MP53-01 PERFORMANCE OF MULTI-PARAMETRIC MRI FOR HIGH GRADE PROSTATE CANCER: CORRELATION WITH WHOLE-MOUNT PATHOLOGY (2014)

You have accessJournal of UrologyProstate Cancer: Detection & Screening II1 Apr 2014MP53-01 PERFORMANCE OF MULTI-PARAMETRIC MRI FOR HIGH GRADE PROSTATE CANCER: CORRELATION WITH WHOLE-MOUNT PATHOLOGY Jesse Le, Nelly Tan, Susan Kerkoutian, Daniel Margolis, David Lu, Lorna Kwan, Steven Raman, and Robert Reiter Jesse LeJesse Le More articles by this author , Nelly TanNelly Tan More articles by this author , Susan KerkoutianSusan Kerkoutian More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , David LuDavid Lu More articles by this author , Lorna KwanLorna Kwan More articles by this author , Steven RamanSteven Raman More articles by this author , and Robert ReiterRobert Reiter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1632AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Higher Gleason score (GS) is associated with increased level of suspicion on multi-parametric magnetic resonance imaging (mp-MRI) of the prostate, but some tumors still evade detection by MRI. The objective of this study was to characterize the performance of mp-MRI for detection of high GS tumors and identify risk factors for missed tumor detection. Methods A retrospective study was performed of 122 consecutive men who underwent mp-MRI prior to radical prostatectomy from 10/2010-2/2013. Clinical, MRI, and pathologic features were obtained. A genitourinary radiologist and pathologist collectively reviewed each case and matched the MRI to whole-mount pathology lesions. Index tumor was defined as the highest GS tumor; in cases of multifocal tumors of identical GS, the largest tumor was considered the index. Chi-square or Fisher’s exact analysis was performed for categorical and t-test for continuous variables. Results 180 regions of interest were identified by mp-MRI and 283 tumors were histologically confirmed among 122 men. Among the 57 tumors determined to be GS ≥4+3, 15/57 tumors (26%) were missed by mp-MRI in 11/50 men (22%), corresponding to a sensitivity of 74%. Index tumor status, tumor size, number of whole mount levels involved, and presence of extra-capsular extension were all associated with tumor detection (p<0.05) (table). 37/44 (84%) of index tumors were correctly identified by mp-MRI. Missed tumors were: less likely to be index tumors (47% vs 88% of MRI-pathology concordant tumors); likely to be smaller (1.24 cm ±0.78 cm SD vs 2.41 ±2.06 SD), involving fewer whole-mount levels; and less likely to have extra-capsular extension (13% vs 55%). Of missed non-index tumors, 4/8 (50%) of the corresponding index tumors were detected by mp-MRI. Of the missed index tumors, no corresponding non-index tumors were detected; review of these slides demonstrated tumor infiltrating benign glands (3/7), small volume tumor within large overall prostate volume (3/7), or abundant foamy gland variant pathology (2/7) as possible reasons for missed tumor detection. Conclusions High Gleason score tumors evaded mp-MRI detection in 26% of cases. Smaller, non-index, organ-confined tumors were more likely to be missed; there may be a histologic basis for non-visualization of tumors by mp-MRI. Table. Characteristics of tumors missed versus detected by mp-MRI. Missed tumors, n=15 Detected tumors, n=42 P-value Mean (SD) Mean (SD) Age (years) 61.5 (5.4) 62.4 (6.2) 0.6258 PSA (ng/ml) 9.4 (6.7) 8.6 (5.0) 0.6338 Weeks from biopsy to MRI 23.2 (33.5) 18.4 (34.4) 0.6494 MRI prostate volume (cc) 52.5 (27.4) 41.4 (16.7) 0.1577 Pathology weight (gm) 60.0 (27.0) 50.7 (18.1) 0.2294 Tumor diameter (cm) 1.24 (0.78) 2.41 (2.06) 0.0004 N (%) N (%) Endorectal coil use 12 (80) 36 (86) 0.6851∗ Gleason score 4+3 9 (60) 29 (69) 0.7154∗ 4+4 5 (33) 9 (21) 4+5 1 (7) 4 (10) Whole mount levels Apex 2 (13) 2 (5) 0.0361∗ Mid 5 (33) 6 (14) Base 1 (7) 1 (2) Apex to mid 4 (27) 5 (12) Mid to base 1 (7) 15 (36) Apex to base 2 (13) 13 (31) Index tumor status 7 (47) 37 (88) 0.0025∗ Apical location 4 (27) 14 (33) 0.7531∗ Extra-capsular extension 2 (13) 23 (55) 0.0055 Seminal vesicle invasion 0 (0) 3 (7) 0.5586∗ Lymph node(s) positive 0 (0) 3 (7) 0.5586∗ T-test for continuous variables; chi-square test for categorical variables (Fisher's exact where noted with an asterisk∗). Standard deviation, SD. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e588 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jesse Le More articles by this author Nelly Tan More articles by this author Susan Kerkoutian More articles by this author Daniel Margolis More articles by this author David Lu More articles by this author Lorna Kwan More articles by this author Steven Raman More articles by this author Robert Reiter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...