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A Grading System for the Assessment of Risk of Extraprostatic Extension of Prostate Cancer at Multiparametric MRI

Mehralivand, Sherif ; Shih, Joanna H ; Harmon, Stephanie ; Smith, Clayton ; Bloom, Jonathan ; Czarniecki, Marcin ; Gold, Samuel ; Hale, Graham ; Rayn, Kareem ; Merino, Maria J ; Wood, Bradford J ; Pinto, Peter A ; Choyke, Peter L ; Turkbey, Baris

Radiology, 2019-03, Vol.290 (3), p.709-719 [Periódico revisado por pares]

United States: Radiological Society of North America

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  • Título:
    A Grading System for the Assessment of Risk of Extraprostatic Extension of Prostate Cancer at Multiparametric MRI
  • Autor: Mehralivand, Sherif ; Shih, Joanna H ; Harmon, Stephanie ; Smith, Clayton ; Bloom, Jonathan ; Czarniecki, Marcin ; Gold, Samuel ; Hale, Graham ; Rayn, Kareem ; Merino, Maria J ; Wood, Bradford J ; Pinto, Peter A ; Choyke, Peter L ; Turkbey, Baris
  • Assuntos: Humans ; Male ; Middle Aged ; Multiparametric Magnetic Resonance Imaging ; Neoplasm Grading ; Original Research ; Prospective Studies ; Prostate-Specific Antigen - blood ; Prostatectomy ; Prostatic Neoplasms - diagnostic imaging ; Prostatic Neoplasms - pathology ; Prostatic Neoplasms - surgery ; Risk ; Robotic Surgical Procedures
  • É parte de: Radiology, 2019-03, Vol.290 (3), p.709-719
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
    content type line 23
    This project has been funded in whole or in part with federal funds from the National Cancer Institute, National Institutes of Health, under Contract No. HHSN261200800001E. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
    Author contributions: Guarantors of integrity of entire study, S.M., K.R., B.T.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, S.M., C.S., J.B., S.G., G.H., K.R., B.T.; clinical studies, S.H., C.S., K.R., M.J.M., B.J.W., P.A.P., P.L.C., B.T.; statistical analysis, S.M., J.H.S., S.G., K.R., B.T.; and manuscript editing, all authors
  • Descrição: Purpose To evaluate MRI features associated with pathologically defined extraprostatic extension (EPE) of prostate cancer and to propose an MRI grading system for pathologic EPE. Materials and Methods In this prospective study, consecutive male study participants underwent preoperative 3.0-T MRI from June 2007 to March 2017 followed by robotic-assisted laparoscopic radical prostatectomy. An MRI-based EPE grading system was defined as follows: curvilinear contact length of 1.5 cm or capsular bulge and irregularity were grade 1, both features were grade 2, and frank capsular breach were grade 3. Multivariable logistic regression and decision curve analyses were performed to compare the MRI grade model and clinical parameters (prostate-specific antigen, Gleason score) for pathologic EPE prediction by using the area under the receiver operating characteristic curve (AUC) value. Results Among 553 study participants, the mean age was 60 years ± 8 (standard deviation); the median prostate-specific antigen value was 6.3 ng/mL. A total of 125 of 553 (22%) participants had pathologic EPE at radical prostatectomy. Detection of pathologic EPE, defined as number of pathologic EPEs divided by number of participants with individual MRI features, was as follows: curvilinear contact length, 88 of 208 (42%); capsular bulge and irregularity, 78 of 175 (45%); and EPE visible at MRI, 37 of 56 (66%). For MRI, grades 1, 2, and 3 for detection of pathologic EPE were 18 of 74 (24%), 39 of 102 (38%), and 37 of 56 (66%), respectively. Clinical features plus the MRI-based EPE grading system (prostate-specific antigen, International Society of Urological Pathology stage, MRI grade) predicted pathologic EPE better than did MRI grade alone (AUC, 0.81 vs 0.77, respectively; P < .001). Conclusion Higher MRI-based extraprostatic extension (EPE) grading categories were associated with a greater risk of pathologic EPE. Clinical features plus MRI grading had the highest diagnostic performance for prediction of pathologic EPE. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Eberhardt in this issue.
  • Editor: United States: Radiological Society of North America
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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