Open Access

ARTICLE

Validation of dominant and secondary sequence utilization in PI-RADS v2 for classifying prostatic lesions

Nachiketh Soodana-Prakash¹, R. Patricia Castillo², Isildinha M. Reis^3,4, Radka Stoyanova^3,5, Deukwoo Kwon³, Maria C. Velasquez², Bruno Nahar¹, Pratik Kannabur¹, Taylor A. Johnson¹, Sanjaya K. Swain^1,3, Natalie Ben-Yakar¹, Vivek Venkatramani¹, Chad Ritch^1,3, Ramgopal Satyanarayana^1,3, Mark L. Gonzalgo^1,3, Dipen J. Parekh^1,3, Leonardo Bittencourt⁶, Sanoj Punnen^1,3

1 Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
2 Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
3 Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
4 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
5 Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA
6 Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, Brazil
Address correspondence to Dr. Sanoj Punnen, Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1560, Miami, FL 33136 USA

Canadian Journal of Urology 2019, 26(3), 9763-9768.

Abstract

Introduction: To assess the secondary sequence rule in The Prostate Imaging Reporting Data System (PI-RADS) version 2 by comparing the detection of Grade group 1+ (GG1+) and 2+ (GG2+) cancers in PI-RADS 3, an upgraded PI-RADS 4, and true (non-upgraded) PI-RADS 4 targets.
Materials and methods: We analyzed a total of 589 lesions scored as PI-RADS 3 or 4 obtained from 434 men who underwent mpMRI-US fusion biopsy from September 2015 to November 2017 for evaluation of GG1+ and GG2+ prostate cancer. PI-RADS 4 lesions were differentiated into those that were “upgraded” to PI-RADS 4 based on the secondary sequence and those that were “true” PI-RADS 4 based on the dominant sequence.
Results: The odds of detecting a GG2+ cancer was significantly higher for an upgraded 4 (peripheral zone (PZ): OR 5.06, 95% CI 2.04-12.54, p < 0.001, transitional zone (TZ): OR 3.08, 95% CI 1.04-9.08, p = 0.042) and true 4 (PZ: OR 5.82, 95% CI 3.10-10.94, p < 0.0001, TZ: OR 2.43, 95% CI 1.14-5.18, p = 0.022) lesions compared to PI-RADS 3 lesions. Additionally, we found no difference in the odds of detecting a GG2+ prostate cancer between a true PI-RADS 4 (OR 1.15, 95% CI 0.49-2.71, p = 0.746) and upgraded 4 (referent) in the PZ. Similar non-significance was noted between true 4 (OR 0.79, 95% CI 0.26-2.38, p = 0.674) and upgraded 4 lesions in the TZ for detection of GG2+ cancers.
Conclusions: Upgraded PI-RADS 4 and true 4 targets have a higher odds of detecting GG1+ and GG2+ compared to PI-RADS 3 in the PZ and TZ. Our findings validate the revised scoring system for PI-RADS.

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