Dynamic Contrast Enhanced Magnetic Resonance Imaging Improves Classification of Prostate Lesions: A Study of Pathological Outcomes on Targeted Prostate Biopsy

Sasha C. Druskin, Ryan Ward, Andrei S. Purysko, Allen Young, Jeffrey J. Tosoian, Kamyar Ghabili, Darian Andreas, Eric Klein, Ashley E. Ross, Katarzyna Macura

Research output: Contribution to journalArticle

Abstract

Purpose: PI-RADS™, version 2 stipulates that dynamic contrast enhanced imaging should be used to classify diffusion-weighted imaging score 3 peripheral zone lesions as PI-RADS score 3 (dynamic contrast enhanced imaging negative or nonenhancing) or 4 (dynamic contrast enhanced imaging positive or enhancing). However, to our knowledge it is unknown whether dynamic contrast enhanced imaging separates lesions into clinically meaningful pathological groups. We examined whether dynamic contrast enhanced imaging would improve the detection of clinically significant cancer. Materials and Methods: We identified patients without a prior diagnosis of prostate cancer who underwent multiparametric magnetic resonance imaging-transrectal ultrasound fusion targeted biopsy of peripheral zone lesions with a diffusion-weighted imaging score of 3 or 4. Each lesion was grouped into 1 of 3 classifications, including group 1-diffusion-weighted imaging score 3/nonenhancing/PI-RADS score 3, group 2-diffusion-weighted imaging score 3/enhancing/PI-RADS score 4 or group 3-diffusion-weighted imaging score 4/PI-RADS score 4. We measured the rate of grade group 2 or greater pathology detected for each lesion group with subgroup analyses in patients with vs without prior negative systematic biopsy. Results: We identified a total of 389 peripheral zone diffusion-weighted imaging score 3 or 4 lesions in 290 patients. The rate of grade group 2 or greater cancer on biopsy for group 1, 2 and 3 lesions was 8.9%, 21% and 36.5%, respectively (p <0.03). The rate of grade group 2 or greater pathology was higher in group 2 than group 1 lesions in patients with prior negative systematic prostate biopsy (28% vs 5.0%, p <0.001) but not in those without such a biopsy (16% vs 12%, p = 0.5). Group 3 lesions had a higher rate of grade group 2 or greater cancer than group 2 lesions in the biopsy naïve subgroup (46% vs 16%, p = 0.001). However, the rates were similar in patients with prior negative systematic prostate biopsy (27% vs 28%, p = 0.9). Conclusions: Diffusion-weighted imaging score 3 peripheral zone lesions were more likely to be clinically significant cancer (grade group 2 or greater) if they were dynamic contrast enhanced T1-weighted imaging positive. That was most apparent in patients with a prior negative systematic prostate biopsy. In such patients including a dynamic contrast enhanced sequence in multiparametric magnetic resonance imaging allowed for optimal lesion risk stratification.

Original languageEnglish (US)
JournalJournal of Urology
DOIs
StateAccepted/In press - 2017

Fingerprint

Prostate
Magnetic Resonance Imaging
Outcome Assessment (Health Care)
Biopsy
Neoplasms
Pathology
Prostatic Neoplasms

Keywords

  • Biopsy
  • Diagnostic imaging
  • Magnetic resonance imaging
  • Prostatic neoplasms
  • Standards

ASJC Scopus subject areas

  • Urology

Cite this

Dynamic Contrast Enhanced Magnetic Resonance Imaging Improves Classification of Prostate Lesions : A Study of Pathological Outcomes on Targeted Prostate Biopsy. / Druskin, Sasha C.; Ward, Ryan; Purysko, Andrei S.; Young, Allen; Tosoian, Jeffrey J.; Ghabili, Kamyar; Andreas, Darian; Klein, Eric; Ross, Ashley E.; Macura, Katarzyna.

In: Journal of Urology, 2017.

