A Critical Analysis of the Magnetic Resonance Imaging Lesion Diameter Threshold for Adverse Pathology Features
Yavuz Onur Danacioglu1, Rustu Turkay2, Omer Yildiz3
1Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. dr_yonur@hotmail.com.
Abstract:
To investigate the relationship between lesion size determined using multiparametric magnetic resonance imaging (mpMRI) and histopathological findings of specimens obtained after mpMRI fusion biopsy and radical prostatectomy (RP). We retrospectively analysed 290 patients with PCa who underwent an MRI fusion biopsy. We measured the diameter of suspicious tumour lesions on diffusion-weighted mpMRI and stratified the cohort into two groups. Group A included patients with a suspicious tumour lesion 10 mm and Group B included those with a suspicious tumour lesion > 10 mm. In Group B, the PI-RADS score determined in mpMRI was higher than Group A, and there was a statistically significant difference between the two groups in terms of clinical T-stage. The PCa detection rate and the number of positive cores were statistically significantly higher in Group B than in Group A. In addition, there was a statistically significant difference between the two groups in relation to the biopsy, the International Society of Urological Pathology (ISUP) grade values, and the presence of clinically significant PCa. In Group B, pathological T-stage and extraprostatic extension (EPE) and surgical margin (SM) positivity were found to be higher among the patients who underwent RP. In the multivariate analysis, the mpMRI lesion size being > 10 mm was found to be an independent predictive factor for SM and EPE positivity. The clinical results of this study support the modification of the lesion size threshold as 10 mm for use in the differentiation of PI-RADS scores 4 and 5.
Insights
Multiparametric MRI (mpMRI) lesion size over 10 mm predicts higher prostate cancer (PCa) detection rates and adverse pathology. This finding supports adjusting the 10 mm threshold for differentiating PI-RADS scores 4 and 5.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Accurate prostate cancer (PCa) staging is crucial for treatment decisions.
- Multiparametric magnetic resonance imaging (mpMRI) aids in detecting and characterizing PCa lesions.
- The predictive value of lesion size on mpMRI for histopathological outcomes requires further investigation.
Purpose of the Study:
- To explore the correlation between mpMRI-determined lesion size and histopathological findings in PCa patients.
- To assess if a 10 mm lesion size threshold on mpMRI can differentiate between PI-RADS scores and predict adverse pathology.
Main Methods:
- Retrospective analysis of 290 PCa patients undergoing mpMRI fusion biopsy.
- Lesion diameter measured on diffusion-weighted mpMRI, stratified into ≤10 mm (Group A) and >10 mm (Group B).
- Comparison of PI-RADS scores, clinical T-stage, PCa detection rates, positive cores, ISUP grade, and pathological outcomes (RP specimens).
Main Results:
- Group B (>10 mm lesions) showed higher PI-RADS scores, clinical T-stage, PCa detection rates, and positive cores than Group A.
- Statistically significant differences observed in ISUP grade and clinically significant PCa presence between groups.
- Larger lesions (>10 mm) were independently predictive of positive surgical margins (SM) and extraprostatic extension (EPE) in multivariate analysis.
Conclusions:
- mpMRI lesion size exceeding 10 mm is associated with higher PCa detection and adverse pathological features.
- A 10 mm lesion size threshold may improve the differentiation of PI-RADS scores 4 and 5.
- Lesion size on mpMRI is a valuable predictor of clinically significant PCa and treatment outcomes.
