False-Positive Prostate Imaging Reporting and Data System Version 2 Category 5 Lesions: A Discussion of Possible Mechanisms

Introduction: Prostate cancer (PCa) is the most common malignancy in men. The multiparametric MRI (mpMRI) significantly improved the diagnostic approach of PCa. Although PCa is highly likely to be present in prostate imaging-reporting and data system (PI-RADS) 5 lesions, there are up to 18% of PI-RADS 5 lesions with benign histopathology after targeted biopsy. Case Description: We present the case of a 66-year-old man who was referred to our hospital for MRI/ultrasound fusion-based targeted biopsy due to an elevated PSA and a PI-RADS 5 lesion described in the mpMRI. After 2 consecutive biopsies, the mpMRI target showed no malignancy. The lesion was described as PI-RADS 2 two years later. Conclusion: This case demonstrates the risk of false-positive classified PI-RADS 5 lesions in the mpMRI and the challenge in some cases to distinguish between BPH nodules and cancer. Until today, a limited amount of studies exists concerning this issue. However, further studies are required to evaluate further characteristics associated with a higher possibility of histopathologically benign findings in PI-RADS 5 lesions.

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MRI-Ultrasound Fusion Targeted Biopsy of Prostate Imaging Reporting and Data System Version 2 Category 5 Lesions Found False-Positive at Multiparametric Prostate MRI

American Journal of Roentgenology ◽

10.2214/ajr.17.18680 ◽

2018 ◽

Vol 210 (5) ◽

pp. W218-W225 ◽

Cited By ~ 11

Author(s):

Alison D. Sheridan ◽

Sameer K. Nath ◽

Sanjay Aneja ◽

Jamil S. Syed ◽

Jay Pahade ◽

...

Keyword(s):

False Positive ◽

Data System ◽

Targeted Biopsy ◽

Prostate Mri ◽

Prostate Imaging ◽

Multiparametric Prostate Mri

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An integrated nomogram combining deep learning, Prostate Imaging–Reporting and Data System (PI-RADS) scoring, and clinical variables for identification of clinically significant prostate cancer on biparametric MRI: a retrospective multicentre study

The Lancet Digital Health ◽

10.1016/s2589-7500(21)00082-0 ◽

2021 ◽

Vol 3 (7) ◽

pp. e445-e454

Author(s):

Amogh Hiremath ◽

Rakesh Shiradkar ◽

Pingfu Fu ◽

Amr Mahran ◽

Ardeshir R Rastinehad ◽

...

Keyword(s):

Prostate Cancer ◽

Deep Learning ◽

Multicentre Study ◽

Data System ◽

Clinical Variables ◽

Prostate Imaging ◽

Clinically Significant

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Interobserver agreement of Prostate Imaging–Reporting and Data System (PI-RADS–v2)

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00378-w ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Hala Maher Ahmed ◽

Ahmed Ebrahim Ebeed ◽

Ahmed Hamdy ◽

Mohamed Abou El-Ghar ◽

Ahmed Abdel Khalek Abdel Razek

Keyword(s):

Interobserver Agreement ◽

Imaging Modality ◽

Peripheral Zone ◽

Transitional Zone ◽

Data System ◽

3 Tesla ◽

Prostate Imaging ◽

Percent Agreement ◽

3 Tesla Mri

Abstract Background A retrospective study was conducted on 71 consecutive patients with suspected prostate cancer (PCa) with a mean age of 56 years and underwent mp-MRI of the prostate at 3 Tesla MRI. Two readers recognized all prostatic lesions, and each lesion had a score according to Prostate Imaging–Reporting and Data System version 2 (PI-RADS-v2). Purpose of the study To evaluate the interobserver agreement of PI-RADS-v2 in characterization of prostatic lesions using multiparametric MRI (mp-MRI) at 3 Tesla MRI. Results The overall interobserver agreement of PI-RADS-v2 for both zones was excellent (k = 0.81, percent agreement = 94.9%). In the peripheral zone (PZ) lesions are the interobserver agreement for PI-RADS II (k = 0.78, percent agreement = 83.9%), PI-RADS III (k = 0.66, percent agreement = 91.3 %), PI-RADS IV (k = 0.69, percent agreement = 93.5%), and PI-RADS V (k = 0.91, percent agreement = 95.7 %). In the transitional zone (TZ) lesions are the interobserver agreement for PI-RADS I (k = 0.98, percent of agreement = 96%), PI-RADS II (k = 0.65, percent agreement = 96%), PI-RADS III (k = 0.65, percent agreement = 88%), PI-RADS IV (k = 0.83, percent agreement = 96%), and PI-RADS V (k = 0.82, percent agreement = 92%). Conclusion We concluded that PI-RADS-v2 is a reliable and a reproducible imaging modality for the characterization of prostatic lesions and detection of PCa.

