Related Experiment Video
Updated: Dec 22, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Extraprostatic Tumor Extension: Comparison of Preoperative Multiparametric MRI Criteria and Histopathologic
Kye Jin Park1, Mi-Hyun Kim1, Jeong Kon Kim1
1From the Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Abstract:
Background There are no standardized and well-validated criteria for assessing the risk of extraprostatic extension (EPE) of prostate cancer at preoperative multiparametric MRI. Purpose To compare diagnostic performance, intra- and interreader agreement, and correlations of MRI-based criteria for assessment of EPE after radical prostatectomy, including EPE grade, European Society of Urogenital Radiology (ESUR) score, Likert scale, and capsular contact length (CCL). Materials and Methods This retrospective study included consecutive men who underwent MRI and radical prostatectomy between July 2016 and March 2017. Two genitourinary radiologists independently estimated the probability of EPE by using four MRI-based scoring methods. The diagnostic accuracies and intra- and interobserver agreement were evaluated with area under the receiver operating characteristic curve (AUC) and κ statistics, respectively. Correlations between MRI-based score and histologic extent of EPE were analyzed by using the Spearman correlation coefficient (ρ). Results A total of 301 men (mean age ± standard deviation, 65 years ± 7) were evaluated. A total of 129 (42.9%) men had EPE. The AUC ranges of EPE grade, ESUR score, Likert scale, and CCL for assessment of EPE were 0.77-0.81, 0.79-0.81, 0.78-0.79, and 0.78-0.85, respectively, for the two readers. The Likert scale showed lower sensitivity (68.2% [88 of 129] for reader 1, 72.1% [93 of 129] for reader 2) than did EPE grade (77.5% [100 of 129] for reader 1, 79.8% [103 of 129] for reader 2; P ≤ .04). Intra- and interreader agreement were substantial (κ range, 0.61-0.74) for the four methods, with ESUR score showing the lowest values (κ = 0.61 and κ = 0.63, respectively). EPE grade showed highest correlation with histologic extent of EPE (ρ = 0.53 and ρ = 0.55 for circumferential length; ρ = 0.42 and ρ = 0.55 for radial length for readers 1 and 2, respectively; P < .001). Conclusion Extraprostatic extension (EPE) grade, European Society of Urogenital Radiology score, Likert scale, and capsular contact length showed good overall diagnostic performance; however, the EPE grade resulted in more reliable performance and had the highest correlation with histologic EPE extent. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Padhani and Petralia in this issue.
Insights
Standardized criteria for assessing prostate cancer's extraprostatic extension (EPE) risk on MRI are lacking. EPE grade demonstrated the most reliable preoperative multiparametric MRI performance and highest correlation with histologic EPE extent.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Standardized criteria for preoperative assessment of extraprostatic extension (EPE) in prostate cancer using multiparametric MRI are currently lacking.
- Accurate EPE assessment is crucial for guiding treatment decisions, including radical prostatectomy.
Purpose of the Study:
- To compare the diagnostic performance, intra- and interreader agreement, and correlation with histologic findings of four MRI-based criteria for EPE assessment.
- The criteria evaluated include EPE grade, European Society of Urogenital Radiology (ESUR) score, Likert scale, and capsular contact length (CCL).
Main Methods:
- Retrospective analysis of 301 men who underwent preoperative MRI and radical prostatectomy.
- Two genitourinary radiologists independently assessed EPE probability using four scoring methods.
- Diagnostic accuracy (AUC), agreement (κ statistics), and correlation with histology (Spearman's ρ) were evaluated.
Main Results:
- All four MRI-based methods showed good diagnostic performance for EPE detection.
- EPE grade demonstrated higher sensitivity compared to the Likert scale (77.5-79.8% vs. 68.2-72.1%).
- EPE grade exhibited the strongest correlation with the histologic extent of EPE (circumferential and radial length).
Conclusions:
- EPE grade, ESUR score, Likert scale, and CCL show good diagnostic performance for preoperative EPE assessment.
- EPE grade offers more reliable performance and the highest correlation with histologic EPE extent, making it a valuable tool for clinical decision-making.
