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PI-RADS Version 2: Detection of Clinically Significant Cancer in Patients With Biopsy Gleason Score 6 Prostate Cancer

 Ji Won Seo  ;  Su-Jin Shin  ;  Young Taik Oh  ;  Dae Chul Jung  ;  Nam Hoon Cho  ;  Young Deuk Choi  ;  Sung Yoon Park 
 American Journal of Roentgenology, Vol.209(1) : W1-W9, 2017 
Journal Title
 American Journal of Roentgenology 
Issue Date
Adult ; Aged ; Aged, 80 and over ; Biopsy ; Humans ; Magnetic Resonance Imaging/methods* ; Male ; Middle Aged ; Neoplasm Grading ; Predictive Value of Tests ; Prostate-Specific Antigen/blood ; Prostatectomy ; Prostatic Neoplasms/diagnostic imaging* ; Prostatic Neoplasms/pathology* ; Prostatic Neoplasms/surgery ; Retrospective Studies ; Sensitivity and Specificity ; Tumor Burden
Gleason score ; MRI ; PI-RADS ; clinically significant cancer ; prostate cancer
OBJECTIVE: The purpose of this study was to analyze the utility of the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) in the detection of a clinically significant cancers in patients with prostate cancers with a biopsy Gleason score of 6. MATERIALS AND METHODS: A group of 182 consecutively registered patients with biopsy-proven prostate cancer with a Gleason score of 6 underwent MRI and radical prostatectomy. Clinically significant cancer was surgically defined as Gleason score of 7 or greater, tumor volume of 0.5 cm3 or greater, or tumor category T3 or greater. Clinical parameters (prostate-specific antigen level, greatest percentage of biopsy core, and percentage of positive cores) and the PI-RADSv2 ratings by three independent readers (experienced readers 1 and 2, inexperienced reader 3) were investigated. Cutoffs and the diagnostic performance of PI-RADSv2 for clinically significant cancer were analyzed. RESULTS: Clinically significant cancer was found in 87.4% (159/182) of patients. The cutoff PI-RADSv2 score for clinically significant cancer was 4 for readers 1 and 2 and 5 for reader 3. The AUCs were 0.829 and 0.853 for readers 1 and 2 (p < 0.001) and 0.602 for reader 3 (p = 0.067). For reader 1, sensitivity was 89.9% (143/159); specificity, 69.6% (16/23); positive predictive value, 95.3% (143/150); negative predictive value, 50.0% (16/32); and accuracy, 87.4% (159/182). The corresponding values for reader 2 were 81.1% (129/159), 82.6% (19/23), 97.0% (129/133), 38.8% (19/49), and 81.3% (148/182). For the experienced readers, 66.7-81.3% of patients with false-negative results had clinically significant cancers with tumor volume less than 1 cm3. CONCLUSION: PI-RADSv2 may help experienced readers identify clinically significant prostate cancers in patients with a biopsy Gleason score of 6. However, some small (< 1 cm3) clinically significant cancers can be missed when PI-RADSv2 is used.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
박성윤(Park, Sung Yoon)
서지원(Seo, Ji Won)
신수진(Shin, Su Jin)
오영택(Oh, Young Taik) ORCID logo https://orcid.org/0000-0002-4438-8890
정대철(Jung, Dae Chul) ORCID logo https://orcid.org/0000-0001-5769-5083
조남훈(Cho, Nam Hoon) ORCID logo https://orcid.org/0000-0002-0045-6441
최영득(Choi, Young Deuk) ORCID logo https://orcid.org/0000-0002-8545-5797
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