Prostate imaging-reporting and data system version 2 has improved biopsy tumor grade accuracy: a single, tertiary...

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Prostate cancer (PCa) diagnosis relies on accurate tumor grading.
• Biopsy accuracy is crucial for treatment decisions.
• The Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) aimed to standardize prostate MRI interpretation.

Purpose of the Study:

• To assess changes in prostate biopsy accuracy for tumor grading before and after PI-RADSv2 implementation.
• To evaluate the impact of PI-RADSv2 on biopsy concordance with surgical pathology.
• To identify factors associated with improved biopsy accuracy post-PI-RADSv2.

Main Methods:

• Retrospective analysis of 1191 patients with biopsy-proven PCa undergoing MRI and surgery.
• Comparison of biopsy tumor grade concordance, underestimation, and overestimation rates between pre-PI-RADSv2 (2013) and post-PI-RADSv2 (2020) cohorts.
• Logistic regression analysis to determine factors associated with biopsy accuracy, including pre-biopsy MRI utilization.

Main Results:

• Biopsy concordance rates increased from 47.2% to 54.5% (p=.019) after PI-RADSv2.
• Underestimation rates decreased significantly from 46.3% to 36.4% (p=.003).
• Pre-biopsy MRI use rose dramatically from 4.9% to 80.9% (p<.001) and was independently associated with accurate biopsy results (OR=1.486, p=.022).

Conclusions:

• The adoption of PI-RADSv2 was associated with a significant increase in prostate biopsy accuracy.
• Increased utilization of pre-biopsy MRI following PI-RADSv2 guidelines appears to be a key factor in reducing tumor grade underestimation.
• These findings suggest improved diagnostic precision for prostate cancer management.