonance imaging (mpMRI) improves diagnosis of clinically significant cancer and reduces over-detection of nonsignificant cancer. Disagreement in the interpretation of mpMRI readings is well-known, with a reported discrepancy rate of 10% to 42%. We report the clinical repercussions of this variability on prostate biopsy candidates.
Medical records of patients referred from 11 medical centers for MR-guided prostate biopsy (MRGpB) between October, 2017 and January, 2019 were retrospectively analyzed. Patients with at least one prostate imaging reporting and data system (PI-RADS) 3 or greater prostate lesion were selected, and the mpMRI studies (all read by others) were reviewed by our prostate mpMRI reader. Outcomes included changes in PI-RADS score and the subsequent effect on total needle samples and indication for biopsy.
Eighty-two patients with 128 lesions were suitable for analysis (mean age 66.5 ± 7.1 years, mean PSA 6.8 ± 8.5 ng/ml). Nine (11%) patients had suspicious rectal exams (T2a). Following our prostate mpMRI reader's imaging revisions, the PI-RADS score was downgraded in 66 (52%) lesions, upgraded in 15 (12%), and unchanged in 47 (37%), leaving a total of 84 suspected lesions (kappa = 0.17). Biopsy was deferred in 22 (27%) patients, and an estimated 136.4 (34.4%) samples were avoided (P = 0.0001 for both). There was a trend toward prostate size to correlate with imaging revision and abortion of biopsy (P = 0.06) while enrollment in active surveillance correlated with proof from such outcome (P = 0.007).
These data suggest that high interobserver disagreement in prostate mpMRIs from diverse institutes significantly affects prostate biopsy practice. The clinical consequences of this discord are significant.
Urologic oncology. 2020 Apr 15 [Epub ahead of print]
Barak Rosenzweig, Yael Laitman, Dorit E Zilberman, Orit Raz, Jacob Ramon, Zohar A Dotan, Orith Portnoy
Department of Urology, Chaim Sheba Medical Center, Ramat Gan, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. Electronic address: ., Oncogenetics Unit, Institute of Human Genetics, and Meirav High Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Israel., Department of Urology, Chaim Sheba Medical Center, Ramat Gan, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel., Assuta Ashdod University Hospital, Ashdod, Israel., The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel.