False Positive Multiparametric Magnetic Resonance Imaging Phenotypes in the Biopsy-naïve Prostate: Are They Distinct from Significant Cancer-associated Lesions? Lessons from PROMIS.

Biopsy False Positive Reactions Humans Male Multiparametric Magnetic Resonance Imaging Phenotype Prostate Prostate-Specific Antigen Prostatic Neoplasms / diagnostic imaging
False positive lesions Multiparametric magnetic resonance imaging PROMIS Prostate cancer

Journal

European urology
ISSN: 1873-7560
Titre abrégé: Eur Urol
Pays: Switzerland
ID NLM: 7512719

Informations de publication

Date de publication:
01 2021
Historique:
received: 24 03 2020
accepted: 21 09 2020
pubmed: 15 10 2020
medline: 28 9 2021
entrez: 14 10 2020
Statut: ppublish

Résumé

False positive multiparametric magnetic resonance imaging (mpMRI) phenotypes prompt unnecessary biopsies. The Prostate MRI Imaging Study (PROMIS) provides a unique opportunity to explore such phenotypes in biopsy-naïve men with raised prostate-specific antigen (PSA) and suspected cancer. To compare mpMRI lesions in men with/without significant cancer on transperineal mapping biopsy (TPM). PROMIS participants (n=235) underwent mpMRI followed by a combined biopsy procedure at University College London Hospital, including 5-mm TPM as the reference standard. Patients were divided into four mutually exclusive groups according to TPM findings: (1) no cancer, (2) insignificant cancer, (3) definition 2 significant cancer (Gleason ≥3+4 of any length and/or maximum cancer core length ≥4mm of any grade), and (4) definition 1 significant cancer (Gleason ≥4+3 of any length and/or maximum cancer core length ≥6mm of any grade). Index and/or additional lesions present in 178 participants were compared between TPM groups in terms of number, conspicuity, volume, location, and radiological characteristics. Most lesions were located in the peripheral zone. More men with significant cancer had two or more lesions than those without significant disease (67% vs 37%; p< 0.001). In the former group, index lesions were larger (mean volume 0.68 vs 0.50 ml; p< 0.001, Wilcoxon test), more conspicuous (Likert 4-5: 79% vs 22%; p< 0.001), and diffusion restricted (mean apparent diffusion coefficient [ADC]: 0.73 vs 0.86; p< 0.001, Wilcoxon test). In men with Likert 3 index lesions, log Significant cancer-associated MRI lesions in biopsy-naïve men have clinical-radiological differences, with lesions seen in prostates without significant disease. MRI-calculated PSA density and ADC could predict significant cancer in those with indeterminate MRI phenotypes. Magnetic resonance imaging (MRI) lesions that mimic prostate cancer but are, in fact, benign prompt unnecessary biopsies in thousands of men with raised prostate-specific antigen. In this study we found that, on closer look, such false positive lesions have different features from cancerous ones. This means that doctors could potentially develop better tools to identify cancer on MRI and spare some patients from unnecessary biopsies.

Sections du résumé

BACKGROUND
False positive multiparametric magnetic resonance imaging (mpMRI) phenotypes prompt unnecessary biopsies. The Prostate MRI Imaging Study (PROMIS) provides a unique opportunity to explore such phenotypes in biopsy-naïve men with raised prostate-specific antigen (PSA) and suspected cancer.
OBJECTIVE
To compare mpMRI lesions in men with/without significant cancer on transperineal mapping biopsy (TPM).
DESIGN, SETTING, AND PARTICIPANTS
PROMIS participants (n=235) underwent mpMRI followed by a combined biopsy procedure at University College London Hospital, including 5-mm TPM as the reference standard. Patients were divided into four mutually exclusive groups according to TPM findings: (1) no cancer, (2) insignificant cancer, (3) definition 2 significant cancer (Gleason ≥3+4 of any length and/or maximum cancer core length ≥4mm of any grade), and (4) definition 1 significant cancer (Gleason ≥4+3 of any length and/or maximum cancer core length ≥6mm of any grade).
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Index and/or additional lesions present in 178 participants were compared between TPM groups in terms of number, conspicuity, volume, location, and radiological characteristics.
RESULTS AND LIMITATIONS
Most lesions were located in the peripheral zone. More men with significant cancer had two or more lesions than those without significant disease (67% vs 37%; p< 0.001). In the former group, index lesions were larger (mean volume 0.68 vs 0.50 ml; p< 0.001, Wilcoxon test), more conspicuous (Likert 4-5: 79% vs 22%; p< 0.001), and diffusion restricted (mean apparent diffusion coefficient [ADC]: 0.73 vs 0.86; p< 0.001, Wilcoxon test). In men with Likert 3 index lesions, log
CONCLUSIONS
Significant cancer-associated MRI lesions in biopsy-naïve men have clinical-radiological differences, with lesions seen in prostates without significant disease. MRI-calculated PSA density and ADC could predict significant cancer in those with indeterminate MRI phenotypes.
PATIENT SUMMARY
Magnetic resonance imaging (MRI) lesions that mimic prostate cancer but are, in fact, benign prompt unnecessary biopsies in thousands of men with raised prostate-specific antigen. In this study we found that, on closer look, such false positive lesions have different features from cancerous ones. This means that doctors could potentially develop better tools to identify cancer on MRI and spare some patients from unnecessary biopsies.

