Investigating the ability of multiparametric MRI to exclude significant prostate cancer prior to transperineal biopsy

Authors

  • Eva M Serrao Department of Radiology, Champalimaud Foundation, Lisbon, 1400-038, Portugal Department of Biochemistry, University of Cambridge and Cancer Research UK, Cambridge Research Institute, Cambridge, CB2 0QQ, UK
  • Tristan Barrett Addenbrooke’s Hospital Hills Road, Cambridge, CB2 0QQ UK
  • Karan Wadhwa Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
  • Deepak Parashar Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
  • Julia Frey Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
  • Brendan C Koo Addenbrooke’s Hospital and the University of Cambridge, Cambridge, CB2 0QQ, UK
  • Anne Y Warren Addenbrooke’s Hospital and the University of Cambridge, Cambridge, CB2 0QQ, UK
  • Andrew Doble Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
  • Christof Kastner Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
  • Ferdia A Gallagher Addenbrooke’s Hospital and University of Cambridge, Cambridge, CB2 0QQ, UK

DOI:

https://doi.org/10.5489/cuaj.2895

Abstract

Introduction: We characterized false negative prostate magnetic resonance imaging (MRI) reporting by using histology derived from MRI-transrectal ultrasound (TRUS)-guided transperineal (MTTP) fusion biopsies.

Methods: In total, 148 consecutive patients were retrospectively reviewed. Men underwent multiparametric MRI (mpMRI), reported by a consultant/attending radiologist in line with European Society of Urogenital Radiology (ESUR) standards. MTTP biopsy of the lesions was performed according to the Ginsburg recommendations. Cases with an MRI-histology mismatch were identified and underwent a second read by an experienced radiologist. A third review was performed with direct histology comparison to determine a true miss from an MRI-occult cancer. Statistical analysis was performed with McNemar’s test.

Results: False negative lesions were identified in 29 MRI examinations (19.6%), with a total of 46 lesions. Most false negative lesions (21/46) were located in the anterior sectors of the prostate. The second read led to a significant decrease of false-negative lesions with 7/29 further studies identified as positive on a patientby- patient basis (24.1% of studies, p = 0.016) and 11/46 lesions (23.9%; p = 0.001). Of these, 30 lesions following the first read and 23 lesions after the second read were considered significant cancer according to the University College London criteria. However, on direct comparison with histology, most lesions were MRI occult.

Conclusion: We demonstrate that MRI can fail to detect clinically relevant lesions. Improved results were achieved with a second read but despite this, a number of lesions remain MRI-occult. Further advances in imaging are required to reduce false negative results.

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Author Biographies

Eva M Serrao, Department of Radiology, Champalimaud Foundation, Lisbon, 1400-038, Portugal Department of Biochemistry, University of Cambridge and Cancer Research UK, Cambridge Research Institute, Cambridge, CB2 0QQ, UK

Department of Radiology, Champalimaud Foundation, Lisbon, 1400-038, Portugal

Department of Biochemistry, University of Cambridge and Cancer Research UK,
Cambridge Research Institute, Cambridge, CB2 0QQ, UK

Tristan Barrett, Addenbrooke’s Hospital Hills Road, Cambridge, CB2 0QQ UK

Department of Radiology, Level 5

University Lecturer

Karan Wadhwa, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK

Department of Urology

Julia Frey, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK

Department of Urology

Brendan C Koo, Addenbrooke’s Hospital and the University of Cambridge, Cambridge, CB2 0QQ, UK

Department of Radiology

Anne Y Warren, Addenbrooke’s Hospital and the University of Cambridge, Cambridge, CB2 0QQ, UK

Department of Histopathology

Andrew Doble, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK

Department of Urology

Christof Kastner, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK

Department of Urology

Ferdia A Gallagher, Addenbrooke’s Hospital and University of Cambridge, Cambridge, CB2 0QQ, UK

Department of Radiology

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Published

2015-12-14

How to Cite

Serrao, E. M., Barrett, T., Wadhwa, K., Parashar, D., Frey, J., Koo, B. C., Warren, A. Y., Doble, A., Kastner, C., & Gallagher, F. A. (2015). Investigating the ability of multiparametric MRI to exclude significant prostate cancer prior to transperineal biopsy. Canadian Urological Association Journal, 9(11-12), E853–8. https://doi.org/10.5489/cuaj.2895

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Section

Original Research