Detection of prostate cancer index lesions with multiparametric magnetic resonance imaging (mp-MRI) using whole-mount histological sections as the reference standard

Filippo Russo, Daniele Regge, Enrico Armando, Valentina Giannini, Anna Vignati, Simone Mazzetti, Matteo Manfredi, Enrico Bollito, Loredana Correale, Francesco Porpiglia

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To evaluate the sensitivity of multiparametric magnetic resonance imaging (mp-MRI) for detecting prostate cancer foci, including the largest (index) lesions. Patients and Methods: In all, 115 patients with biopsy confirmed prostate cancer underwent mp-MRI before radical prostatectomy. A single expert radiologist recorded all prostate cancer foci including the index lesion ‘blinded’ to the pathologist's biopsy report. Stained whole-mount histological sections were used as the reference standard. All lesions were contoured by an experienced uropathologist who assessed their volume and pathological Gleason score. All lesions with a volume of >0.5 mL and/or pathological Gleason score of >6 were defined as clinically significant prostate cancer. Multivariate analysis was used to ascertain the characteristics of lesions identified by MRI. Results: In all, 104 of 115 index lesions were correctly diagnosed by mp-MRI (sensitivity 90.4%; 95% confidence interval [CI] 83.5–95.1%), including 98/105 clinically significant index lesions (93.3%; 95% CI 86.8–97.3%), among which three of three lesions had a volume of 6. Overall, mp-MRI detected 131/206 lesions including 13 of 68 ‘insignificant’ prostate cancers. The multivariate logistic regression modelling showed that pathological Gleason score (odds ratio [OR] 11.7, 95% CI 2.3–59.8; P = 0.003) and lesion volume (OR 4.24, 95% CI 1.3–14.7; P = 0.022) were independently associated with the detection of index lesions at MRI. Conclusions: This study shows that mp-MRI has a high sensitivity for detecting clinically significant prostate cancer index lesions, while having disappointing results for the detection of small-volume, low Gleason score prostate cancer foci. Thus, mp-MRI could be used to stratify patients according to risk, allowing better treatment selection.

Original languageEnglish
Pages (from-to)84-94
Number of pages11
JournalBJU International
Volume118
Issue number1
DOIs
Publication statusPublished - Jul 1 2016

Keywords

  • diagnostic imaging
  • magnetic resonance imaging
  • prostatic neoplasm

ASJC Scopus subject areas

  • Urology

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