Identifiants

DOI: 10.1016/j.eururo.2020.09.043 PMID: 33051065 PMC: PMC7772750
pubmed: 33051065
pii: S0302-2838(20)30770-3
doi: 10.1016/j.eururo.2020.09.043
pmc: PMC7772750
pii:
doi:

Substances chimiques

Prostate-Specific Antigen EC 3.4.21.77

Types de publication

Comparative Study Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

20-29

Subventions

Organisme : Medical Research Council
ID : MC_UU_00004/02
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/S005897/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_UU_12023/20
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 204998/Z/16/Z
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_UU_12023/28
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_UU_00004/01
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/S00680X/1
Pays : United Kingdom

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.

Auteurs

Vasilis Stavrinides (V)

UCL Division of Surgery & Interventional Science, University College London, London, UK; The Alan Turing Institute, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK. Electronic address: v.stavrinides@ucl.ac.uk.

Tom Syer (T)

UCL Division of Surgery & Interventional Science, University College London, London, UK; Centre for Medical Imaging, University College London, London, UK.

Yipeng Hu (Y)

UCL Division of Surgery & Interventional Science, University College London, London, UK; Centre for Medical Image Computing, University College London, London, UK; Wellcome EPSRC Centre for Interventional & Surgical Science (WEISS), University College London, London, UK; Department of Medical Physics & Biomedical Engineering, University College London, London, UK.

Francesco Giganti (F)

UCL Division of Surgery & Interventional Science, University College London, London, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK.

Alex Freeman (A)

Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK.

Solon Karapanagiotis (S)

The Alan Turing Institute, London, UK; Medical Research Council (MRC) Biostatistics Unit, University of Cambridge, Cambridge, UK.

Simon R J Bott (SRJ)

Department of Urology, Frimley Health NHS Foundation Trust, London, UK.

Louise C Brown (LC)

Medical Research Council (MRC) Clinical Trials Unit, University College London, London, UK.

Nicholas Burns-Cox (N)

Department of Urology, Taunton & Somerset NHS Foundation Trust, Taunton, UK.

Timothy J Dudderidge (TJ)

Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.

Ahmed El-Shater Bosaily (AE)

Department of Radiology, Royal Free London NHS Foundation Trust, London, UK.

Elena Frangou (E)

Medical Research Council (MRC) Clinical Trials Unit, University College London, London, UK.

Maneesh Ghei (M)

Department of Urology, Whittington Health NHS Trust, London, UK.

Alastair Henderson (A)

Department of Urology, Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK.

Richard G Hindley (RG)

Department of Urology, Hampshire Hospitals NHS Foundation Trust, Hampshire, UK.

Richard S Kaplan (RS)

Medical Research Council (MRC) Clinical Trials Unit, University College London, London, UK.

Robert Oldroyd (R)

Public and patient representative, Nottingham, UK.

Chris Parker (C)

Department of Academic Urology, The Royal Marsden NHS Foundation Trust, Sutton, UK.

Raj Persad (R)

Department of Urology, North Bristol NHS Trust, Bristol, UK.

Derek J Rosario (DJ)

Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

Iqbal S Shergill (IS)

Department of Urology, Wrexham Maelor Hospital NHS Trust, Wrexham, UK.

Lina M Carmona Echeverria (LMC)

UCL Division of Surgery & Interventional Science, University College London, London, UK.

Joseph M Norris (JM)

UCL Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.

Mathias Winkler (M)

Department of Urology, Imperial College Healthcare NHS Trust, London, UK; Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK.

Dean Barratt (D)

UCL Division of Surgery & Interventional Science, University College London, London, UK; Centre for Medical Image Computing, University College London, London, UK; Wellcome EPSRC Centre for Interventional & Surgical Science (WEISS), University College London, London, UK; Department of Medical Physics & Biomedical Engineering, University College London, London, UK.

Alex Kirkham (A)

Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK.

Shonit Punwani (S)

UCL Division of Surgery & Interventional Science, University College London, London, UK; Centre for Medical Imaging, University College London, London, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK.

Hayley C Whitaker (HC)

UCL Division of Surgery & Interventional Science, University College London, London, UK.

Hashim U Ahmed (HU)

Department of Urology, Imperial College Healthcare NHS Trust, London, UK; Imperial Prostate, Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK.

Mark Emberton (M)

UCL Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Techniques d'investigation › Techniques cytologiques › Cytodiagnostic › Biopsie › False Positive Multiparametric Magnetic...
questionsmedicales.fr › Diagnostic › Faux positifs › False Positive Multiparametric Magnetic...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › False Positive Multiparametric Magnetic...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Tomographie › Imagerie par résonance magnétique › Imagerie par résonance magnétique multiparamétrique › False Positive Multiparametric Magnetic...
questionsmedicales.fr › Phénomènes génétiques › Phénotype › False Positive Multiparametric Magnetic...
questionsmedicales.fr › Tissus › Glandes exocrines › Prostate › False Positive Multiparametric Magnetic...
questionsmedicales.fr › Facteurs biologiques › Marqueurs biologiques › Marqueurs biologiques tumoraux › Antigène spécifique de la prostate › False Positive Multiparametric Magnetic...
questionsmedicales.fr › Maladies urogénitales › Tumeurs de l'appareil urogénital › Tumeurs de l'appareil génital mâle › Tumeurs de la prostate › False Positive Multiparametric Magnetic...