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Prostate cancer in PI-RADS scores 1 and 2 version 2.1: a comparison to previous PI-RADS versions

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Abstract

Purpose

To evaluate the validity of PI-RADS categories 1 and 2 version 2.1 (V2.1) as predictors of the absence of carcinoma and to reevaluate lesions that were analysed as suspicious prior to PI-RADS or according to PI-RADS versions 1 and 2 and classified as PI-RADS 1 or 2 in V2.1.

Methods

Retrospective evaluation of 1170 multiparametric MRIs performed at one academic teaching hospital (2012–2019). Study cohort comprised 188 men that achieved PI-RADS scores 1 or 2 (V2.1) and underwent systematic and targeted biopsy, split into one group with suspect findings in the original reports that were created prior to PI-RADS or with version 1 and 2, and another group with unremarkable reports. Differences in presence of prostate cancer and PSA density were assessed by Chi-square and Fisher’s exact test, and the negative predictive value (NPV) for both groups was conducted.

Results

The NPV for clinically significant carcinoma (csCa) was 89.1% for 55 men with suspect findings in the original report and 93.2% for 133 men with negative MRI. There was no difference between the groups regarding the detection of csCa (p = 0.103). PSA density was significantly higher in the group with suspect original reports (p = 0.015).

Conclusion

A PI-RADS score 1 or 2 appears less likely to miss existing prostate cancer, although a small amount of csCa can be overlooked. In case of clinical suspicion or elevated PSA density and PI-RADS score 1 or 2, an individual decision has to be taken if biopsy is necessary or if monitoring is sufficient.

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Funding

No funds, grants or other support were received.

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Authors and Affiliations

  1. Institute of Radiology, Martha-Maria Hospital, Stadenstrasse 58, 90491, Nuremberg, Germany

    Katja Bogner, Karl Engelhard, Wolfgang Wuest & Sajad Hamel

Authors
  1. Katja Bogner
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  2. Karl Engelhard
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  3. Wolfgang Wuest
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  4. Sajad Hamel
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Katja Bogner, Karl Engelhard and Sajad Hamel. The first draft of the manuscript was written by Katja Bogner and all authors commented on previous versions of the manuscript. Wolfgang Wuest and Katja Bogner revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Katja Bogner.

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Disclosures

Wolfgang Wuest: Siemens speaker bureau and consultancy. The other authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Friedrich-Alexander-University Erlangen-Nuremberg (Approval Number 384_20 Bc) and informed research consent was waived.

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Bogner, K., Engelhard, K., Wuest, W. et al. Prostate cancer in PI-RADS scores 1 and 2 version 2.1: a comparison to previous PI-RADS versions. Abdom Radiol 47, 2187–2196 (2022). https://doi.org/10.1007/s00261-022-03444-1

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