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Diffusion-weighted MRI as a predictor of extracapsular extension in prostate cancer
Chan Kyo Kim1, Sung Yoon Park, Jung Jae Park
11 All authors: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
Objective:
The objective of our study was to evaluate the value of the apparent diffusion coefficient (ADC) from diffusion-weighted imaging (DWI) as a predictor of extracapsular extension (ECE) in patients with localized prostate cancer.
Materials And Methods:
Enrolled in this study were 167 patients who underwent preoperative DWI at 3 T followed by surgery. Univariate and multivariate analyses including clinical variables (serum prostate-specific antigen level, biopsy-based Gleason score, clinical stage, greatest percentage of cancer in all biopsy cores, and presence of perineural invasion) and tumor ADC data were performed for predicting ECE. Receiver operating characteristic curve analysis was also performed to investigate the diagnostic performance of the clinical variables and tumor ADC for predicting ECE.
Results:
Histopathologic results indicated that 23 (13.8%) patients had ECE. At univariate analysis, tumor ADC, biopsy-based Gleason score, the presence of perineural invasion, and greatest percentage of cancer in all biopsy cores were associated with ECE (p<0.05). Multivariate analysis revealed that the greatest percentage of cancer in all biopsy cores (p=0.001), biopsy-based Gleason score (p=0.015), and tumor ADC (p=0.032) were independent predictors of ECE. For predicting ECE, the area under the curve (AUC) of tumor ADC was 0.771, which is the second best AUC of all the variables evaluated.
Conclusion:
As an imaging biomarker, tumor ADC may have potential for predicting ECE before surgery in patients with prostate cancer. Further studies investigating this possibility are warranted.
Insights
Apparent diffusion coefficient (ADC) from diffusion-weighted imaging (DWI) shows potential in predicting extracapsular extension (ECE) in prostate cancer patients before surgery. This imaging biomarker can aid in surgical planning and patient management.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Prostate cancer staging is crucial for treatment planning.
- Accurate prediction of extracapsular extension (ECE) impacts surgical approach and patient outcomes.
- Diffusion-weighted imaging (DWI) offers non-invasive insights into tissue characteristics.
Purpose of the Study:
- To evaluate the apparent diffusion coefficient (ADC) from DWI as a predictor of ECE in localized prostate cancer.
- To compare the predictive value of ADC with established clinical and pathological variables for ECE.
Main Methods:
- 167 patients with localized prostate cancer underwent preoperative DWI at 3T.
- Univariate and multivariate analyses assessed clinical variables and tumor ADC for ECE prediction.
- Receiver operating characteristic (ROC) curve analysis determined diagnostic performance.
Main Results:
- ECE was present in 23.8% of patients.
- Tumor ADC, Gleason score, perineural invasion, and cancer percentage in biopsy cores were associated with ECE (univariate analysis).
- Greatest cancer percentage, Gleason score, and tumor ADC were independent predictors of ECE (multivariate analysis); ADC AUC was 0.771.
Conclusions:
- Tumor ADC is a potential imaging biomarker for predicting ECE in prostate cancer.
- Further research is warranted to confirm the utility of ADC in preoperative ECE assessment.
- ADC may assist in refining surgical strategies and improving patient management for prostate cancer.
