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Characterization and PI-RADS version 2 assessment of prostate cancers missed by prebiopsy 3-T multiparametric MRI: Correlation with whole-mount thin-section histopathology

  • Kye Jin Park
    Affiliations
    Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul 05507, Republic of Korea
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  • Mi-hyun Kim
    Correspondence
    Corresponding author at: Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Republic of Korea.
    Affiliations
    Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul 05507, Republic of Korea
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  • Jeong Kon Kim
    Affiliations
    Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul 05507, Republic of Korea
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  • Kyoung-Sik Cho
    Affiliations
    Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul 05507, Republic of Korea
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      Highlights

      • Multiparametric MRI can miss a clinically significant prostate cancer.
      • Prostate cancers can be missed if the tumour volume is below 1 cm3.
      • Not all clinically significant prostate cancers can be demonstrated on multiparametric MRI.

      Abstract

      Objectives

      To determine the clinical and histopathologic characteristics of missed prostate cancers and their Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score on a pre-biopsy MRI and subsequent MR-ultrasound (US) fusion biopsy.

      Methods

      We analysed 59 prostate cancer patients who underwent a 3-T MRI prior to an MR-US fusion biopsy and subsequent radical prostatectomy. A radiologist initially reviewed these cases to correlate target lesions and pathology-proven lesions. The patients were categorized as detected or missed prostate cancer cases. Three radiologists independently assigned the PI-RADS v2 score for each case. The missed lesions were further categorized as suspicious or invisible by consensus. The clinical characteristics, PI-RADS v2 scores, and histopathologic features were thereby obtained.

      Results

      Thirty seven (62.7%) of the 59 study cases had a detected prostate cancer and 22 (37.3%) as having missed cancer. Seventeen (77.3%) of the 22 missed patients had a clinically significant lesion. The missed cancer cases had a smaller tumour volume, and higher ADC ratio than the detected cancer cases. Fourteen (63.6%) of the missed lesions were not visible on MRI, even though 71.4% of these cancers were clinically significant. Invisible but clinically significant cancers had a tumour volume below 1 cm3 in 70% of cases.

      Conclusions

      A negative MRI result does not rule out the current PI-RADS v2 definition of a clinically significant prostate cancer as these tumours can be missed if their volume is below 1 cm3.

      Abbreviations:

      mpMRI (multiparametric magnetic resonance imaging), TRUS (transrectal ultrasound), PI-RADS v2 (the Prostate Imaging–Reporting and Data system version 2), RP (radical prostatectomy), MR-US (magnetic resonance-ultrasound), PSA (prostate-specific antigen), GS (Gleason score), ROI (region-of-interest), ICC (intraclass correlation coefficient)

      Keywords

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