Results from a PI-RADS-based MRI-directed diagnostic pathway for biopsy-naive patients in a non-university hospital

• Published in: Abdominal imaging Vol. 46; no. 12; pp. 5639 - 5646
• Main Authors: Reijnen, Jeroen S., Marthinsen, Jon B., Tysland, Alf O., Müller, Christoph, Schönhardt, Irina, Andersen, Erlend, Seierstad, Therese, Hole, Knut H.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2021; Springer Nature B.V
• Subjects: Algorithms; Biopsy; Diagnostic systems; Gastroenterology; Hepatology; Histopathology; Hospitals; Humans; Image-Guided Biopsy; Imaging; Magnetic Resonance Imaging; Magnetic Resonance Imaging, Interventional; Male; Medical diagnosis; Medicine; Medicine & Public Health; Monitoring; Patient safety; Patients; Practice; Prostate cancer; Prostatectomy; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - surgery; Radiology; Retrospective Studies; Safety; Tumors; Prostate neoplasms; Algorithms; Magnetic resonance imaging; Biopsy; Patient care team
• ISSN: 2366-004X; 2366-0058
• DOI: 10.1007/s00261-021-03249-8

Purpose To assess the safety and performance of a MRI-directed diagnostic pathway for patients with first-time suspicion of prostate cancer in a non-university hospital. Methods Between May 2017 and December 2018 all biopsy-naive patients examined in our hospital followed a MRI-directed diagnostic work-up algorithm based on PI-RADS score. In short, PI-RADS 1–2 was generally not biopsied and PI-RADS 3–5 was reviewed by a multidisciplinary team. Patients with PI-RADS 4-5 were all referred to biopsy, either transrectal ultrasound-guided biopsy or MRI in-bore biopsy for small tumors and for sites difficult to access. PI-RADS scores were compared to the histopathology from biopsies and surgical specimens for patients who had prostatectomy. Non-biopsied patients were referred to a safety net monitoring regimen. Results Two hundred and ninety-eight men were enrolled. 97 (33%) had PI-RADS 1–2, 44 (15%) had PI-RADS 3, and 157 (53%) had PI-RADS 4–5. 116 (39%) of the patients avoided biopsy. None of these were diagnosed with significant cancer within 2–3.5 years of safety net monitoring. Almost all high ISUP grade groups (≥ 3) were in the PI-RADS 4–5 category (98%). Prostatectomy specimens and systematic biopsies from MRI-negative areas indicated that very few clinically significant cancers were missed by the MRI-directed diagnostic pathway. Conclusion Our findings add to evidence that a MRI-directed diagnostic pathway can be safely established in a non-university hospital. The pathway reduced the number of biopsies and reliably detected the site of the most aggressive cancers. Graphic abstract