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The role of 3-tesla diffusion-weighted magnetic resonance imaging in selecting prostate cancer patients for active surveillance.

Jeong CW, Park YH, Hwang SI, Lee S, Jeong SJ, Hong SK, Byun SS, Lee HJ, Lee SE - Prostate Int (2014)

Bottom Line: The predictive accuracy was as high as 0.804.The rates were significantly different between low (≤3, 3.5%) and high (>3, 28.1%, P<0.001) grades.ADC grade (odds ratio [OR], 10.696; 95% confidence interval [CI], 2.675-42.773) was significantly associated with unfavorable pathological features, even after adjusting for other variables (OR, 11.274; 95% CI, 2.622-48.471).

View Article: PubMed Central - PubMed

Affiliation: Departments of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

ABSTRACT

Purpose: Differentiating significant cancer from insignificant cancer is a major challenge in active surveillance (AS) for prostate cancer. We evaluated whether the apparent diffusion coefficient (ADC) grade from 3-T diffusion-weighted magnetic resonance imaging (DW-MRI) is useful to exclude men with unfavorable pathological features from men meeting current AS eligibility criteria.

Methods: Among patients who underwent radical prostatectomy, 117 potential AS candidates defined according to 2013 European Association of Urology guidelines who had undergone preoperative 3-T DW-MRI were included. A blinded uro-radiologist graded the level of suspicion from the ADC map using the Likert scale from 1 to 5. The rate of unfavorable pathological features was evaluated according to ADC grade. Unfavorable pathological features were defined as non-organ-confined disease or pathological Gleason score≥7 (4+3). The associations between unfavorable pathological features and clinical variables including ADC grade (>3 vs. ≤3) were evaluated using logistic regression analysis.

Results: The rates of unfavorable pathological features were 0.0% (0/14), 2.9% (1/34), 5.4% (2/37), 25.0% (6/24), and 37.5% (3/8) from grades 1 to 5 (P=0.002). The predictive accuracy was as high as 0.804. The rates were significantly different between low (≤3, 3.5%) and high (>3, 28.1%, P<0.001) grades. The sensitivity, specificity, and positive and negative predictive values were 75.0%, 78.1%, 28.1%, and 96.5%. ADC grade (odds ratio [OR], 10.696; 95% confidence interval [CI], 2.675-42.773) was significantly associated with unfavorable pathological features, even after adjusting for other variables (OR, 11.274; 95% CI, 2.622-48.471).

Conclusions: ADC grade from 3-T DW-MRI is useful to predict men with unfavorable pathologic features from AS candidates.

No MeSH data available.


Related in: MedlinePlus

Axial apparent diffusion coefficient map shows focal low signal intensity nodule (arrow) at right peripheral zone, which was graded 5.
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f1-pi-2-4-169: Axial apparent diffusion coefficient map shows focal low signal intensity nodule (arrow) at right peripheral zone, which was graded 5.

Mentions: An experienced uro-radiologist (S.I.H.), who was blinded to all clinical variables including pathological outcome, independently graded the level of suspicion for clinically significant cancer from ADC mapping images using the Likert scale from 1 to 5 as follows: grade 1, highly unlikely to be present; grade 2, unlikely to be present; grade 3, equivocal; grade 4, likely to be present; and grade 5, highly likely to be present (Fig. 1) [14]. No T1 or T2-weighted images were used for grading the level of suspicion.


The role of 3-tesla diffusion-weighted magnetic resonance imaging in selecting prostate cancer patients for active surveillance.

Jeong CW, Park YH, Hwang SI, Lee S, Jeong SJ, Hong SK, Byun SS, Lee HJ, Lee SE - Prostate Int (2014)

Axial apparent diffusion coefficient map shows focal low signal intensity nodule (arrow) at right peripheral zone, which was graded 5.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4286728&req=5

f1-pi-2-4-169: Axial apparent diffusion coefficient map shows focal low signal intensity nodule (arrow) at right peripheral zone, which was graded 5.
Mentions: An experienced uro-radiologist (S.I.H.), who was blinded to all clinical variables including pathological outcome, independently graded the level of suspicion for clinically significant cancer from ADC mapping images using the Likert scale from 1 to 5 as follows: grade 1, highly unlikely to be present; grade 2, unlikely to be present; grade 3, equivocal; grade 4, likely to be present; and grade 5, highly likely to be present (Fig. 1) [14]. No T1 or T2-weighted images were used for grading the level of suspicion.

Bottom Line: The predictive accuracy was as high as 0.804.The rates were significantly different between low (≤3, 3.5%) and high (>3, 28.1%, P<0.001) grades.ADC grade (odds ratio [OR], 10.696; 95% confidence interval [CI], 2.675-42.773) was significantly associated with unfavorable pathological features, even after adjusting for other variables (OR, 11.274; 95% CI, 2.622-48.471).

View Article: PubMed Central - PubMed

Affiliation: Departments of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

ABSTRACT

Purpose: Differentiating significant cancer from insignificant cancer is a major challenge in active surveillance (AS) for prostate cancer. We evaluated whether the apparent diffusion coefficient (ADC) grade from 3-T diffusion-weighted magnetic resonance imaging (DW-MRI) is useful to exclude men with unfavorable pathological features from men meeting current AS eligibility criteria.

Methods: Among patients who underwent radical prostatectomy, 117 potential AS candidates defined according to 2013 European Association of Urology guidelines who had undergone preoperative 3-T DW-MRI were included. A blinded uro-radiologist graded the level of suspicion from the ADC map using the Likert scale from 1 to 5. The rate of unfavorable pathological features was evaluated according to ADC grade. Unfavorable pathological features were defined as non-organ-confined disease or pathological Gleason score≥7 (4+3). The associations between unfavorable pathological features and clinical variables including ADC grade (>3 vs. ≤3) were evaluated using logistic regression analysis.

Results: The rates of unfavorable pathological features were 0.0% (0/14), 2.9% (1/34), 5.4% (2/37), 25.0% (6/24), and 37.5% (3/8) from grades 1 to 5 (P=0.002). The predictive accuracy was as high as 0.804. The rates were significantly different between low (≤3, 3.5%) and high (>3, 28.1%, P<0.001) grades. The sensitivity, specificity, and positive and negative predictive values were 75.0%, 78.1%, 28.1%, and 96.5%. ADC grade (odds ratio [OR], 10.696; 95% confidence interval [CI], 2.675-42.773) was significantly associated with unfavorable pathological features, even after adjusting for other variables (OR, 11.274; 95% CI, 2.622-48.471).

Conclusions: ADC grade from 3-T DW-MRI is useful to predict men with unfavorable pathologic features from AS candidates.

No MeSH data available.


Related in: MedlinePlus