Enhancement of inter-/intra-reader agreement using the Prostate Imaging Reporting and Data System version 2.1 for prostate cancer detection in magnetic resonance imaging/transrectal ultrasound software fusion prostate biopsy

• Published in: Investigative and clinical urology Vol. 66; no. 5; pp. 405 - 415
• Main Authors: Song, Won Hoon, Kim, Tae Un, Ryu, Hwa Seong, Yun, Mi Sook, Park, Sung-Woo
• Format: Journal Article
• Language: English
• Published: Korea (South) 대한비뇨의학회 01.09.2025
• Subjects: Aged; Humans; Image-Guided Biopsy - methods; Magnetic Resonance Imaging; Male; Middle Aged; Multiparametric Magnetic Resonance Imaging; Observer Variation; Prostate - diagnostic imaging; Prostate - pathology; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Software; Ultrasonography, Interventional; 비뇨기과학; Multiparametric magnetic resonance imaging; Reading; Biopsy; Prostate cancer
• ISSN: 2466-0493; 2466-054X; 2466-054X
• DOI: 10.4111/icu.20250208

This study evaluated inter-/intra-reader agreement with the Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 to improve the detection rate of prostate cancer. We enrolled 210 patients who underwent multiparametric magnetic resonance imaging (mpMRI) for clinically suspected or diagnosed prostate cancer. Four readers, including two urologists, viewed patients' mpMRI and scored PI-RADS between two sessions, including the time for feedback and training after the first reading session. Inter- and intra-reader agreements were evaluated using Fleiss' kappa coefficient (κ), agreement coefficient 1 (AC1), and percentage of agreement (PA). The overall inter-reader agreement between all readers was moderate (κ=0.466, AC1=0.522, and PA=0.610). The overall inter-reader agreement improved in the second session. The agreement for peripheral zone (PZ) lesions was higher than that for transitional zone (TZ) lesions. At a PI-RADS cut-off of 4, the agreement for PZ lesions was almost perfect (PA=0.888) and higher than that for TZ lesions. The inter-reader agreement for lesions with a PI-RADS ≥4 and Gleason score ≥7 was almost perfect (AC1=0.960 and PA=0.964). The intra-reader agreement for lesions overall and PI-RADS ≥4 lesions were substantial (AC1=0.601) and almost perfect (PA=0.876), respectively. Readers achieved moderate agreement for PI-RADS version 2.1 and benefitted from training sessions. Feedback, training, and multidisciplinary discussions also improved inter-reader agreement. Our study can provide guidance, updates, and further steps for the standardization and improvement of PI-RADS scoring.