Evaluation of the European Society of Urogenital Radiology (ESUR) PI-RADS scoring system for assessment of extra-prostatic extension in prostatic carcinoma.

To evaluate extra-prostatic extension (EPE) comparing PI-RADS to non-standardized reporting.

With IRB approval, 145 consecutive patients underwent radical prostatectomy (RP) and multi-parametric (T2W+DWI+DCE) MRI between 2012 and 2013.

Eighty patients (66.3% with EPE) were staged without PI-RADS and 65 patients (64.6% with EPE) were staged using a 5-point PI-RADS scoring system. Studies were reported by fellowship-trained radiologists in routine clinical practice. Individual PIRADS scores were assessed using ROC to determine the score which optimized sensitivity/specificity. Diagnostic accuracy for EPE was compared with/without PI-RADS using the McNemar test. Subgroup analysis by radiologist experience was performed using Spearman correlation and chi-square.

Area under ROC curve for EPE using PI-RADS was 0.62 and optimal sensitivity/specificity was achieved with PI-RADS score ≥3. Compared to non-standardized reporting, sensitivity for EPE improved with PI-RADS (59.5% [49.1-68.2] vs. 24.5% [16.7-31.2]), p=0.01; with no difference in specificity (68.0% [50.5-82.6]) vs. (75.0% [60.1-87.6]), p=0.06. Overall accuracy improved with PI-RADS (62.7% [49.6-73.6] vs. 42.0% [31.7-50.7%]), p=0.006. Diagnostic accuracy was better among experienced radiologists without PI-RADS (p=0.005); however, there was no difference in accuracy by reader experience using PI-RADS (p=0.24).

The PI-RADS criteria for EPE improves sensitivity without reducing specificity. PI-RADS may reduce differences in accuracy by reader experience.

European journal of radiology 2015 Jun 20 [Epub ahead of print]

Nicola Schieda, Jeffrey S Quon, Christopher Lim, Mohammed El-Khodary, Wael Shabana, Vivek Singh, Christopher Morash, Rodney H Breau, Matthew D F McInnes, Trevor A Flood

The Ottawa Hospital, The University of Ottawa, Canada Electronic address: nschieda@toh on ca , The Ottawa Hospital, The University of Ottawa, Canada Electronic address: jquon@toh on ca , The Ottawa Hospital, The University of Ottawa, Canada Electronic address: clim@toh on ca , The Ottawa Hospital, The University of Ottawa, Canada Electronic address: melkhodary@toh on ca , The Ottawa Hospital, The University of Ottawa, Canada Electronic address: wshabana@toh on ca , The Ottawa Hospital, The University of Ottawa, Canada Electronic address: vsingh@toh on ca , The Ottawa Hospital, The University of Ottawa, Department of Surgery, Division of Urology, Canada Electronic address: cmorash@toh on ca , The Ottawa Hospital, The University of Ottawa, Department of Surgery, Division of Urology, Canada Electronic address: rbreau@toh on ca , The Ottawa Hospital, The University of Ottawa, Canada Electronic address: mmcinnes@ottawahospital on ca , The Ottawa Hospital, The University of Ottawa, Department of Anatomical Pathology, Canada  

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