Abstract
Objective
To compare test performance of multiparametric magnetic resonance imaging (mpMRI)
for detection of prostate cancer between individual radiologists using the Prostate
Imaging Reporting and Data System (PI-RADS) and to identify clinical factors that
may predict test performance.
Materials and Methods
We examined our database of consecutive men who received prostate mpMRI prior to biopsy
between September 2014 and December 2016 (n = 459). Test performance (eg, sensitivity,
specificity, positive predictive value [PPV] and negative predictive value) were defined
with PI-RADS classification 4 or 5 considered test positive and Gleason score ≥7 on
biopsy from any targeted core considered outcome positive. Multivariate logistic regression
was performed to identify clinical variables that affect test performance.
Results
No significant differences in test performance were found among individual radiologists.
Prior biopsy (odds ratio [OR] 0.10, P = .01), radiologist experience >500 prostate mpMRI (OR 0.18, P = .04), transition zone location (OR 0.10, P = .04), and posterior location (OR 0.04, P = .03) were predictors of diminished sensitivity. Location of the mpMRI lesion in
the TZ was a predictor of improved specificity (OR 2.53, P = .04). Increasing age (OR 1.07, P <.01) and prostate-specific antigen (OR 1.10, P <.01) predicted increased PPV, while prior biopsy predicted decreased PPV (OR 0.50,
P <.01).
Conclusion
Although variation exists in test performance among individual radiologists using
PI-RADS, significant differences were not observed. Additional prostate mpMRI experience
was not beneficial in improving accuracy of interpretation. Nonmodifiable patient
variables—including prostate lesion location, prior biopsy history, prostate-specific
antigen, and age—are predictive of prostate mpMRI test performance.
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Article info
Publication history
Published online: February 23, 2019
Accepted:
January 16,
2019
Received:
October 9,
2018
Footnotes
Financial Disclosures: None.
Conflicts of Interest: None.
Funding/Support: We did not receive funding specifically for this study.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
