Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer before Robot-Assisted Radical Prostatectomy
<i>Background:</i> The accuracy of multi-parametric MRI (mpMRI) in the pre-operative staging of prostate cancer (PCa) remains controversial. <i>Objective:</i> The purpose of this study was to evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (E...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-04-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/12/5/1057 |
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| author | Eoin Dinneen Clare Allen Tom Strange Daniel Heffernan-Ho Jelena Banjeglav Jamie Lindsay John-Patrick Mulligan Tim Briggs Senthil Nathan Ashwin Sridhar Jack Grierson Aiman Haider Christos Panayi Dominic Patel Alex Freeman Jonathan Aning Raj Persad Imran Ahmad Lorenzo Dutto Neil Oakley Alessandro Ambrosi Tom Parry Veeru Kasivisvanathan Francesco Giganti Greg Shaw Shonit Punwani |
| author_facet | Eoin Dinneen Clare Allen Tom Strange Daniel Heffernan-Ho Jelena Banjeglav Jamie Lindsay John-Patrick Mulligan Tim Briggs Senthil Nathan Ashwin Sridhar Jack Grierson Aiman Haider Christos Panayi Dominic Patel Alex Freeman Jonathan Aning Raj Persad Imran Ahmad Lorenzo Dutto Neil Oakley Alessandro Ambrosi Tom Parry Veeru Kasivisvanathan Francesco Giganti Greg Shaw Shonit Punwani |
| author_sort | Eoin Dinneen |
| collection | DOAJ |
| description | <i>Background:</i> The accuracy of multi-parametric MRI (mpMRI) in the pre-operative staging of prostate cancer (PCa) remains controversial. <i>Objective:</i> The purpose of this study was to evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (EPE) on a side-specific basis using a risk-stratified 5-point Likert scale. This study also aimed to assess the influence of mpMRI scan quality on diagnostic accuracy. <i>Patients and Methods:</i> We included 124 men who underwent robot-assisted RP (RARP) as part of the NeuroSAFE PROOF study at our centre. Three radiologists retrospectively reviewed mpMRI blinded to RP pathology and assigned a Likert score (1–5) for EPE on each side of the prostate. Each scan was also ascribed a Prostate Imaging Quality (PI-QUAL) score for assessing the quality of the mpMRI scan, where 1 represents the poorest and 5 represents the best diagnostic quality. <i>Outcome measurements and statistical analyses:</i> Diagnostic performance is presented for the binary classification of EPE, including 95% confidence intervals and the area under the receiver operating characteristic curve (AUC). <i>Results:</i> A total of 231 lobes from 121 men (mean age 56.9 years) were evaluated. Of these, 39 men (32.2%), or 43 lobes (18.6%), had EPE. A Likert score ≥3 had a sensitivity (SE), specificity (SP), NPV, and PPV of 90.4%, 52.3%, 96%, and 29.9%, respectively, and the AUC was 0.82 (95% CI: 0.77–0.86). The AUC was 0.76 (95% CI: 0.64–0.88), 0.78 (0.72–0.84), and 0.92 (0.88–0.96) for biparametric scans, PI-QUAL 1–3, and PI-QUAL 4–5 scans, respectively. <i>Conclusions:</i> MRI can be used effectively by genitourinary radiologists to rule out EPE and help inform surgical planning for men undergoing RARP. EPE prediction was more reliable when the MRI scan was (a) multi-parametric and (b) of a higher image quality according to the PI-QUAL scoring system. |
| first_indexed | 2024-03-10T03:03:48Z |
| format | Article |
| id | doaj.art-5bb7fe416c324a44a12c36ef12decbd2 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T03:03:48Z |
| publishDate | 2022-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-5bb7fe416c324a44a12c36ef12decbd22023-11-23T10:38:43ZengMDPI AGDiagnostics2075-44182022-04-01125105710.3390/diagnostics12051057Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer before Robot-Assisted Radical ProstatectomyEoin Dinneen0Clare Allen1Tom Strange2Daniel Heffernan-Ho3Jelena Banjeglav4Jamie Lindsay5John-Patrick Mulligan6Tim Briggs7Senthil Nathan8Ashwin Sridhar9Jack Grierson10Aiman Haider11Christos Panayi12Dominic Patel13Alex Freeman14Jonathan Aning15Raj Persad16Imran Ahmad17Lorenzo Dutto18Neil Oakley19Alessandro Ambrosi20Tom Parry21Veeru Kasivisvanathan22Francesco Giganti23Greg Shaw24Shonit Punwani25Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UKDepartment of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UKDepartment of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UKDepartment of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UKDepartment of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UKDepartment of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UKDepartment of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UKDepartment of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UKDepartment of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UKDepartment of Urology, University College Hospital London, Westmoreland Street Hospital, 16-18 Westmoreland Street, London W1G 8PH, UKDivision of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UKDepartment