Clinical and Reader Associated Correlates of Clinically Significant Magnetic Resonance Imaging-Invisible Prostate...

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Multiparametric MRI (mpMRI) aids in detecting clinically significant prostate cancer (csPCa) while reducing unnecessary biopsies.
• False-negative (FN) mpMRI results can lead to delayed diagnosis and treatment.

Purpose of the Study:

• To identify clinical and reader-associated factors contributing to false-negative mpMRI results in prostate cancer detection.
• To improve the accuracy of mpMRI in identifying csPCa and guiding biopsy decisions.

Main Methods:

• Retrospective analysis of 6,679 patients undergoing prostate mpMRI and biopsy.
• Comparison of FN cases with true negative (TN) and true positive (TP) cases using logistic regression and propensity score matching.
• Sensitivity analysis on patients who deferred biopsy after a negative mpMRI.

Main Results:

• FN mpMRI cases were associated with positive family history, Black race, high PSA density, and PI-RADS 2.
• Radiologists with less fellowship training and lower annual mpMRI read volume ( < 84/yr) showed higher rates of FN mpMRI.
• Higher radiologist read volume (>50 reads/year) was protective against FN mpMRI.
• FN cases had lower csPCa volume/grade and more signs of BPH/prostatitis compared to TP cases.

Conclusions:

• Clinical predictors for csPCa remain consistent even with negative mpMRI findings.
• Factors like MRI signs of BPH/prostatitis and lower radiologist experience differentiate FN from TP cases.
• Enhanced clinical stratification and mpMRI refinements are needed to increase confidence in ruling out biopsy for negative mpMRI scans.