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Reconciling discordance between PI-RADS 4 lesions and targeted biopsy: Early experience of a multidisciplinary quality improvement protocol with PI-RADS 4 subcategorization.

Publication ,  Journal Article
Deivasigamani, S; Kotamarti, S; Adams, ES; Séguier, D; Zhang, D; Michael, Z; Polascik, TJ; Gupta, RT
Published in: Eur J Radiol
August 2023

PURPOSE: PI-RADS 4 lesions are considered to have a "high" likelihood of clinically-significant prostate cancer (csPCa). However, patients undergoing targeted biopsy have a range of histologic findings. Understanding discordant cases is critical to improve diagnostic accuracy and inform subsequent management. We studied early findings from implementation of a multidisciplinary Quality Improvement (QI) protocol for reconciling discordance and evaluate the potential heterogeneity of PI-RADS 4. METHODS: Patients with mpMRI PI-RADS 4 lesions undergoing fusion-targeted biopsy from January 2017 to May 2021 were retrospectively reviewed. The discordant targeted biopsy pathology (benign/GG1) was evaluated utilizing a QI protocol and all lesions were subcategorized based on ADC values. Positive Predictive Value (PPV) for PI-RADS 4 lesions overall and the Cancer Detection Rate (CDR) for subcategorized lesions were calculated. RESULTS: 248 patients with 286 lesions were reviewed. Prior to re-review, PI-RADS 4 PPV for ≥ GG1 and ≥ GG2 lesions were 0.55 and 0.34, increasing to 0.67 and 0.43 following reconciliation. Lesion subcategorization based on ADC value as higher suspicion (4+) and lower suspicion (4-) resulted in 158 and 117 lesions, with reverse-fusion analysis revealing that 61% and 17% of lesions contained csPCa, respectively. Subgroup analysis among PI-RADS 4+ lesions led to an increase in the CDR to 75% and 61% for ≥ GG1 and ≥ GG2. CONCLUSION: Use of multidisciplinary QI protocol to review discordance cases of PI-RADS 4 improves diagnostic accuracy and guides subsequent management. Our findings highlight the known heterogeneity of this category with reference to csPCa CDR, suggesting the potential value of PI-RADS 4 subcategorization.

Duke Scholars

Published In

Eur J Radiol

DOI

EISSN

1872-7727

Publication Date

August 2023

Volume

165

Start / End Page

110929

Location

Ireland

Related Subject Headings

  • Retrospective Studies
  • Quality Improvement
  • Prostatic Neoplasms
  • Nuclear Medicine & Medical Imaging
  • Male
  • Magnetic Resonance Imaging
  • Image-Guided Biopsy
  • Humans
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

APA
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ICMJE
MLA
NLM
Deivasigamani, S., Kotamarti, S., Adams, E. S., Séguier, D., Zhang, D., Michael, Z., … Gupta, R. T. (2023). Reconciling discordance between PI-RADS 4 lesions and targeted biopsy: Early experience of a multidisciplinary quality improvement protocol with PI-RADS 4 subcategorization. Eur J Radiol, 165, 110929. https://doi.org/10.1016/j.ejrad.2023.110929
Journal cover image

Published In

Eur J Radiol

DOI

EISSN

1872-7727

Publication Date

August 2023

Volume

165

Start / End Page

110929

Location

Ireland

Related Subject Headings

  • Retrospective Studies
  • Quality Improvement
  • Prostatic Neoplasms
  • Nuclear Medicine & Medical Imaging
  • Male
  • Magnetic Resonance Imaging
  • Image-Guided Biopsy
  • Humans
  • 3202 Clinical sciences
  • 1103 Clinical Sciences