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Endorectal MR imaging of prostate cancer: Evaluation of tumor capsular contact length as a sign of extracapsular extension

  • Gustavo Mendez
    Correspondence
    Corresponding author at: Department of Radiology, University of Chicago, 5841 S. Maryland Ave. M/C 2026, Chicago, IL 60637, United States.
    Affiliations
    Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States
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  • Bryan R. Foster
    Affiliations
    Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States
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  • Author Footnotes
    1 XL and JS supported by DOD Synergy Award W81XWH-12-1-0169 PC110361P1.
    Xin Li
    Footnotes
    1 XL and JS supported by DOD Synergy Award W81XWH-12-1-0169 PC110361P1.
    Affiliations
    Advanced Imaging Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States
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  • Author Footnotes
    1 XL and JS supported by DOD Synergy Award W81XWH-12-1-0169 PC110361P1.
    Jackilen Shannon
    Footnotes
    1 XL and JS supported by DOD Synergy Award W81XWH-12-1-0169 PC110361P1.
    Affiliations
    OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States
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  • Mark Garzotto
    Affiliations
    Department of Urology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States

    Portland VA Medical Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States
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  • Christopher L. Amling
    Affiliations
    Department of Urology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States
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  • Fergus V. Coakley
    Affiliations
    Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States
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  • Author Footnotes
    1 XL and JS supported by DOD Synergy Award W81XWH-12-1-0169 PC110361P1.

      Highlights

      • 101 patients underwent endorectal multiparametric prostate MR imaging prior to radical prostatectomy for prostate cancer
      • Extracapsular extension was found at histopathological review in 27 patients
      • Tumor capsular contact length of 18 to 24 mm or more should be regarded as highly suggestive of extracapsular extension.

      Abstract

      Objective

      To evaluate the length of contact between dominant tumor foci and the prostatic capsule as a sign of extracapsular extension at endorectal multiparametric MR imaging.

      Materials and methods

      We retrospectively identified 101 patients over a three-year interval who underwent endorectal multiparametric prostate MR imaging prior to radical prostatectomy for prostate cancer. Two readers identified the presence of dominant tumor focus (largest lesion with PI-RADS version 2 score of 4 or 5), and measured the length of tumor capsular contact and likelihood of extracapsular extension by standard criteria (1–5 Likert scale). Results were analyzed using histopathological review as reference standard.

      Results

      Extracapsular extension was found at histopathological review in 27 patients. Reader 1 (2) identified dominant tumor in 79 (73) patients, with mean tumor capsular contact length of 18.2 (14.0) mm. The area under the receiver operating characteristic curve for identification of extracapsular extension by tumor capsular contact length was 0.76 for reader 1 and 0.77 for reader 2, with optimal discrimination at values of 18 mm and 21 mm, respectively. In the subset of patients without obvious extracapsular extension by standard criteria (Likert scores 1–3), corresponding values were 0.74 and 0.66 with optimal thresholds of 24 and 21 mm.

      Conclusion

      Length of contact between the dominant tumor focus and the capsule is a moderately useful sign of extracapsular extension at endorectal multiparametric prostate MR imaging, including the subset of patients without obvious extracapsular extension by standard criteria, with optimal discrimination at threshold values of 18 to 24 mm.

      Keywords

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