Research output: Contribution to journalArticle

Druskin, Sasha C. ; Ward, Ryan ; Purysko, Andrei S. ; Young, Allen ; Tosoian, Jeffrey J. ; Ghabili, Kamyar ; Andreas, Darian ; Klein, Eric ; Ross, Ashley E. ; Macura, Katarzyna. / Dynamic Contrast Enhanced Magnetic Resonance Imaging Improves Classification of Prostate Lesions : A Study of Pathological Outcomes on Targeted Prostate Biopsy. In: Journal of Urology. 2017.
@article{d69dba6db80c4ccbb1da94e8365d4d59,
title = "Dynamic Contrast Enhanced Magnetic Resonance Imaging Improves Classification of Prostate Lesions: A Study of Pathological Outcomes on Targeted Prostate Biopsy",
abstract = "Purpose: PI-RADS™, version 2 stipulates that dynamic contrast enhanced imaging should be used to classify diffusion-weighted imaging score 3 peripheral zone lesions as PI-RADS score 3 (dynamic contrast enhanced imaging negative or nonenhancing) or 4 (dynamic contrast enhanced imaging positive or enhancing). However, to our knowledge it is unknown whether dynamic contrast enhanced imaging separates lesions into clinically meaningful pathological groups. We examined whether dynamic contrast enhanced imaging would improve the detection of clinically significant cancer. Materials and Methods: We identified patients without a prior diagnosis of prostate cancer who underwent multiparametric magnetic resonance imaging-transrectal ultrasound fusion targeted biopsy of peripheral zone lesions with a diffusion-weighted imaging score of 3 or 4. Each lesion was grouped into 1 of 3 classifications, including group 1-diffusion-weighted imaging score 3/nonenhancing/PI-RADS score 3, group 2-diffusion-weighted imaging score 3/enhancing/PI-RADS score 4 or group 3-diffusion-weighted imaging score 4/PI-RADS score 4. We measured the rate of grade group 2 or greater pathology detected for each lesion group with subgroup analyses in patients with vs without prior negative systematic biopsy. Results: We identified a total of 389 peripheral zone diffusion-weighted imaging score 3 or 4 lesions in 290 patients. The rate of grade group 2 or greater cancer on biopsy for group 1, 2 and 3 lesions was 8.9{\%}, 21{\%} and 36.5{\%}, respectively (p <0.03). The rate of grade group 2 or greater pathology was higher in group 2 than group 1 lesions in patients with prior negative systematic prostate biopsy (28{\%} vs 5.0{\%}, p <0.001) but not in those without such a biopsy (16{\%} vs 12{\%}, p = 0.5). Group 3 lesions had a higher rate of grade group 2 or greater cancer than group 2 lesions in the biopsy na{\"i}ve subgroup (46{\%} vs 16{\%}, p = 0.001). However, the rates were similar in patients with prior negative systematic prostate biopsy (27{\%} vs 28{\%}, p = 0.9). Conclusions: Diffusion-weighted imaging score 3 peripheral zone lesions were more likely to be clinically significant cancer (grade group 2 or greater) if they were dynamic contrast enhanced T1-weighted imaging positive. That was most apparent in patients with a prior negative systematic prostate biopsy. In such patients including a dynamic contrast enhanced sequence in multiparametric magnetic resonance imaging allowed for optimal lesion risk stratification.",
keywords = "Biopsy, Diagnostic imaging, Magnetic resonance imaging, Prostatic neoplasms, Standards",
author = "Druskin, {Sasha C.} and Ryan Ward and Purysko, {Andrei S.} and Allen Young and Tosoian, {Jeffrey J.} and Kamyar Ghabili and Darian Andreas and Eric Klein and Ross, {Ashley E.} and Katarzyna Macura",
year = "2017",
doi = "10.1016/j.juro.2017.07.011",
language = "English (US)",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Dynamic Contrast Enhanced Magnetic Resonance Imaging Improves Classification of Prostate Lesions

T2 - A Study of Pathological Outcomes on Targeted Prostate Biopsy

AU - Druskin, Sasha C.

AU - Ward, Ryan

AU - Purysko, Andrei S.

AU - Young, Allen

AU - Tosoian, Jeffrey J.

AU - Ghabili, Kamyar

AU - Andreas, Darian

AU - Klein, Eric

AU - Ross, Ashley E.

