Nalavenkata Sunny B, Vertosick Emily, Briganti Alberto, Ahmed Hashim, Eldred-Evans David, Gordon Steven, Raghallaigh Holly, Gratzke Christian, O'Callaghan Michael, Liss Michael, Chiu Peter, Müntener Michael, Yaxley John, Poyet Cedric, Jahnen Matthias, Toi Ants, Ghai Sangeet, Margolis Daniel, Ankerst Donna, Ehdaie Behfar, Patel Manish I, Vickers Andrew J
Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Westmead Hospital, The University of Sydney, Sydney, Australia.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Eur Urol Oncol. 2025 May 2. doi: 10.1016/j.euo.2025.02.007.
The quality and reporting of prostate magnetic resonance imaging (MRI) are operator dependent, leading to variations in estimates such as positive predictive value across sites. This impacts patient counseling, risk modeling, and risk calculators. This study assessed variation in Prostate Imaging Reporting and Data System (PI-RADS) score classification and subsequent probability of grade group (GG) ≥2 + prostate cancer.
Data from the Prostate Biopsy Collaborative Group, including multiple sites in North America, Europe, and Asia Pacific, were analyzed. Patients underwent multiparametric MRI (mpMRI) of the prostate followed by prostate biopsy during the years 2010-2023. Only those with MRI-targeted biopsy and PI-RADS score ≥3 were included. The risk of being assigned PI-RADS 4 or 5 and risk of GG ≥2 disease for these scores were estimated using logistic regression.
The cohort included 7325 biopsies from 7320 unique patients from 13 sites. A two-fold variation in the probability of PI-RADS 4 or 5 assignment across sites persisted even after adjustment for patient risk (heterogeneity p < 0.001 for both). There were significant differences in the absolute risk of GG ≥2 disease for PI-RADS 4 and 5 (heterogeneity p < 0.001 for both), varying between 23% and 68% and between 49% and 87%, respectively. The use of prostate biopsy as a reference standard has limitations but reflects typical usage of mpMRI in clinical practice.
The probability of being assigned PI-RADS 4 or 5 and subsequent detection of GG ≥2 disease varies widely between institutions. This impacts counseling, risk stratification, and clinical practice, necessitating better standardization in the performance and interpretation of mpMRI.
前列腺磁共振成像（MRI）的质量和报告依赖于操作人员，导致各机构间诸如阳性预测值等评估存在差异。这会影响患者咨询、风险建模和风险计算器。本研究评估了前列腺影像报告和数据系统（PI-RADS）评分分类的差异以及随后高级别组（GG）≥2级前列腺癌的概率。
分析了来自前列腺活检协作组的数据，该组包括北美、欧洲和亚太地区的多个机构。患者在2010年至2023年期间接受了前列腺多参数MRI（mpMRI）检查，随后进行了前列腺活检。仅纳入那些进行了MRI靶向活检且PI-RADS评分≥3的患者。使用逻辑回归估计这些评分被判定为PI-RADS 4或5的风险以及GG≥2级疾病的风险。
该队列包括来自13个机构的7320例独特患者的7325次活检。即使在对患者风险进行调整后，各机构间PI-RADS 4或5判定概率仍存在两倍的差异（两者的异质性p均<0.001）。PI-RADS 4和5的GG≥2级疾病的绝对风险存在显著差异（两者的异质性p均<0.001），分别在23%至68%和49%至87%之间变化。将前列腺活检用作参考标准存在局限性，但反映了mpMRI在临床实践中的典型应用。
各机构间被判定为PI-RADS 4或5的概率以及随后检测到GG≥2级疾病的概率差异很大。这会影响咨询、风险分层和临床实践，因此在mpMRI的操作和解读方面需要更好的标准化。
