Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland.
PLoS One. 2020 Oct 5;15(10):e0239975. doi: 10.1371/journal.pone.0239975. eCollection 2020.
To assess the value of the PI-RADS 2.1 scoring system in the detection of prostate cancer on multiparametric MRI in comparison to the standard PI-RADS 2.0 system and to assess its inter-reader variability.
This IRB-approved study included 229 patients undergoing multiparametric prostate MRI prior to MRI-guided TRUS-based biopsy, which were retrospectively recruited from our prospectively maintained institutional database. Two readers with high (reader 1, 6 years) and low (reader 2, 2 years) level of expertise identified the lesion with the highest PI-RADS score for both version 2.0 and 2.1 for each patient. Inter-reader agreement was estimated, and diagnostic accuracy analysis was performed.
Inter-reader agreement on PI-RADS scores was fair for both version 2.0 (kappa: 0.57) and 2.1 (kappa: 0.51). Detection rates for prostate cancer (PCa) and clinically significant prostate cancer (csPCa) were almost identical for both PI-RADS versions and higher for the more experienced reader (AUC, Reader 1: PCa, 0.881-0.887, csPCa, 0.874-0.879; Reader 2: PCa, 0.765, csPCa, 0.746-0.747; both p > 0.05), both when using a PI-RADS score of ≥ 4 and ≥3 as indicators for positivity for cancer.
The new PI-RADS 2.1 scoring system showed comparable diagnostic performance and inter-reader variability compared to version 2.0. The introduced changes in the version 2.1 seem only to take effect in a very small number of patients.
评估 PI-RADS 2.1 评分系统在多参数 MRI 检测前列腺癌方面的价值，与标准 PI-RADS 2.0 系统进行比较，并评估其读者间可变性。
这项经 IRB 批准的研究纳入了 229 例在 MRI 引导下基于 TRUS 活检前接受多参数前列腺 MRI 的患者，这些患者是从我们前瞻性维护的机构数据库中回顾性招募的。两位具有丰富（读者 1，6 年）和低（读者 2，2 年）经验水平的读者分别为每位患者识别出 PI-RADS 评分最高的病变，适用于两个版本 2.0 和 2.1。评估了读者间的一致性，并进行了诊断准确性分析。
两个版本的 PI-RADS 评分的读者间一致性为中等（kappa：0.57 和 0.51）。对于两个 PI-RADS 版本，前列腺癌（PCa）和临床显著前列腺癌（csPCa）的检测率几乎相同，且经验更丰富的读者更高（AUC，读者 1：PCa，0.881-0.887，csPCa，0.874-0.879；读者 2：PCa，0.765，csPCa，0.746-0.747；均 P > 0.05），当使用 PI-RADS 评分≥4 和≥3 作为癌症阳性的指标时。
新的 PI-RADS 2.1 评分系统与版本 2.0 相比具有相似的诊断性能和读者间可变性。在版本 2.1 中引入的变化似乎仅对极少数患者起作用。
