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Structured approach to resolving discordance between PI-RADS v2.1 score and targeted prostate biopsy results: an opportunity for quality improvement.

Publication ,  Journal Article
Arcot, R; Sekar, S; Kotamarti, S; Krischak, M; Michael, ZD; Foo, W-C; Huang, J; Polascik, TJ; Gupta, RT
Published in: Abdom Radiol (NY)
August 2022

BACKGROUND: Prostate multiparametric magnetic resonance imaging (mpMRI) can identify lesions within the prostate with characteristics identified in Prostate Imaging Reporting and Data System (PI-RADS) v2.1 associated with clinically significant prostate cancer (csPCa) or Gleason grade group (GGG) ≥ 2 at biopsy. OBJECTIVE: To assess concordance (PI-RADS 5 lesions with csPCa) of PI-RADS v2/2.1 with targeted, fusion biopsy results and to examine causes of discordance (PI-RADS 5 lesions without csPCa) with aim to provide a structured approach to resolving discordances and develop quality improvement (QI) protocols. METHODS: A retrospective study of 392 patients who underwent mpMRI at 3 Tesla followed by fusion biopsy. PI-RADS v2/2.1 scores were assigned to lesions identified on mpMRI and compared to biopsy results expressed as GGG. Positive predictive value (PPV) of PI-RADS v2/2.1 was calculated for all prostate cancer and csPCa. Discordant cases were re-reviewed by a radiologist with expertise in prostate mpMRI to determine reason for discordance. RESULTS: A total of 521 lesions were identified on mpMRI. 121/521 (23.2%), 310/524 (59.5%), and 90/521 (17.3%) were PI-RADS 5, 4, and 3, respectively. PPV of PI-RADS 5, 4, and 3 for all PCa and csPCa was 0.80, 0.55, 0.24 and 0.63, 0.33, and 0.09, respectively. 45 cases of discordant biopsy results for PI-RADS 5 lesions were found with 27 deemed "true" discordances or "unresolved" discordances where imaging re-review confirmed PI-RADS appropriateness, while 18 were deemed "false" or resolved discordances due to downgrading of PI-RADS scores based on imaging re-review. Adjusting for resolved discordances on re-review, the PPV of PI-RADS 5 lesions for csPCa was deemed to be 0.74 and upon adjusting for presence of csPCa found in cases of unresolved discordance, PPV rose to 0.83 for PI-RADS 5 lesions. CONCLUSION: Although PIRADS 5 lesions are considered high risk for csPCa, the PPV is not 100% and a diagnostic dilemma occurs when targeted biopsy returns discordant. While PI-RADS score is downgraded in some cases upon imaging re-review, a number of "false" or "unresolved" discordances were identified in which MRI re-review confirmed initial PI-RADS score and subsequent pathology confirmed presence of csPCa in these lesions. CLINICAL IMPACT: We propose a structured approach to resolving discordant biopsy results using multi-disciplinary re-review of imaging and archived biopsy strikes as a quality improvement pathway. Further work is needed to determine the value of re-biopsy in cases of unresolved discordance and to develop robust QI systems for prostate MRI.

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Published In

Abdom Radiol (NY)

DOI

EISSN

2366-0058

Publication Date

August 2022

Volume

47

Issue

8

Start / End Page

2917 / 2927

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Quality Improvement
  • Prostatic Neoplasms
  • Prostate
  • Male
  • Magnetic Resonance Imaging
  • Image-Guided Biopsy
  • Humans
 

Citation

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Arcot, R., Sekar, S., Kotamarti, S., Krischak, M., Michael, Z. D., Foo, W.-C., … Gupta, R. T. (2022). Structured approach to resolving discordance between PI-RADS v2.1 score and targeted prostate biopsy results: an opportunity for quality improvement. Abdom Radiol (NY), 47(8), 2917–2927. https://doi.org/10.1007/s00261-022-03562-w
Arcot, Rohith, Sitharthan Sekar, Srinath Kotamarti, Madison Krischak, Zoe D. Michael, Wen-Chi Foo, Jiaoti Huang, Thomas J. Polascik, and Rajan T. Gupta. “Structured approach to resolving discordance between PI-RADS v2.1 score and targeted prostate biopsy results: an opportunity for quality improvement.Abdom Radiol (NY) 47, no. 8 (August 2022): 2917–27. https://doi.org/10.1007/s00261-022-03562-w.
Arcot R, Sekar S, Kotamarti S, Krischak M, Michael ZD, Foo W-C, et al. Structured approach to resolving discordance between PI-RADS v2.1 score and targeted prostate biopsy results: an opportunity for quality improvement. Abdom Radiol (NY). 2022 Aug;47(8):2917–27.
Arcot, Rohith, et al. “Structured approach to resolving discordance between PI-RADS v2.1 score and targeted prostate biopsy results: an opportunity for quality improvement.Abdom Radiol (NY), vol. 47, no. 8, Aug. 2022, pp. 2917–27. Pubmed, doi:10.1007/s00261-022-03562-w.
Arcot R, Sekar S, Kotamarti S, Krischak M, Michael ZD, Foo W-C, Huang J, Polascik TJ, Gupta RT. Structured approach to resolving discordance between PI-RADS v2.1 score and targeted prostate biopsy results: an opportunity for quality improvement. Abdom Radiol (NY). 2022 Aug;47(8):2917–2927.
Journal cover image

Published In

Abdom Radiol (NY)

DOI

EISSN

2366-0058

Publication Date

August 2022

Volume

47

Issue

8

Start / End Page

2917 / 2927

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Quality Improvement
  • Prostatic Neoplasms
  • Prostate
  • Male
  • Magnetic Resonance Imaging
  • Image-Guided Biopsy
  • Humans