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Re: Risk of Clinically Significant Prostate Cancer Associated with Prostate Imaging Reporting and Data System Category 3 (Equivocal) Lesions Identified on Multiparametric Prostate MRI

The Journal of Urology ◽

10.1016/j.juro.2018.03.123 ◽

2018 ◽

Vol 200 (1) ◽

pp. 11-11

Author(s):

Cary Siegel

Keyword(s):

Prostate Cancer ◽

Data System ◽

Prostate Mri ◽

Prostate Imaging ◽

Multiparametric Prostate Mri ◽

Clinically Significant

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Prostate Imaging Reporting and Data System (PI-RADS): What the radiologists need to know?

Clinical Imaging ◽

10.1016/j.clinimag.2021.05.026 ◽

2021 ◽

Author(s):

Ahmed Abdel Khalek Abdel Razek ◽

Tarek El-Diasty ◽

Ahmed Elhendy ◽

Dalia Fahmy ◽

Mohamed Ali EL-Adalany

Keyword(s):

Data System ◽

Prostate Imaging

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Evaluating the performance of clinical and radiological data in predicting prostate cancer in prostate imaging reporting and data system version 2.1 category 3 lesions of the peripheral and the transition zones

International Urology and Nephrology ◽

10.1007/s11255-021-03071-7 ◽

2021 ◽

Author(s):

Caterina Gaudiano ◽

Lorenzo Bianchi ◽

Beniamino Corcioni ◽

Francesca Giunchi ◽

Riccardo Schiavina ◽

...

Keyword(s):

Prostate Cancer ◽

Data System ◽

Transition Zones ◽

Prostate Imaging ◽

Radiological Data

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Comparison of prostate imaging reporting and data system v2.1 and 2 in transition and peripheral zones: evaluation of interreader agreement and diagnostic performance in detecting clinically significant prostate cancer

British Journal of Radiology ◽

10.1259/bjr.20201434 ◽

2021 ◽

pp. 20201434

Author(s):

Yasuyo Urase ◽

Yoshiko Ueno ◽

Tsutomu Tamada ◽

Keitaro Sofue ◽

Satoru Takahashi ◽

...

Keyword(s):

Prostate Cancer ◽

Diagnostic Performance ◽

Area Under The Curve ◽

Data System ◽

Transition Zones ◽

Prostate Imaging ◽

Institutional Review ◽

3.0 T ◽

Clinically Significant ◽

Interreader Agreement

Objectives: To evaluate the interreader agreement and diagnostic performance of the Prostate Imaging Reporting and Data System (PI-RADS) v2.1, in comparison with v2. Methods: Institutional review board approval was obtained for this retrospective study. Seventy-seven consecutive patients who underwent a prostate multiparametric magnetic resonance imaging at 3.0 T before radical prostatectomy were included. Four radiologists (two experienced uroradiologists and two inexperienced radiologists) independently scored eight regions [six peripheral zones (PZ) and two transition zones (TZ)] using v2.1 and v2. Interreader agreement was assessed using κ statistics. To evaluate diagnostic performance for clinically significant prostate cancer (csPC), area under the curve (AUC) was estimated. Results 228 regions were pathologically diagnosed as positive for csPC. With a cutoff ≥3, the agreement among all readers was better with v2.1 than v2 in TZ, PZ, or both zones combined (κ-value: TZ, 0.509 vs 0.414; PZ, 0.686 vs 0.568; both zones combined, 0.644 vs 0.531). With a cutoff ≥4, the agreement among all readers was also better with v2.1 than v2 in the PZ or both zones combined (κ-value: PZ, 0.761 vs 0.701; both zones combined, 0.756 vs 0.709). For all readers, AUC with v2.1 was higher than with v2 (TZ, 0.826–0.907 vs 0.788–0.856; PZ, 0.857–0.919 vs 0.853–0.902). Conclusions: Our study suggests that the PI-RADS v2.1 could improve the interreader agreement and might contribute to improved diagnostic performance compared with v2. Advances in knowledge: PI-RADS v2.1 has a potential to improve interreader variability and diagnostic performance among radiologists with different levels of expertise.

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