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Evaluation of the PI-RADS scoring system for mpMRI of the prostate: a whole-mount step-section analysis

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World Journal of Urology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 12 February 2015

Abstract

Purpose

Evaluation of the Prostate Imaging Reporting and Data System (PI-RADS) scoring system for classifying multi-parametric magnetic resonance imaging findings of the prostate using whole-mount step-section slides as reference standard.

Materials and methods

Prospective inclusion of 50 consecutive patients with biopsy-proven prostate cancer (PCa). All patients received a multi-parametric MRI of the prostate, consisting of T2-weighted, diffusion-weighted, and dynamic contrast-enhanced MRI. After prostatectomy, all prostates were prepared as whole-mount step-section slides. For each patient, six lesions were predefined on whole-mount step-sections according to a distinct scheme and the corresponding regions were identified on MRI. Each lesion then was scored on MRI according to PI-RADS by an experienced blinded uro-radiologist and compared with histopathological findings.

Results

PCa received significant (p < 0.01) higher overall PI-RADS scores (4.10 ± 0.75) compared with benign changes (2.00 ± 0.74). In the peripheral zone, each single modality score showed good diagnostic accuracy for PCa detection (area under the curve [AUC] > 0.90). When combining all single modality scores, an even higher discriminative ability of PCa detection (AUC = 0.97, 95 % CI 0.95–0.99) could be achieved. In contrast, in the transitional zone, dynamic contrast-enhanced MRI (DCE) showed very low diagnostic accuracy (AUC = 0.60). Regarding tumor malignancy, no high-grade PCa (Gleason >7a) was present at PI-RADS scores <4 and no Gleason 6 PCa at a PI-RADS score of 5.

Conclusion

The PI-RADS scoring system showed good diagnostic accuracy: Only PI-RADS 4 and 5 showed high-grade PCa. However, it seems necessary to revise the PI-RADS scoring system concerning DCE in the transitional zone.

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Conflict of interest

None.

Ethical standard

The current study has been approved by the local ethics committee in Innsbruck (Study number: AN4468 304/4.17) and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients gave their informed consent prior to their inclusion in the study.

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Authors and Affiliations

  1. Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria

    Daniel Junker, Werner Jaschke & Friedrich Aigner

  2. Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany

    Michael Quentin

  3. Landeskrankenhaus Hall, Abteilung für Urologie und Andrologie, Milser Straße 10, 6060, Hall in Tirol, Austria

    Udo Nagele

  4. Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Schopfstraße 41/1, 6020, Innsbruck, Austria

    Michael Edlinger

  5. Royal Sussex County Hospital, Brighton, BN2 5BE, UK

    Jonathan Richenberg

  6. Department of Pathology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria

    Georg Schaefer

  7. Department of Urology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria

    Georg Schaefer, Michael Ladurner & Wolfgang Horninger

Authors
  1. Daniel Junker
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  2. Michael Quentin
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  3. Udo Nagele
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  4. Michael Edlinger
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  8. Werner Jaschke
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  9. Wolfgang Horninger
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  10. Friedrich Aigner
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Corresponding author

Correspondence to Daniel Junker.

Additional information

Daniel Junker and Michael Quentin equally contributed for this work.

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Junker, D., Quentin, M., Nagele, U. et al. Evaluation of the PI-RADS scoring system for mpMRI of the prostate: a whole-mount step-section analysis. World J Urol 33, 1023–1030 (2015). https://doi.org/10.1007/s00345-014-1370-x

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  • DOI: https://doi.org/10.1007/s00345-014-1370-x

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