of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UKDepartment of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UKDepartment of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UKDepartment of Histopathology, University College Hospital London, 235 Euston Road, London NW1 2BU, UKNorth Bristol Hospitals Trust, Department of Urology, Southmead Hospital, Southmead Lane, Westbury-on-Trym, Bristol BS10 5NB, UKNorth Bristol Hospitals Trust, Department of Urology, Southmead Hospital, Southmead Lane, Westbury-on-Trym, Bristol BS10 5NB, UKDepartment of Urology, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, 1345 Govan Road, Glasgow G51 4TF, UKDepartment of Urology, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, 1345 Govan Road, Glasgow G51 4TF, UKDepartment of Urology, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UKFaculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milano, ItalyCentre for Medical Imaging, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London W1W 7TS, UKDivision of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UKDivision of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UKDivision of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London W1W 7TS, UKDepartment of Radiology, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK<i>Background:</i> The accuracy of multi-parametric MRI (mpMRI) in the pre-operative staging of prostate cancer (PCa) remains controversial. <i>Objective:</i> The purpose of this study was to evaluate the ability of mpMRI to accurately predict PCa extra-prostatic extension (EPE) on a side-specific basis using a risk-stratified 5-point Likert scale. This study also aimed to assess the influence of mpMRI scan quality on diagnostic accuracy. <i>Patients and Methods:</i> We included 124 men who underwent robot-assisted RP (RARP) as part of the NeuroSAFE PROOF study at our centre. Three radiologists retrospectively reviewed mpMRI blinded to RP pathology and assigned a Likert score (1–5) for EPE on each side of the prostate. Each scan was also ascribed a Prostate Imaging Quality (PI-QUAL) score for assessing the quality of the mpMRI scan, where 1 represents the poorest and 5 represents the best diagnostic quality. <i>Outcome measurements and statistical analyses:</i> Diagnostic performance is presented for the binary classification of EPE, including 95% confidence intervals and the area under the receiver operating characteristic curve (AUC). <i>Results:</i> A total of 231 lobes from 121 men (mean age 56.9 years) were evaluated. Of these, 39 men (32.2%), or 43 lobes (18.6%), had EPE. A Likert score ≥3 had a sensitivity (SE), specificity (SP), NPV, and PPV of 90.4%, 52.3%, 96%, and 29.9%, respectively, and the AUC was 0.82 (95% CI: 0.77–0.86). The AUC was 0.76 (95% CI: 0.64–0.88), 0.78 (0.72–0.84), and 0.92 (0.88–0.96) for biparametric scans, PI-QUAL 1–3, and PI-QUAL 4–5 scans, respectively. <i>Conclusions:</i> MRI can be used effectively by genitourinary radiologists to rule out EPE and help inform surgical planning for men undergoing RARP. EPE prediction was more reliable when the MRI scan was (a) multi-parametric and (b) of a higher image quality according to the PI-QUAL scoring system.https://www.mdpi.com/2075-4418/12/5/1057extra-prostatic extensionmagnetic resonance imagingradical prostatectomynerve-sparingprostate cancerstaging |
| spellingShingle | Eoin Dinneen Clare Allen Tom Strange Daniel Heffernan-Ho Jelena Banjeglav Jamie Lindsay John-Patrick Mulligan Tim Briggs Senthil Nathan Ashwin Sridhar Jack Grierson Aiman Haider Christos Panayi Dominic Patel Alex Freeman Jonathan Aning Raj Persad Imran Ahmad Lorenzo Dutto Neil Oakley Alessandro Ambrosi Tom Parry Veeru Kasivisvanathan Francesco Giganti Greg Shaw Shonit Punwani Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer before Robot-Assisted Radical Prostatectomy Diagnostics extra-prostatic extension magnetic resonance imaging radical prostatectomy nerve-sparing prostate cancer staging |
| title | Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer before Robot-Assisted Radical Prostatectomy |
| title_full | Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer before Robot-Assisted Radical Prostatectomy |
| title_fullStr | Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer before Robot-Assisted Radical Prostatectomy |
| title_full_unstemmed | Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer before Robot-Assisted Radical Prostatectomy |
| title_short | Negative mpMRI Rules Out Extra-Prostatic Extension in Prostate Cancer before Robot-Assisted Radical Prostatectomy |
| title_sort | negative mpmri rules out extra prostatic extension in prostate cancer before robot assisted radical prostatectomy |
| topic | extra-prostatic extension magnetic resonance imaging radical prostatectomy nerve-sparing prostate cancer staging |
| url | https://www.mdpi.com/2075-4418/12/5/1057 |
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