Related Experiment Video
Updated: Jul 18, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Incremental value of multiplanar cross-referencing for prostate cancer staging with endorectal MRI
Liang Wang1, Jingbo Zhang, Lawrence H Schwartz
1Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Rm. C-278, New York, NY 10021, USA.
Objective:
The purpose of this study was to assess whether use of the PACS cross-referencing tool in 3D MRI improves tumor staging of prostate cancer when pathologic findings are used as the reference standard.
Materials And Methods:
The institutional review board granted a waiver of informed consent for the study. Endorectal MRI at 1.5 T was performed before radical prostatectomy in 255 consecutive patients. Two radiologists unaware of the clinical data retrospectively and independently interpreted MR images without and with cross-referencing to predict the presence of extracapsular extension (ECE) and seminal vesicle invasion (SVI). Histopathologic findings were used as the reference standard. Area under the receiver operating characteristics curve (AUC), sensitivity and specificity, and weighted kappa statistics were calculated.
Results:
At histologic examination, 68 (27%) of the patients were found to have ECE and 13 (5%) of the patients to have SVI; the latter all had ECE. In detecting ECE, both reviewers had a higher AUC using cross-referencing (p < 0.001 for both). The weighted kappa value was 0.56 for MRI alone and 0.76 for MRI with cross-referencing, indicating fair to good interobserver agreement. Sensitivity and specificity for ECE with MRI alone and with cross-referencing were 43% and 94% and 57% and 100% for reviewer 1 and 40% and 93% and 59% and 98% for reviewer 2, respectively. In detecting SVI, both reviewers had a higher AUC with cross-referencing (p = 0.007 and p = 0.056 for reviewers 1 and 2, respectively). Reviewer 1 benefited much more from cross-referencing than did reviewer 2. The weighted kappa statistic was 0.69 for MRI alone and the same with cross-referencing, indicating good interobserver agreement. Sensitivity and specificity for SVI with MRI alone and with cross-referencing, respectively, were 23% and 83% and 46% and 93% for reviewer 1 and 31% and 91% and 54% and 95% for reviewer 2.
Conclusion:
PACS cross-referencing significantly improves tumor staging of prostate cancer with 3D MRI. Some reviewers benefit more than others from use of this tool.
Insights
The PACS cross-referencing tool significantly enhances 3D MRI accuracy for prostate cancer staging. This improves the detection of extracapsular extension and seminal vesicle invasion, aiding in better patient management.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Accurate staging of prostate cancer is crucial for effective treatment planning.
- Three-dimensional (3D) MRI is a valuable tool for visualizing prostate anatomy and potential tumor spread.
- The Picture Archiving and Communication System (PACS) cross-referencing tool may offer enhanced diagnostic capabilities.
Purpose of the Study:
- To evaluate the impact of a PACS cross-referencing tool on the accuracy of 3D MRI for prostate cancer staging.
- To determine if this tool improves the detection of extracapsular extension (ECE) and seminal vesicle invasion (SVI).
- To compare diagnostic performance with histopathologic findings as the reference standard.
Main Methods:
- 255 patients undergoing radical prostatectomy had pre-operative 3D endorectal MRI.
- Two radiologists independently interpreted MR images with and without PACS cross-referencing.
- Diagnostic performance was assessed using area under the receiver operating characteristics curve (AUC), sensitivity, specificity, and weighted kappa statistics.
Main Results:
- PACS cross-referencing significantly increased the AUC for detecting both ECE and SVI for both reviewers.
- Interobserver agreement, measured by weighted kappa, improved from fair/good to good for ECE detection with cross-referencing.
- Sensitivity and specificity for ECE and SVI detection were improved with the use of the PACS tool, though benefits varied between reviewers.
Conclusions:
- The PACS cross-referencing tool significantly improves the accuracy of 3D MRI for prostate cancer staging.
- Utilizing this tool enhances the detection of critical staging features like ECE and SVI.
- The degree of benefit from the PACS tool may vary among individual radiologists.
