Wallström Jonas, Alterbeck Max, Godtman Rebecka Arnsrud, Bratt Ola, Jiborn Thomas, Thimansson Erik
Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Eur Urol Open Sci. 2025 Jun 5;77:32-38. doi: 10.1016/j.euros.2025.05.008. eCollection 2025 Jul.
The European Council advises evaluating the feasibility of organized prostate cancer testing (OPT) programs, but it is unclear whether results from screening trials can be replicated in population-based testing. The aim of this study is to compare magnetic resonance imaging (MRI) assessments and biopsy outcomes with and without a central review in two Swedish OPT programs.
Two regional population-based OPT programs invited 65 000 men (2020-2022). MRI scans were read locally, and biopsies followed a strict MRI-based and prostate-specific antigen (PSA) density-based protocol. A blinded central review was done by two radiologists with 8 and 9 yr of experience. Reader agreement was assessed with percentages and kappa scores. Positive predictive values (PPVs) for detecting grade group (GG) 2-5 prostate cancer were calculated with 95% confidence intervals (CIs).
MRI scans for 416 men (median age 52 yr) with PSA ≥3 ng/ml were evaluated. In Skåne, 27% of scans were primarily assigned Prostate Imaging Reporting and Data System (PI-RADS) scores ≥4, compared with 10% in Västra Götaland. At the primary reading, 76 men had PI-RADS ≥4, yielding 43 GG 2-5 prostate cancer cases: PPV 0.57 (95% CI 0.45-0.67). At the central review, 65 men had PI-RADS ≥4. Out of 61 men biopsied, 50 had GG 2-5 prostate cancer: PPV 0.82 (95% CI 0.71-0.90, < 0.001 for PPV difference). The central review radiologists' kappa score was 0.83. No additional biopsies were taken based on the central review findings.
In population-based screening with local MRI reading, MRI assignment may vary substantially. Centralized reading could reduce these differences and increase the biopsy PPV for GG ≥2 cancer.
In this report, we reviewed local magnetic resonance imaging (MRI) reading in population-based screening. We found that MRI assignment varied between centers. We conclude that centralized reading could reduce differences and improve biopsy outcomes.
欧洲理事会建议评估有组织的前列腺癌检测（OPT）项目的可行性，但尚不清楚筛查试验的结果能否在基于人群的检测中得到重现。本研究的目的是比较瑞典两个OPT项目中有无中央审查时的磁共振成像（MRI）评估和活检结果。
两个基于地区人群的OPT项目邀请了65000名男性（2020 - 2022年）。MRI扫描在当地进行解读，活检遵循严格的基于MRI和基于前列腺特异性抗原（PSA）密度的方案。由两位分别有8年和9年经验 的放射科医生进行盲法中央审查。通过百分比和kappa评分评估阅片者间的一致性。计算检测2 - 5级组前列腺癌的阳性预测值（PPV）及其95%置信区间（CI）。
对416名PSA≥3 ng/ml的男性（中位年龄52岁）的MRI扫描进行了评估。在斯科讷，2
7%的扫描最初被指定为前列腺影像报告和数据系统（PI-RADS）评分≥4，而在韦斯特哥特兰为10%。在初次阅片时，76名男性的PI-RADS≥4，检出43例2 - 5级组前列腺癌病例：PPV为0.57（95% CI 0.45 - 0.67）。在中央审查时，65名男性的PI-RADS≥4。在61名接受活检的男性中，50例患有2 - 5级组前列腺癌：PPV为0.82（95% CI 0.71 - 0.90，PPV差异<0.001）。中央审查放射科医生的kappa评分为0.83。未根据中央审查结果进行额外的活检。
在基于人群的筛查中，采用当地MRI阅片时，MRI的判定可能存在很大差异。集中阅片可以减少这些差异，并提高≥2级癌症活检的PPV。
在本报告中，我们回顾了基于人群筛查中的当地磁共振成像（MRI）阅片情况。我们发现各中心之间MRI的判定存在差异。我们得出结论，集中阅片可以减少差异并改善活检结果。