AU - Macura, Katarzyna

PY - 2017

Y1 - 2017

N2 - Purpose: PI-RADS™, version 2 stipulates that dynamic contrast enhanced imaging should be used to classify diffusion-weighted imaging score 3 peripheral zone lesions as PI-RADS score 3 (dynamic contrast enhanced imaging negative or nonenhancing) or 4 (dynamic contrast enhanced imaging positive or enhancing). However, to our knowledge it is unknown whether dynamic contrast enhanced imaging separates lesions into clinically meaningful pathological groups. We examined whether dynamic contrast enhanced imaging would improve the detection of clinically significant cancer. Materials and Methods: We identified patients without a prior diagnosis of prostate cancer who underwent multiparametric magnetic resonance imaging-transrectal ultrasound fusion targeted biopsy of peripheral zone lesions with a diffusion-weighted imaging score of 3 or 4. Each lesion was grouped into 1 of 3 classifications, including group 1-diffusion-weighted imaging score 3/nonenhancing/PI-RADS score 3, group 2-diffusion-weighted imaging score 3/enhancing/PI-RADS score 4 or group 3-diffusion-weighted imaging score 4/PI-RADS score 4. We measured the rate of grade group 2 or greater pathology detected for each lesion group with subgroup analyses in patients with vs without prior negative systematic biopsy. Results: We identified a total of 389 peripheral zone diffusion-weighted imaging score 3 or 4 lesions in 290 patients. The rate of grade group 2 or greater cancer on biopsy for group 1, 2 and 3 lesions was 8.9%, 21% and 36.5%, respectively (p <0.03). The rate of grade group 2 or greater pathology was higher in group 2 than group 1 lesions in patients with prior negative systematic prostate biopsy (28% vs 5.0%, p <0.001) but not in those without such a biopsy (16% vs 12%, p = 0.5). Group 3 lesions had a higher rate of grade group 2 or greater cancer than group 2 lesions in the biopsy naïve subgroup (46% vs 16%, p = 0.001). However, the rates were similar in patients with prior negative systematic prostate biopsy (27% vs 28%, p = 0.9). Conclusions: Diffusion-weighted imaging score 3 peripheral zone lesions were more likely to be clinically significant cancer (grade group 2 or greater) if they were dynamic contrast enhanced T1-weighted imaging positive. That was most apparent in patients with a prior negative systematic prostate biopsy. In such patients including a dynamic contrast enhanced sequence in multiparametric magnetic resonance imaging allowed for optimal lesion risk stratification.

AB - Purpose: PI-RADS™, version 2 stipulates that dynamic contrast enhanced imaging should be used to classify diffusion-weighted imaging score 3 peripheral zone lesions as PI-RADS score 3 (dynamic contrast enhanced imaging negative or nonenhancing) or 4 (dynamic contrast enhanced imaging positive or enhancing). However, to our knowledge it is unknown whether dynamic contrast enhanced imaging separates lesions into clinically meaningful pathological groups. We examined whether dynamic contrast enhanced imaging would improve the detection of clinically significant cancer. Materials and Methods: We identified patients without a prior diagnosis of prostate cancer who underwent multiparametric magnetic resonance imaging-transrectal ultrasound fusion targeted biopsy of peripheral zone lesions with a diffusion-weighted imaging score of 3 or 4. Each lesion was grouped into 1 of 3 classifications, including group 1-diffusion-weighted imaging score 3/nonenhancing/PI-RADS score 3, group 2-diffusion-weighted imaging score 3/enhancing/PI-RADS score 4 or group 3-diffusion-weighted imaging score 4/PI-RADS score 4. We measured the rate of grade group 2 or greater pathology detected for each lesion group with subgroup analyses in patients with vs without prior negative systematic biopsy. Results: We identified a total of 389 peripheral zone diffusion-weighted imaging score 3 or 4 lesions in 290 patients. The rate of grade group 2 or greater cancer on biopsy for group 1, 2 and 3 lesions was 8.9%, 21% and 36.5%, respectively (p <0.03). The rate of grade group 2 or greater pathology was higher in group 2 than group 1 lesions in patients with prior negative systematic prostate biopsy (28% vs 5.0%, p <0.001) but not in those without such a biopsy (16% vs 12%, p = 0.5). Group 3 lesions had a higher rate of grade group 2 or greater cancer than group 2 lesions in the biopsy naïve subgroup (46% vs 16%, p = 0.001). However, the rates were similar in patients with prior negative systematic prostate biopsy (27% vs 28%, p = 0.9). Conclusions: Diffusion-weighted imaging score 3 peripheral zone lesions were more likely to be clinically significant cancer (grade group 2 or greater) if they were dynamic contrast enhanced T1-weighted imaging positive. That was most apparent in patients with a prior negative systematic prostate biopsy. In such patients including a dynamic contrast enhanced sequence in multiparametric magnetic resonance imaging allowed for optimal lesion risk stratification.

KW - Biopsy

KW - Diagnostic imaging

KW - Magnetic resonance imaging

KW - Prostatic neoplasms

KW - Standards

UR - http://www.scopus.com/inward/record.url?scp=85031722679&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85031722679&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2017.07.011

DO - 10.1016/j.juro.2017.07.011

M3 - Article

C2 - 28709889

AN - SCOPUS:85031722679

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

ER -